Growing burden
Pandemic may worsen health care staff shortages
In the early days of the pandemic, signs thanking health care heroes were omnipresent. Church bells would ring out in appreciation at certain times and people would gather in hospital parking lots to clap as workers came and went.
Public attention has waned in recent months, but the burden on health care workers has not. The arrival of COVID-19 vaccines was the light at the end of a long, dark tunnel. But herd immunity, a fluid target, remains in the distance as virus variants spread and cases tick up locally and around the world.
The pandemic has impacted everyone in some way, but some doctors and mental health professionals are concerned COVID-19 could lead to high burnout rates among health care workers, prompting retirements or career shifts and exacerbating a shortage of doctors and nurses that existed before the pandemic.
Dr. Heather Owen is chief clinical officer of emergency medicine for Teamhealth, a Knoxville-based national medical group with doctors in Memphis and across the country. She said as the pandemic has worn on and many people have grown weary of masking, social distancing and business restrictions, medical professionals haven’t been able to relax.
“We don’t have the luxury to get, you know, frustrated with restrictions,” she said. “We can’t let our guard down. We really have to be our best, on it, all day, every day, all the time. And it’s not just the pandemic.”
Besides the near-constant fear of contracting COVID-19 and passing it to family members, the repeated donning and doffing of personal protective equipment throughout the day, high patient volumes, extra shifts during surges and separation from relatives and friends, doctors are now seeing the ancillary impacts of the pandemic, Owen said.
She and other physicians are seeing patients who struggled to afford medications or became homeless after losing their jobs. They’re seeing the repercussions of increases in domestic violence and substance abuse registered across the country.
Health care has always been a demanding and sometimes emotionally draining profession, Owen said, and medical workers are trained to compartmentalize and be resilient. However, like other people, many are no longer able to do the things that helped them decompress, like going out with friends, traveling or spending time with extended family.
“Now we’re in a situation where we don’t have that reprieve. So we’re working in a more stressful environment and a more stressful situation. And then that time at home is just as equally stressful as our shifts are,” she said. “The opportunity to kind of rejuvenate and refresh and come back is just gone.”
‘One can only take so much’
Dr. Laura Shultz, director of Behavioral Health-ambulatory Care for Methodist Le Bonheur Healthcare, said there are health care workers who have experienced extreme stress or been in traumatizing situations during the pandemic that could lead to lasting mental health issues.
In the early days of the pandemic, she saw a lot of medical professionals seeking mental health care resources. Now, her biggest concern is burnout.
“I think more folks are considering taking early retirement and leaving the profession or changing professions because this is just too much,” she said.
In a survey of more than 5,000 clinicians in Utah conducted in August 2020, 20% of respondents said they had considered leaving their jobs during the pandemic and 30% said they were considering cutting back hours. The study, published in a journal associated with the American Medical Association, showed those figures were higher among women, particularly women of color.
Studies conducted in the U.S. and around the world showed elevated rates of anxiety, depression and peritraumatic dissociation – reactions to traumatic events that can include out-of-body experiences, emotional numbness, distorted perception of time and dissociative amnesia – among health care workers.
“I think the longest term damage is going to be ... I’m worried about our workforce,” Shultz said. “How many nurses and doctors have just left, and or will leave, due to the fact that this has gone on so long, and they’re tired?”
If the pandemic has put doctors, nurses, respiratory therapists and other medical workers in a position where they feel they need to leave the workforce or cut hours, it could further stress a system that was already “in a really challenging position,” Owen said.
Owen, an emergency medicine physician who practices in Dallas, said her specialty already has higher burnout rates than other areas of medicine and emergency medicine practitioners are two times as likely to commit suicide as the overall population.
That was before the added stress and anxiety wrought by COVID-19. In the past year, she’s seen colleagues who used to love their job retire or go part time and observed medical school applications drop.
“We’re trained to be resilient, but one can only take so much,” Owen said.
Integrated mental health care
The pandemic has not only taken a toll on health care workers. In the early months of the pandemic, fear and anxiety were omnipresent for many people, Shultz said. Many people with preexisting mental health problems had those exacerbated by the pandemic.
However, for many people, the fear and anxiety have abated over time as people have become accustomed to the pandemic and, recently, as vaccinations have progressed. Shultz said she has been impressed with all the ways people have found to stay connected to the people and things they love.
“Overall we are resilient people,” she said. “We define that as the process of adapting well in the face of adversity and trauma and significant stress.”
There are many people, families and certain populations who have been more impacted by the pandemic than others, Shultz said. However, society as a whole has adapted better than she and many mental health professionals thought a year ago.
“There certainly have been challenges. And I think there are lots of people who are still feeling that. But overall, I’ve seen so much impressive innovation and determination to stay connected with people and to try to stay well,” she said. “Life has continued.”
Finding those ways to stay emotionally close while physically distanced –
Zoom birthday parties, religious services on Youtube and Facebook, holiday meals shared from across a backyard – have helped people to stay mentally healthy over the past year.
“I think we’ve seen this really beautiful example in our society of how resilient people are,” she said.
Both Shultz and Owen said there is something positive that can be taken away from the pandemic: better integration of mental health care into medicine overall.
During the pandemic, Methodist launched an integrated behavioral health program and behavioral health care providers are now “embedded” within primary care practices at Methodist, Shultz said.
Owen said the pandemic forced mental health issues into the spotlight and promoted more conversations about the role of behavioral health in the wider healthcare landscape.
“I do hope that we will continue to push those conversations and have those difficult conversations about ‘where does mental health fit into our health care system and how do we adequately resource and spend the time and effort that we need,’” she said. “And how do we break the stigma? Not only for health care professionals but for everyone.”
Corinne S Kennedy covers economic development, soccer and COVID-19’S impact on hospitals for The Commercial Appeal. She can be reached via email at Corinne.kennedy@commercialappeal. com or at 901-297-3245.