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Burnout was a recognized issue in Critical Care Medicine well before the pandemic began. The Critical Care Societies Collaborative (CCSC) issued a call to action in 2016 to address “Burnout Syndrome” among those in their member societies, which include the Society of Critical Care Medicine, American Thoracic Society, American College of Chest Physicians, and American Association of Critical-Care Nurses.1,2
According to the CCSC call to action, “Up to 45% of critical care physicians reported symptoms of severe [burnout syndrome].”1,2
Not surprisingly, the COVID-19 pandemic has added to the burnout rate. In February 2021, during the thick of the pandemic, 48% of pulmonary/critical care physicians reported experiencing either burnout or both burnout and depression in a study published by Medscape, which also indicated that pre-pandemic burnout levels were only somewhat lower.3
According to Seppo T. Rinne, MD, PhD, lead author of a study on burnout in critical care published in the September 2021 Annals of the American Thoracic Society, the burnout problem is a systemic one. The journal article based on this study highlights professional societies’ responsibility for addressing burnout among their members.4
Pulmonology Advisor spoke with Dr Rinne, who is also Assistant Professor of Medicine, Division of Pulmonary, Allergy, Sleep, and Critical Care Medicine at Boston University School of Medicine, about the problem of burnout in critical care and what can and should be done to address it.
What drives burnout in critical care?
Dr Rinne: Fundamentally, burnout is driven by 3 core factors: what kind of work you do; how much you work; and where you work, including the work environment. Pulmonology and critical care burnout tends to be higher than burnout in other specialties, in part because our work deals with very challenging clinical issues. Oftentimes, we manage patients at the end of life, and this care can include some amount of uncertainty and conflict about how to provide the best care.
We may even have internal conflicts in which we want to provide a certain approach to care but are constrained in our ability to do so because of local policies, unavailable resources, differing opinions with the patients and caregivers, and more. The resulting struggle leads to a phenomenon that we call “moral distress,” which can contribute to higher rates of burnout. Pulmonary and critical care physicians also tend to work long hours in stressful environments.
How, specifically, has the pandemic contributed to greater levels of burnout?
The COVID-19 pandemic increased burnout among pulmonary and critical care physicians in somewhat predictable ways. The work itself has been more challenging because we are dealing with a disease that is difficult to treat and has contributed to high levels of morbidity and mortality. For those of us who work in critical care settings, we have undoubtedly experienced moral distress as we have tried to treat a disease that does not have a lot of great treatment options.
Many of us have been pulled to work long hours, and our work environment has fundamentally changed with personal protective equipment, social distancing, and hospital policies impacting how we interact with team members and patients. Although these measures are important for controlling the pandemic, they do influence interpersonal relationships and workplace climate.
The pandemic has undoubtedly contributed to higher levels of stress and burnout, but we have also observed tremendous displays of resilience and camaraderie. In the hospitals where I work, I have been blown away by the support that clinicians have shown each other and the sense of togetherness that has emerged in our department. I recognize that this response may differ in other hospitals, and I worry that for some, the pandemic has strained the local culture.
What measures are most needed to address burnout in critical care?
Dr Rinne: First and foremost, we need to recognize that burnout is a systemic problem that requires organizational practice and policy changes. Historically, there was a tendency to see burnout as a personal problem that required individual interventions, such as mindfulness programs or encouraging more time away from work. While these interventions may have some value for each of us, this approach fails to recognize the root cause of burnout. With physicians experiencing nearly 50% burnout, it is clear that we have systemic problems.
Solving these problems is not easy. We need to recognize that our work can be stressful, and we should search for ways to mitigate that stress. Technology has certainly created opportunities for improved care delivery, but it has also added stress. We spend most of our days staring at computer screens and fighting with electronic health records that are designed for billing rather than for patient care. We need to make these technologies more usable and find ways to alleviate the burden that they place on clinicians. The use of scribes is one evidence-based way to improve efficiency and reduce burnout.
We also need to change the way that we incentivize — or penalize — workload. Productivity pressures are a major driver of the burnout crisis. We need our health systems and policy makers to realize that this approach is unsustainable.
Lastly, we need to develop better work environments that are built on a culture of mutual respect that helps foster positive working relationships. In short, we need transformational changes that recognize the value of the individuals who are delivering care.
What has helped you personally to avoid burnout?
Dr Rinne: This is a challenging question because I do think that there are some things that we can do to help manage work-related stress, but these steps need to be accompanied by the types of systemic changes that I discussed previously. That said, there are a few key things that have helped me derive more joy in my work, reduced my feelings of burnout, and allowed me to have better mental health.
One of the most important changes I have made has been diversifying my work focus. I spend a fair amount of my time conducting research, which allows me to have a different work schedule and a different focus in my work. Research can also be stressful, but the work variety helps me from constantly getting overwhelmed by one thing. Teaching or administrative work may provide similar diversity, although these types of endeavors need to come with protected time so that you don’t just add more work onto an already busy work schedule.
Another thing that has helped me is that I prioritize my family and my physical health. About a year ago, I decided that I was going to exercise every day, and I have been pretty consistent with this. To do so, I sometimes need to leave work earlier than I previously did or even cancel unnecessary meetings. I use the same approach in protecting time for my family; I don’t work as many nights or weekends as I used to. I suppose I don’t take work as seriously, and I have accepted the fact that this may influence my productivity, status, and identity as a hard-working academic pulmonologist.
References
1. Critical Care Societies Collaborative (CCSC). Burnout: National Summit on Prevention and Management of Burnout in the ICU. Accessed March 24, 2022. http://ccsconline.org/optimizing-the-workforce/burnout
2. Kleinpell R, Moss M, Good VS, Gozal D, Sessler CN. The critical nature of addressing burnout prevention: results from the Critical Care Societies Collaborative’s National Summit and Survey on Prevention and Management of Burnout in the ICU. Crit Care Med. 2020 Feb;48(2):249-253. doi: 10.1097/CCM.0000000000003964
3. Martin KL, Koval ML. Medscape pulmonologist lifestyle, happiness and burnout report 2021. Published online February 19, 2021. Medscape. Accessed December 21, 2021.
4. Rinne ST, Shah T, Anderson E, et al. Professional societies’ role in addressing member burnout and promoting well-being. Ann Am Thorac Soc. 2021;18(9):1482-1489. doi:10.1513/AnnalsATS.202012-1506OC
