OMA Spotlight on Health – Burnout

Dr. Carolyn Snider talks about physician burnout on the pandemic’s front lines.

OMA data shows physician burnout is on the rise. Dr. Carolyn Snider, chief of emergency medicine at St. Michael’s Hospital in Toronto, describes what it’s been like to be on the front lines of the pandemic and what health-care workers are doing to cope.

For more information on physician burnout please visit:  https://www.oma.org/newsroom/news/2021/aug/ontarios-doctors-report-increased-burnout-propose-five-solutions/

Transcript

OMA Spotlight on Health – Burnout 5

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Georgia Balogiannis: In this podcast the Ontario Medical Association looks at current issues of interest in health care. Spotlight on Health gives you all the straight talk. We're Ontario's doctors and your health matters to us. I'm Georgia Balogiannis for the Ontario Medical Association.

Dr. Carolyn Snyder is the chief of Emergency Medicine at St. Michael's Hospital. In this episode, she discusses doctor burnout.

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Dr. Carolyn Snyder: A lot of the concerns around burnout were raised long before the pandemic, they were just exacerbated, and they are ongoing. These challenges are not just experienced by us as physicians, but by our many, many colleagues that are essential to all of us delivering safe and effective care. All of us are struggling.

We all got into medicine to care for people and to care with them and their families. And what's been highlighted here is how, over time, the complexity of our system — whether it's technology, or paper, or the processes and protocols that we follow — have become more and more time intensive. And, as a result, it takes away from why we actually got into medicine, and it really has a large impact on our well-being.

We also spend a lot of time, as a result, during pandemic with fear. We have spent a lot of time not understanding what it meant to be on the front lines. And so, that added complexity of constant change and constant new information and fear for what it meant for our patients, for our colleagues, for ourselves, and our family, has had a humongous impact on who we can be when we deliver care for our patients.

Very, very importantly, and probably some of the biggest impact this has had, is that it takes us away from being the humans that we are. We are all partners and family members and friends and parents and children of people that need us, and to be stretched by the end of the day to realize we actually haven't fulfilled what is the most basic requirement of who we are as humans to be in those relationships has had incredible damage to so many of my colleagues over time.

So, I'll often ask my colleagues, when they speak to me about the challenges they're having, what they would suggest to a patient. And almost always the solutions that are actually recommended are echoed back. “I want to spend my time doing the kind of job I got into. I want to ensure I have a healthy work life balance, making sure that I have the flexibility to choose what that means for me.” But what's really important to me is that this becomes the rule. Talking to the frontline workers and involving them in the solutions is actually the norm, not the exception.

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Dr. Snyder: I think I could probably use every emotion in the dictionary to speak about the last two years as a frontline emergency physician and as a person, like everyone else in our world who's been trying to survive within the pandemic and having life go on in the way it did over the last two years. So, as a physician and a leader in our downtown emergency department where 20 per cent of our patients are homeless and many, many more vulnerably housed, it was overwhelming, at times frustrating, to see the gaps that we already knew existed in health care just widen immensely.

It was exhausting; the hours were…there were rare days in the year of 2020 that I actually slept a full night. So, a lot of that was around uncertainty. A lot of that was an overload of information that changed so incredibly quickly. Even for somebody like myself who works in emergency medicine — this is what I live for, this is who I am — it was incredibly tough because there were no breaks from that overload. And then what I'm seeing amongst all of my colleagues around the moral injury of still having to make choices that we know are going to have impact on our patients.

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Dr. Snyder: I think there has been a sense that things have gotten better with COVID because the COVID numbers are down within hospitalization and ICUs overall. We're all obviously worried about what will come this fall. But what's really important is that the volume and acuity of patients coming through our hospital systems now are unprecedented. And I personally, in my career having been in this field for over 20 years, have never seen it as busy as over the past few months.

We as hospital systems across Ontario, and in fact across Canada and North America, are absolutely full. And it's incredibly worrisome going into this fall. And what it means is that people who had delayed care because of COVID, are coming in sicker. People who've been waiting for so long for very necessary surgeries, but that they're just not emergent during this last year, but they're pretty darn urgent, still having their surgeries cancelled, because we don't have a bed to care for them afterwards.

And so, the impact of the health human resources here is big. It's really, really important because if anything right now we need more than our baseline. And yet, because of the burnout, because of some of the attrition in multiple health-care worker groups, we're actually finding it incredibly difficult right now, and we are doing everything possible.

But I can tell you, as the head of the department, I'm on daily phone calls for having to make really tough decisions that impact many people who are wanting to get their

care and their surgeries now. And I know that I am not alone in that. People have extremely long wait times and they’re getting longer instead of shorter.

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Dr. Snyder: So, I am the — the head of an emergency department. And we have an incredible group of physicians who have really committed to physician wellness and ensuring that it is a safe place to —and safe space — to say, hey, I need to step away. And also, to ensure that we're checking in on people after really tough days and really tough cases. So, an example of that was during the first wave our wellness team, after every intubation in those first days of COVID, they got a phone call that next day. The team had a check-in. We knew how scary it was to actually do an intubation in those early days of COVID without truly having enough evidence and understanding on how we are keeping ourselves and our colleagues and therefore our families and the people around us safe. And so, it's incredibly important for us to be looking inwards and around us to ensure that the people we work with are healthy.

And so, I can say that, for my end, I do truly believe patients are safe. I believe that there are people looking out for each other, and probably that looking out for each other has probably escalated through the pandemic, and we've seen the benefits of that. We are an incredibly tight group. And I think that that's an incredibly important piece too.

I also felt really proud. I worked in a hospital with an incredible group of colleagues across all disciplines to step in and do what we didn't realize how well trained we were to do. We were all scared of what our job ahead of us was. But it was incredibly empowering to be part of a team that really stepped up, even when it meant a lot of personal sacrifice. And that was tough.

As a physician, and as a leader, I was always on in that role. But I also had a lot of personal circumstance last year. My mother-in-law died, our house was destroyed by a fire, my father had a stroke. And in every one of those moments, my team turned around, tapped me on the shoulder and said, "We've got this — we need you back, take care of yourself — but we’ve got this." And that's what it meant in this pandemic to really highlight the importance of a well-working environment. And to me, I know that I have to continue and especially clearly make steps forward to ensure that that continues within our group.

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Dr. Snyder: I have strong memories of those years of residency and as medical students and how inhumane it actually felt to be trying to care for patients during those hours. And I obviously see many of the residents that come down to our emergency department that continue to live those hours. But I'm glad to be seeing it

addressed, even in my hospital, in ways to try and rethink how we can schedule to ensure that they have better care.

But I also think, along with just ours when we talk about wellness amongst learners, we have to think about making sure that they can go into their careers expecting that wellness should be the norm and that they shouldn't have to expect burnout, which somehow has become a bit of a narrative and almost accepted that it is normal to be get burnt out. And it can't be.

One of the things I'm trying to do — emergency medicine residents in my field, so they only work the eight hours, they have a circadian rhythm. We're very conscious to try to protect their education time and their sleep time, et cetera because we need them to be safe in the emergency department.

One of the other things that I'm personally trying to do is to remind them why they're there. So, at the end of every shift, we do an evaluation of how the day went — what did they learn, what might they want to keep working on, what do we think they should keep working on, and areas of opportunity. But I’ve started asking the question, what touched your heart today? Because if you can finish your shift and remind yourself why I'm in this calling, why I love what I want to do, you come out of an incredibly busy shift that at times got really tough, remembering the impact you can have. And if we can teach our learners to have that self-reflective moment, it will go a very long way.

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Georgia Balogiannis: This podcast is brought to you by the Ontario Medical Association and is edited and produced by Jodi Crawford Productions. I'm Georgia Balogiannis, Director of Member Editorial Communications at the Ontario Medical Association. To learn more about the Ontario Medical Association, please visit oma.org

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