Smoldering

April 9, 2021
Catherine Y. Spong, MD
Catherine Y. Spong, MD

Catherine Y. Spong, MD, is Editor-in-Chief of Contemporary OB/GYN; Professor and Vice-Chair of Obstetrics and Gynecology; Gillette Professorship of Obstetrics and Gynecology; and Chief of Maternal-Fetal Medicine at UT Southwestern Medical Center in Dallas, Texas.

Rarely a day goes by without a post, article, or email about physician burnout.

New variants of coronavirus disease 2019 (COVID-19) and slow vaccination rates are prolonging the quarantine, and there is no certain end in sight. Without a clear path to a semblance of normalcy for our careers, families, and communities, it should be no surprise that our well-being is in jeopardy.

From private practice to academic medicine, strategies to proactively address physician wellness are urgently needed. Results from a survey of 1122 academic faculty across the nation reported that individuals feeling very or extremely stressed more than doubled from 2019 (32%) to 2020 (70%), and almost 3 times as many had increased anger (12% vs 35%).1

During the same time frame, more than 12,000 physicians surveyed reported their rate of being “somewhat” or “very” happy declined from 82% to 58%,with a similar decline reported for ob/gyn physicians (81% to 57%).2,3 Female faculty members reported a dramatic increase in feeling stressed, from 34% to 75%, and they experienced stress at higher rates than men, 75% to 59%.1 Since May 2020, 40% of women reported symptoms of anxiety or depression (Figure), which is almost 4 times higher than the 11% reported in 2019.4

Given the predominance of female ob/gyns—83% of residents are women—these statistics really hit home. The shift to remote learning and limited child care options have affected these colleagues, as women disproportionally shouldered the burden.5 For women, the dual role of being the family’s primary caregiver and practicing medicine has made the balancing act untenable for many, affecting both their mental health and career.

Many accept—often request—night and/or weekend shifts to maximize time at home to assist with child care and remote learning. In return, they have no down time, time to accomplish academic goals, or opportunity to recharge. Remote working has resulted in busier schedules and often longer hours for many, with fewer breaks as virtual meetings are stacked one on top of another. As eloquently stated in a recent Womxn’s Health Collaborative online post, the effort “comes at the expense of our own health and well-being.”6

Solutions are not obvious, especially for ob/gyns. Early responses have been to encourage us to take care of ourselves, but when can we do this? Others have recommended taking time off; this burdens our colleagues and often results in insurmountable amounts of catch-up when we return.6 Physician burnout as a critical topic predates the pandemic.

The National Academy of Medicine launched a resource repository on clinical burnout and well-being in 2018.7 There is a wealth of information on causes, effects, and solutions for clinical burnout available. Solutions include organizational and individual strategies, such as fostering communication, cultivating teamwork, and practicing mindfulness; however, data demonstrating their effectiveness are limited. Ultimately, system changes to address the inequity are needed to adjust metrics and support women in all roles: career, family, and community.

Physician burnout and the need for wellness will not be resolved once the pandemic is behind us. The American College of Obstetricians and Gynecologists has 5 warning signs of burnout: dread, increased complaining, irritability, lapses in confidentiality, and loosening boundaries.8

For ourselves and our colleagues, let’s keep these in mind and work with each other to identify and address burnout proactively. A first step, although clearly not a solution, is having someone to talk to, someone to share the realities of life with. This can help us to address our burnout and provide an outlet.

Although we cannot eliminate the current emphasis on virtual working, remote learning, and limited child care, we can enhance our support for each other.

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References

1. On the verge of burnout: COVID-19’s impact on faculty well-being and career plans. Chronicle of Higher Education. Accessed March 22, 2021.https://connect.chronicle.com/rs/931-EKA-218/images/Covid%26FacultyCareerPaths_Fidelity_ResearchBrief_v3%20%281%29.pdf

2. Martin KL. Medscape physician lifestyle & happiness report 2021. January 15, 2021. Accessed March 22, 2021. http://www.medscape.com/slideshow/2021-lifestyle-happiness-6013446

3. Martin KL. Medscape obstetrician & gynecologist lifestyle, happiness & burnout report 2021. February 19, 2021. Accessed March 22, 2021. http://www.medscape.com/slideshow/2021-lifestyle-obgyn-6013515

4. Anxiety and depression: Household Pulse Survey. Centers for Disease Control and Prevention. Updated March 10, 2021. Accessed March 22, 2021. http://www.cdc.gov/nchs/covid19/pulse/mental-health.htm

5.Sevilla A, Smith S.Baby steps: the gender division of childcare during the COVID-19 pandemic. Oxford Review of Economic Policy. 2020;36(suppl 1):S169-S186. doi:10.1093/oxrep/graa027

6. Johnson C, Thornton H. Bracing for impact. Womxns Health Collaborative. Accessed March 22, 2021. https://womxnshealth.medium.com/bracing-for-impact-894b9f13db84

7. Sharing knowledge to combat clinician burnout. Clinician Well-Being Knowledge Hub. Accessed March 22, 2021. https://nam.edu/clinicianwellbeing/

8. At risk for burnout? Check these 5 warning signs. The American College of Obstetricians and Gynecologists. January 28, 2019. Accessed March 22, 2021. http://www.acog.org/news/news-articles/2019/01/at-risk-for-burnout-check-these-5-warning-signs