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Primary Care Burnout in the Wake of COVID-19

In the US, the conversation about healthcare often revolves around national policy, cost and patient access. Among the less discussed but nonetheless very important issues is that of practitioner stress leading to professional burnout. While provider burnout was thrust into the national conversation by the pandemic, questions remain on how to better manage it in the future.

Harrowing stories from the pandemic’s frontlines included descriptions of heavy workloads and prolonged long hours for doctors and nurses. These were in addition to the risk of contracting COVID-19. While they may not have shown it, these conditions put providers under great stress. This led to some practitioners experiencing primary care burnout. Hospitals took on the most severe COVID cases but many sick and frightened patients turned to primary care providers for COVID-19 questions and treatment. Higher patient loads coincided with new medical protocols and the implementation of telehealth services at most practices. While practitioners doubtless met the challenge head-on, doing so took a mental and emotional toll on many.

“Burnout” is a medical condition marked by a specific set of mental, emotional and physical symptoms that lead to serious work impairment and emotional turmoil. Doctors and researchers have spent decades researching the condition.

The primary symptoms of burnout are:

  • Exhaustion (both physical and mental)
  • Lack of interest in work
  • Poor work performance
  • Worry and anxiety
  • Sleep problems
  • Isolation (either real or perceived)
  • Agitation and mood swings
  • Job dissatisfaction

In the primary care setting, these symptoms can manifest as increased medical errors, riskier prescribing patterns, and poorer long-term patient outcomes and treatment satisfaction.

Primary care burnout–as well as overall rates of provider burnout–had been increasing prior to the pandemic’s onset, which subsequently threw proverbial gasoline on the fire. Higher job demands, more uncertainty and maintaining continuity of care all affected providers’ emotional health.

These demands are in addition to the fear of exposing loved ones to COVID-19 as well as higher rates of anxiety and depression overall. As with many issues in healthcare, female practitioners experience higher burnout rates, although the exact reason for this disparity remains unknown.

Rates of burnout and pre-burnout symptoms spiked from 55% to over 70% just months into the pandemic. While some family medicine providers faced obviously high workloads, others experienced financial stress from seeing fewer patients. Lockdowns, staff illness and turnover and the implementation of new medical protocols all impacted bottom lines. However, many family medicine patients–particularly during the early days of the pandemic–chose to forgo care altogether out of fear of disease exposure. This reduced revenue just as providers’ costs went up.

Within the context of pandemic care, family medicine providers not only experienced the added stress of higher patient loads, but were forced to adapt to regularly changing (and sometimes confusing) federal COVID-19 health guidance.

Next Steps

Strategies to prevent and reverse burnout are coming into focus. The timing is key. While providers are likely to see reduced stress levels as the worst of the pandemic subsides, the effects of burnout will linger for many.

Access to Mental Health Services

Primary care providers should have access to quality mental health services that are available when and where they need them.

Peer Support

Doctors can benefit from networks of peers they can rely on for support.

Simplify Life Outside the Workplace

Access to childcare services, schooling for children and quality care medical care for loved ones can all help doctors simplify life outside of the office.

Compassion and Empathy from Administrators

Being heard by health system administrators and supervisors ensures that gaps in support are quickly met before stress reaches the burnout stage.

Open Lines of Communication

Health system decision-makers should have direct lines of communication with all employees, including primary care providers.