2 years ago

An interview with Dr. Joy Melnikow on ‘Frontline physician burnout during the COVID-19 pandemic: national survey findings’

Dr. Joy Melnikow

 

This content is part of the Research in Practice in General Medicine series of interviews with scientists, focusing on how their research work can have impact on medical practice. Click here to follow 'Research in Practice in General Medicine' - for free - on Researcher for more great interviews.

 

 

Can you please state your name, where you work, and what your current focus is?

My name is Joy Melnikow. I'm a family physician. I work at the University of California, Davis, in the Department of Family Medicine. I'm a professor emeritus, and my current focus is on research, including an interest in behavioral health as well as a long-standing interest in cancer prevention work.

 

In regard to this paper, in particular, could you summarize it and perhaps provide some of the key takeaways?

This paper was written based on two surveys we did of physicians in five specialties in the United States, during the first year of the pandemic. We used a sample from the AMA Master File, which captures 99% of all practicing physicians in the United States. It’s very broad and doesn’t only include AMA members, but all physicians, and gives information about specialty and years in practice. The benefit of it is that it also allows us to make comparisons between people in our sample who responded and people who did not respond. We can then make adjustments so that the respondents reflect the larger sample more appropriately. Our results were statistically weighted so that they reflect the full sample. The five specialties that we surveyed were emergency medicine, critical care, primary care, infectious disease, and hospitalists. We chose them because we figured that those would cover most physicians, at least in the early days of the pandemic, who were dealing with COVID-19 patients. As you may or may not recall, early on, we thought children weren't really affected very much. That's obviously changed a lot as our understanding has grown. However, pediatricians were not included in this sample.

 

What is the connection between your paper and the impact on the medical practice? Were there any changes or impacts on therapies and treatments, or changes that happened as a result perhaps?

Our findings were that overall, among our physician sample, burnout, as measured by a validated instrument, increased from May-June of 2020, which was early in the pandemic during the first wave, to December-January of 2020-2021. So, we found a consistent overall increase in burnout. When we looked by specialty, we found that hospitalists and primary care physicians increased the most and that emergency medicine physicians and critical care physicians started out high and stayed high, although gradually emergency medicine went down a little bit. That had some interesting potential implications for what was going on in the pandemic as it went on over time. Presumably, in the beginning, it was especially impacting emergency rooms and intensive care units. Then, as time went on, it was having a greater impact on primary care physicians. Hospitalists were taking care of people who were hospitalized for prolonged periods of time with COVID. So that became, I would surmise, more and more difficult as time went on.

 

So, one implication of this is that burnout, already a recognized problem prior to the pandemic worsened (and may be continuing to worsen) during the pandemic. Physician burnout is really important as it affects the quality of care for patients and physicians’ quality of life.  It leads to higher turnover in physicians, and people leaving their work younger in life. Another factor is the increased costs for health care systems because we need to train and recruit new physicians. All of this says something about the job that is leading to these high rates of burnout. So, there's been some discussion and some efforts to mitigate that. But we do not have definitive answers yet for mitigating burnout among physicians.

 

Do you think that this paper and perhaps your research could lead to any future steps or changes in medical practice in the future?

By itself, it's a somewhat limited finding other than sensitizing, perhaps, administrators and health systems to think about how COVID and the experience of caring for people with COVID are impacting the physician workforce. It also, of course, put people who work in health care at high risk to get COVID themselves, which also contributes to the ongoing burnout. So, there are some straightforward workplace changes that can potentially make a difference for people, and we're exploring that right now in a survey to try to understand both what has been done by workplaces to try to support physicians working during the pandemic, and what the respondents think should be done. So, this survey will give us some more interesting data to try to make recommendations for concrete changes in the future.

 

The other challenge is that the pandemic is persisting much longer than many people, including myself, thought it would at the beginning. It's shifting, which means both the virus is shifting, and so are the challenges. Early on, physicians wanted a vaccine because a vaccine could keep people from getting sick. Now we have vaccines, and they do a reasonable job of keeping people from getting sick, but a number of people have declined to be vaccinated. That is particularly true in the United States, which overall has lower vaccination rates than other countries. So, for a lot of physicians, it's very frustrating to see that they have this ongoing pandemic challenge, which is now primarily shifted to the unvaccinated, in terms of people who are getting very ill. In the meantime, the virus has also mutated so the vaccines are not quite as protective as they were previously. All of this makes for a more difficult work situation and more stress.

Based on qualitative comments that we've received on our surveys from physicians, as well as my own experience in practice, it's very frustrating to try to talk to patients about what they can do to prevent getting sick or to treat them when they are sick because so many people have bought into misinformation about the vaccine and about what the effective treatments for COVID are. That has shifted the relationship between physicians and patients in a way that's taken away some of the things that were previously gratifying.

 

Is there anything else perhaps that we should know about this paper or the next steps?

What this paper is, is a red flag. It's an alert, that this is very important and needs more attention, both in terms of research and in terms of how workplaces can do a better job of supporting physicians who are continuing to work in this pandemic with patients who are sick with COVID-19. It doesn't answer the question of what needs to be done but directs attention to the problem. So, that should lead to more research and more interventions to see if the situation can be improved.

 

 

You can read and discover Dr. Joy Melnikow’s research here.

 

Frontline physician burnout during the COVID-19 pandemic: national survey findings is published in Springer Nature.

 

Photo Credits: UC Davis

 

Disclaimer: This is a transcript of a video conversation. You can listen to the recording on Researcher.

Publisher URL: https://link.springer.com/article/10.1186/s12913-022-07728-6

DOI: 7211.28977.51f003b7-52e7-4dc5-9415-0a099c7850ef.1657182365

You might also like
Discover & Discuss Important Research

Keeping up-to-date with research can feel impossible, with papers being published faster than you'll ever be able to read them. That's where Researcher comes in: we're simplifying discovery and making important discussions happen. With over 19,000 sources, including peer-reviewed journals, preprints, blogs, universities, podcasts and Live events across 10 research areas, you'll never miss what's important to you. It's like social media, but better. Oh, and we should mention - it's free.

  • Download from Google Play
  • Download from App Store
  • Download from AppInChina

Researcher displays publicly available abstracts and doesn’t host any full article content. If the content is open access, we will direct clicks from the abstracts to the publisher website and display the PDF copy on our platform. Clicks to view the full text will be directed to the publisher website, where only users with subscriptions or access through their institution are able to view the full article.