Healthcare workers were in crisis before COVID

Much has been written about the challenges frontline health workers have faced during the COVID-19 pandemic. Long work days, excessive deaths and fear for the safety and well-being of family and colleagues have been constant over the past 22 months. Doctors and nurses started out as heroes, but tense politics and social media abuse have now branded them as outcasts and purveyors of a medical hoax by a significant segment of society.

The timing of this pandemic couldn’t have been worse: According to the 2021 Medscape National Physician Burnout & Suicide Report, 79% of physicians stated their burnout started before the COVID-19 pandemic.

The pandemic has spotlighted a system plagued by burnout and moral distress. Hospitals have always been a safety net for the sickest and most vulnerable patients in society, leading to everyday stressors that were accepted as part of the job. In addition, the past decade has brought new challenges that have led to the gradual erosion of safety, respect and courtesy within hospitals and for frontline staff.

It is estimated that 75% of workplace violence takes place within the healthcare sector. This probably underestimates the true number, as most frontline workers consider verbal and physical assaults to be part of their job. The American College of Emergency Physicians has stated that 70% of ER physicians have reported acts of violence, while only 3% have filed charges.

The opioid epidemic put more risk for frontline staff as physically addicted patients sought access to painkillers. These interactions often led to verbal and physical threats against both doctors and nurses. Moral and ethical issues arose as clinicians attempted to navigate the crisis and differentiate objective pain from opioid abusive behavior.

Politics began infiltrating healthcare long before the pandemic. Doctors were accused of advocating for “death panels” by politicians who opposed the Affordable Care Act. Doctors are now witnessing unnecessary suffering and death from the politicization of the COVID-19 vaccine and misinformation about appropriate treatments.

COVID-19 has brought a new reality: Not only are patients and families willingly making decisions that could cause great harm to themselves and others, but they are actively denying basic scientific facts and accusing clinicians of lying to them about their illness.

Last year in Ohio, a hospital in Ohio was ordered by a local judge to give ivermectin to a COVID-19 patient (then reversed), despite there being currently no scientific consensus that it offers any benefit. This erosion of fundamental respect for science, along with the loss of professional autonomy, has only exacerbated the moral damage suffered by health professionals.

Where do healthcare workers go? What will it take to prevent an ongoing exodus from the front lines, to ensure that patients have continued access to quality, evidence-based care?

1. Health care systems must remove all barriers to frontline workers receiving mental health treatment. One model won’t work for every system, but there is an urgent need for a combination of on-site guidance and easy-to-plan off-campus treatment. Opt-out (automatic enrollment) programs have been shown to increase the use of mental health resources in GP training programmes.

State medical boards must remove questions about mental health from applications completely, or ask questions only about current restrictions. Historically, these questions have made clinicians reluctant to seek much-needed mental health care.

2. More investment is needed to make hospitals safer. This requires a combination of more security personnel, zero tolerance for threatening behavior and eliminating the culture of accepting physical and verbal attacks as ‘just part of the job’. In our due quest for patient-centered care, we must not allow behavior in hospitals that is not tolerated (but likely to be prosecuted) elsewhere.

3. Healthcare systems should consider sabbaticals for the most affected frontline workers. Short-term costs would pale in comparison to long-term costs associated with the loss of experienced personnel and the cost of recruiting and training to replace them.

The industry has recognized that paid sabbaticals (usually for employees with at least three years of service, lasting from one to six months) create a more productive, focused and innovative workforce. While this may be considered radical, it has the potential to reduce overall costs for overstretched hospital budgets and enable health professionals to return to work mentally and physically healthy.

These steps are just a start. Additional innovative ideas are needed, including a holistic view of a system that relies on surgical procedures to keep hospitals financially viable.

Time is of the essence, as the needs of frontline workers to address post-traumatic stress disorder, guilt, anger, depression, anxiety and moral injury will be there long after the pandemic society has evolved.

Rick Hilger is a St. Paul physician and chairman of the Society of Hospital Medicine Public Policy Committee.

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