WINDSOR TERRACE — Long work hours, little sleep, and mountains of paperwork. It’s a way of life for doctors and nurses. The result is stress and, in some cases, burnout.
Dr. Greg Burke, an internist who is co-director of ethics for the Catholic Medical Association, said stress has been a topic of conversation in the medical profession for years, but that the COVID-19 pandemic pushed it into overdrive.
He described the warning signs of burnout: depression, lack of interest in work, feeling depersonalized, and having frequent thoughts of giving up and leaving the profession.
“That all existed before COVID. But COVID added a whole new layer of stress,” Dr. Burke said.
The stress comes from several factors, including the large volume of COVID-19 patients streaming into hospitals at the height of the pandemic, the feeling of loss when a patient dies, having to deal with multiple patients’ families simultaneously, having to navigate through layers of bureaucracy, and facing fears of becoming infected with the virus.
“It’s hard not to take it home with you at the end of your shift,” said Suzanne Molina, a nurse leader in the critical care unit at St. Joseph Hospital in Bethpage, Long Island.
COVID has been around for over a year and now, with the Delta variant, is showing no signs of going away.
“We’re not getting a reprieve,” said Lacey Mantovani, a nurse in the hospital’s intensive care unit.
Many doctors feel isolated, said Dr. Robert Tiballi, an infectious disease specialist and a member of the Catholic Medical Association.
“A lot of doctors have quit. They decided to retire because the stress became too much to deal with,” he said.
The retirements present a whole new problem, according to Dr. Burke.
“One of the concerns is that many physicians will retire earlier. It could create gaps in and deficiencies in access to care,” he said. “Suddenly you’re in a small town and the nearest physician retires at 52. That’s a real burden on a community.”
According to Molina, nurses have also opted to switch jobs: “There’s definitely been a shift to more of a turnover of the staff.”
It’s not just life-and-death situations that cause stress, according to Dr. Tiballi, who said bureaucracy and excess paperwork are also stress-inducers. He pointed to what doctors go through to earn recertification — a process that takes place every six to 10 years and involves filling out numerous forms and taking exams — as burdensome.
According to a Medscape survey released in January, only 49% of physicians said they were happy at work. Prior to the pandemic, the figure was 69%. The survey found the three most common factors cited by doctors for suffering burnout were too much bureaucracy (58%), long work hours (37%), and lack of response from leaders (37%).
However, COVID-19 isn’t entirely to blame — 79% percent reported their burnout symptoms began before the pandemic.
There are signs that hospitals are taking steps to address the issue.
Nurses at St. Joseph Hospital conduct regular “resilience rounds,” which are group sessions where people can feel free to bear their emotions and vent.
“We’ve relied on one another,” Mantovani said.
Molina says the sessions work because “the staff feels they can be vulnerable with one another and with me.” One of the most important parts of her job, she said, is “making sure my staff is okay.”
SUNY Downstate Health Sciences University introduced support groups for medical staff in February 2020, as the pandemic was starting to gain steam.
“This was very helpful for these health professionals,” said Dr. Ramaswamy Viswanathan, interim chairman of the Department of Psychiatry and Behavioral Sciences at SUNY Downstate Health Sciences University in Brooklyn. “First of all, they got support from their peers, which is quite important, and they’re also able to ventilate their feelings and learn from each other.”
SUNY Downstate also offers individual counseling and doctors who seek help need not fear being stigmatized.
“The stigma used to be a barrier in the past,” Dr. Viswanathan said. “But fortunately, now things have changed. Now, especially in the past few months, we have seen several physicians and nurses that have come forward, seeking mental health, and they are quite open about it,” he said.
Last year, New York Health + Hospitals/Queens opened an employee wellness room — a 350-square-foot space for meditation, yoga, aromatherapy, and health coaching. The wellness room can accommodate up to 10 people at a time.
However, self-care only goes so far, according to Dr. Burke.
“The general resources often talked about are sort of self-help,” he said, pointing to usual advice like getting enough sleep, exercising, and finding a hobby. “Great advice. But I can tell you many clinicians will fire back, ‘That’s great but do you have anything to ease my burden?’ We’re not getting at the root of what is causing the stress.”
Still, there is some reason for hope.
“I think there’s greater national recognition by our leaders that this is a real entity, this burnout,” he said, adding that the awareness could lead to change.