Since the start of the COVID-19 pandemic, our nation’s physicians have been pushed to the limit. Top Doctor Magazine interviewed Dr. Priya J. Bansal MD, an allergist and immunologist with published research on how the pandemic has increased burnout among doctors. “We’re taught in residency: tough it out, tough it out, tough it out…but you can only do ‘tough it out’ so much.” She is also a member of the AAAAI COVID-19 Task Force, a rapid response team formed to address and communicate urgent issues related to the practice of allergy and immunology in the context of the pandemic.
Experience with Asthma and Allergy Wellness
Dr. Bansal remembers that she discovered her interest in practicing medicine during her experiences with persistent illness as a child. She would pursue her studies at Pennsylvania State University-Jefferson Medical College and earn her medical degree at the University of Illinois College of Medicine in Chicago. At the University of Illinois, she was Chief Resident in her internal medicine and pediatrics residency. Dr. Bansal then completed her fellowship in Allergy and Immunology at the Rush University Medical Center. During her rotations, Dr. Bansal discovered a love of taking medical care of both adults and children.
Identifying Personal and Institutional Burnout
Before the pandemic hit the world in early 2020, physicians were already showing signs of high levels of burnout. Dr. Bansal tells Top Doctor Magazine that there are several levels of underappreciated physician burnout. First is taking stock of the physician’s baseline mental health, depression, and anxiety levels. She suggests that one of the first things physicians should do is grow personal and professional support networks. This can be done by communicating common issues to peers in groups on social media, forming advocacy teams to address physician fatigue. Another way to achieve this is by taking extra precautions to ensure that the individual physician or a coworker’s baseline mental health needs are being met before dealing with the stress of working during a pandemic.
Dr. Bansal describes burnout as commonly occurring at an institutional level as well. Payment from insurance companies is requiring more energy from physicians than ever before. For example, with today’s over-the-counter allergy medicine, insurance companies are now often incentivized to delay payment for modern allergy therapy. Getting an authorization for a prior prescription from insurance companies is met with endless insurance company cost-saving tactics such as unnecessary delays.
Another issue fatiguing doctors is the insurance company’s insistence on using the cheapest treatment. For allergists, insurance companies tend to prefer patients take older treatments such as steroids which are less expensive than newer therapies. “For the physician and patient, this is a problem because steroids have several side effects such as hypertension, possible cataracts, immune suppression, you can go on and on.”
Communicating, Patient Education, and Physician Burnout during COVID-19
As a member of the American Academy of Allergy Asthma and Immunology COVID-19 Task Force, Dr. Bansal has been monitoring the impact of COVID 19 on practicing allergists and immunologists. Patient education regarding the novel coronavirus has been particularly tricky. Many doctors have to expend significant energy addressing patient resistance to masks, vaccines, or developments in safety protocols. Reestablishing the trust of confused patients has been a major struggle. The pandemic started during a presidential election year, and many patients reported having received conflicting medical messaging and news from social media.
Dr. Bansal stressed that advances with the technological advances in telehealth have allowed physicians to access patients safely, but it is not without problems. During the pandemic, “Telehealth basically went from 0 to 100 overnight,” said Dr. Bansal. The biggest issue is the doctor’s time. They are seeing more patients virtually while already experiencing high patient volume at the clinic.
Other examples of physician burnout from COVID-19 stem from law changes. Many offices received government financial assistance, and the taxation implications are still unclear. Also, recent laws that granted patients instant access to lab results have created a situation where patients are presented with sophisticated data without a medical training context. An example would be a patient finding out lab results from an oncologist before the patient’s doctor could review them. This information overload can give the patient higher anxiety levels which then turns into more phone calls to the doctor’s office. The result is an unsustainable increase in call volume for both physicians and staff.
The Health of the Healthcare Industry
Still, Dr. Bansal sees technology as one way to relieve physician burnout. A pressing issue for doctors today is really about a bottleneck in workflow. To lessen strains on the physicians, offices would benefit from government standardized electronic medical records. On their end, physicians should form support networks and legislative advocacy groups to address problems with insurance companies. Next, Dr. Bansal sees a move towards the “blended approach” of a mix of telemedicine and face-to-face visits as a way of balancing high-level patient care with the physical limits of today’s practicing physician’s workload.
A look into Dr. Bansal’s research on the topic of physician burnout shows that clinicians can alleviate the stress of the pandemic by leveraging easily accessible tools, like the Strength-Focused and Meaning-Oriented Approach to Resilience and Transformation (SMART) crisis management approach, wellness apps, mindfulness, and gratitude. These are highly essential measures to safeguard physician wellness, a critically underappreciated priority.
Clinician Wellness During the COVID-19 Pandemic: Extraordinary Times and Unusual Challenges for the Allergist/Immunologist
Priya Bansal, MD,a Theresa A. Bingemann, MD,b Matthew Greenhawt, MD, MBA, MSc,c Giselle Mosnaim, MD, MS,d Anil Nanda, MD,e,f John Oppenheimer, MD,g Hemant Sharma, MD,h David Stukus, MD,i and Marcus Shaker, MD, MScj,∗
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