The pressures of COVID-19 on an already stressful environment for health workers

By Dr. Ann Collins

Tired and anxious.

As we enter the second year of the COVID-19 pandemic in Canada these two words go a long way to describing how Canada’s physicians are feeling. And I know we are not alone. Hospitals have been ground zero in managing the pandemic and everyone working in these hospitals – from cleaners and food services staff to therapists and nurses are feeling the impact. A recent poll of U.S. hospital executives identified provider burnout as one of the most potentially disruptive forces facing hospitals in the next three years and I am sure many Canadian hospital CEOs would echo this sentiment.

A recent survey of doctors conducted by the Canadian Medical Association (CMA) shows what a toll the pandemic is taking on the mental health of physicians both in hospitals and in community settings. The poll of more than 1600 physicians found that respondents’ fatigue has increased by 69 per cent over the last year, with 64 per cent experiencing anxiety around the pandemic.

A year ago, we and other health care providers were dealing with the stress of procuring adequate (or any) personal protective equipment (PPE) for ourselves, and the unknowns involved in caring for seriously ill-patients sickened by the new virus. Now we must deal with the uncertainties of just when and how COVID-19 vaccines will be distributed, while dealing with a growing number of patients with COVID-19 being admitted to intensive care units (ICUs).

The recent CMA poll showed that concerns about the rollout of COVID-19 vaccines was present among 62 per cent of physicians responding to the survey, with uncertainty about the future impacting 63 per cent.

Our poll shows that in late February, many doctors were disappointed with how governments were handling the one measure that holds the prospect of relieving the situation – the supply and distribution of COVID-19 vaccines. There has been good progress made but we can’t let go of our collective determination to vaccinate our population.

What needs to be emphasized is that the stressful situation caused by the pandemic came at a time when the system was already overburdened. As a colleague, Alberta anesthesiologist Dr. Alika Lafontaine said in a recent interview “the burnout and moral injury that physicians have been experiencing across the country has always been there. We’ve been overworked and under resourced for many years.”

The CMA National Physician Health Survey conducted in 2017 documented some of these concerns and showed nearly one-third of doctors, residents and medical students report burnout and depression at some point in their career. Physicians whose main practice setting was a hospital had increased odds of lower emotional well-being, lower social well-being, and lower psychological well-being, compared with those working in other settings.

It should be noted that those managing our health care system are starting to pay attention. The framework seen as essential for maintaining a high-quality health care system, the so-called Quadruple Aim, now includes the health and well-being of those providing care.

While too many physicians continue to deal with mental health issues in silence and fail to receive the necessary care, the pandemic has seen a willingness by many of my colleagues to share their personal circumstances with their peers and on social media.

Winnipeg internist and author Dr. Jillian Horton who has just published a highly praised personal memoir “We Are All Perfectly Fine” said she has noted a new “esprit de corps” among physicians in the face of the pandemic. Her perspective is echoed by Dr. Micheal Myers, a psychiatrist who has specialized in treating mental health issues of physicians. “Doctors are reaching out to each other in both directions, asking for help and offering help. More and more physicians are talking about their mental health struggles in significant ways, some in private, others publicly,” he writes.

What will it take to significantly improve the well-being and outlook of Canadian physicians?

The recent poll found that the most likely contributing factors to positive mental health are directly related to the pandemic. They include getting accustomed to the “new normal”, more time dedicated to self-care, an improved outlook regarding COVID-19, improved work-life integration, and improved availability of PPE.

Moving forward, physicians and all hospital workers must have the mental health supports they need to face new challenges. If vaccines succeed in vanquishing the immediate threat of COVID-19, doctors and the hospital sector still face the huge challenge of bridging the care gap for the many patients who have seen postponement of elective procedures due to the pandemic.

The COVID-19 pandemic has placed huge pressures on physicians and all front-line workers, not to mention the isolation felt by so many Canadians. We’re all feeling the pressure of a global pandemic that has upend our lives and all that we cherish. Compassion remains the best prescription now and into the future.

Dr. Collins is a family physician in Fredericton, New Brunswick and president of the Canadian Medical Association