Physician Burnout Reaching Critical Levels During COVID-19 with Lakshmana Swamy, MD, MBA

Until the COVID-19 pandemic, the subject of physician burnout was likely not considered by large swaths of the American public. Despite this, burnout has been an issue that has plagued physicians for decades prior to the pandemic, and the consequences of it are wide-reaching and at times lethal.

In an interview for the latest installment of Crisis Point, Lakshmana Swamy, MD, MBA, Cambridge Health Alliance, detailed the history and complications of burnout and how the mental, physical, and emotional effects associated with it worsened with the COVID-19 pandemic.

When speaking of burnout, Swamy described the phenomenon as chronic work-related stress brought on by 3 key dimensions including emotional exhaustion, a lack of personal accomplishment, and depersonalization.

“In the years leading up to the pandemic, it was more and more of something people were talking about and I think in clinical circles, certainly, it was sort of a hot topic and it was because we were feeling it,” Swamy said. “We already knew from most of the burnout research (was) from pre-pandemic, and the work we did showed that somewhere between 30% and 50% of ICU nurses were already burned out, and I think the numbers probably similar for physicians and kind of across the board.”

Swamy noted that additional research on burnout has estimated the prevalence to be above 70%, which could be attributed to much more than the distress detailed earlier.

“You're seeing the effects of racism on people, you're seeing poverty, you're seeing people unable to get their medications, substance abuse, that's coming to you in and leading to many of the medical problems you're taking care of in the ICU,” Swamy said. “So, already that is kind of leading to all of that stuff together, combined with the moral distress about being in the ICU and seeing a lot of people not make it out and suffering. All that is contributing. (to burnout). That was what it was like before COVID-19.”

During the first wave of the virus, Swamy and other physicians immediately immersed themselves in research pertaining to the COVID-19 virus. When not in the hospital, Swamy was reviewing literature regarding the manifestations and intricacies of the disease.

“I think it was a bizarre time because it was both terrifying, and yet, it was like a clarion call,” Swamy said. “This was sounding to us specifically; it was unbelievable how much we heard and felt that this is an ICU problem on a mass scale.”

Despite this, an already overwhelmed medical system became increasingly exhausted during the pandemic, with some physicians having to fend off criticisms and confrontation from the patients they were actively trying to save.

“It went from people really celebrating us, which although it was nice, it also felt hollow a lot of the time because we weren't seeing it echoed in leadership, but then it went to people not believing us, people protesting us outside our hospitals, people not getting vaccinated,” Swamy said. “Once the vaccines came out, we thought ‘we did our part, we got us through to the end game’, and then obviously it's not that simple.”

The issue of burnout was further complicated by discordant voices within the healthcare system challenging the idea of vaccines and the healthcare system. Despite this, Swamy believed that most physicians were unified in their opinion on the efficacy of the vaccines and the strength of working physicians nationwide.

“I think that's challenging, because it would be great to have a unified voice and I think we largely do,” Swamy said. “It's always exciting for media to pick up on discordant voices, and amplify those, (but) I think that the vast majority of healthcare workers really are extremely tightly aligned on all of this.”