Children’s hospitals are packed with patients, and many doctors have been pushed to their limits. Healthcare leaders must recognize and acknowledge the stress on physicians and ask them what they need.
Pediatricians relish the joy of helping children, but treating kids carries its own set of burdens.
Burnout among pediatricians has been rising steadily, even before the arrival of COVID-19. From 2011 to 2014, burnout among pediatricians increased from 35.3% to 46.3%, according to a report released last week by the American Academy of Pediatrics. (The study appears in the November 2022 issue of Pediatrics.)
Pediatricians have endured more stress in the COVID-19 pandemic. Now, an unusually early spike of RSV cases is packing children’s hospitals and emergency departments around the country. Pediatricians are also bracing for the expected uptick in flu cases, as well as more kids testing positive for COVID-19.
Plus, pediatricians must deal with the heartache that comes with caring for seriously ill children. Hilary H. McClafferty, lead author of the report, recalled a conversation with a colleague about the current environment for pediatricians.
“We were comparing this to sprinting after a marathon,” McClafferty said.
A pediatric emergency medicine physician at Tucson Medical Center, McClafferty said patients are flooding the emergency department. Some of the patients are showing up with respiratory issues beyond the capacity of urgent care facilities.
“Pediatric ICUs are overrun with patients,” McClafferty said. “Pediatric emergency departments are overrun with patients.”
In an interview with Chief Healthcare Executive, McClafferty says burnout in pediatrics deserves more attention. Hospital leaders have said they are increasingly concerned about burnout among all physicians. Surgeon General Vivek Murthy issued an advisory on burnout in healthcare in May, and he has urged health systems to address it in order to avoid worsening shortages of physicians and nurses.
McClafferty said it’s important to remember those in pediatrics.
“People are sort of burned out on talking about burnout, and that is understandable,” she said. “And yet we still have a long way to go.”
‘The stakes are really high’
Those working in pediatrics deal with the pressure of caring for patients and wanting to come through for the families of sick children.
“The stakes are really high,” McClafferty said. “You are dealing with the most precious thing to these parents. This child is in most families their most precious thing and they’re coming to you at their most vulnerable moment.”
“As pediatricians, we get it,” she said. “We understand this is the most important thing in the world to you and we need to get this right.”
Pediatricians generally are reporting less satisfaction with their work-life balance, the study found. The COVID-19 pandemic has only added to those burdens.
Early in the pandemic, many pediatricians found themselves in unfamiliar territory. While the initial onset of the pandemic focused on cases among adults, pediatricians were tapped to help treat older patients, McClafferty said.
As the pandemic progressed, doctors in pediatrics began treating younger patients with COVID, and volumes started increasing for other illnesses.
Increasingly, pediatricians are grappling with the same issue affecting so much of healthcare: a lack of staffing.
“We’re working with very lean staffing,” McClafferty said. “That’s a national trend, and pressure and stress is related to volume, acuity and staffing challenges.”
Pediatricians are also bracing for a difficult winter flu season, on top of the spikes in the respiratory virus known as RSV. Typically, RSV poses greater risks for children under 5 years of age. This year, hospitals are seeing some older children and kids with chronic illnesses with severe breathing problems. Some children are getting more exposed to respiratory viruses this year than in the first couple of years in the pandemic.
“We’re now seeing flu and RSV and the resurgence of COVID in the pediatric population,” she said. “I’m peering forward with some trepidation.”
The toll on women
Nearly two-thirds of pediatric doctors are women, according to data from the Association of American Medical Colleges. Typically, female doctors report higher levels of burnout than male physicians.
“We completely and fully acknowledge that burnout impacts all genders,” McClafferty says. “This in no way negates its impact on our male physician colleagues. It’s important to acknowledge that.”
But she adds, “Women physicians across the board report higher levels of burnout, especially in emotional distress measurements, and are at higher risk of suicidality. In pediatrics, we see that trend.”
Surveys indicate higher prevalence of burnout - from 20% to 60% - among women physicians, according to the Pediatrics study.
Women in pediatrics typically carry the bulk of family responsibilities, even as they work long hours in practice, she notes. Plenty of female pediatricians are also single parents, adding to the burden.
Plus, women in pediatrics, and notably women of color, suffer harassment based on gender. McClafferty said it’s an area worthy of more study.
“They also need further action,” she said.
Leaders: Acknowledge the stress
Hospital and health systems need to understand the stress on their doctors in pediatrics. Even those who may appear to be doing fine could be struggling, McClafferty said.
Healthcare leaders need to recognize the strain and vocalize it, she said.
“The number one issue is acknowledgement,” McClafferty said. “Acknowledging and recognizing the enormous stress that their teams are under. Do not underestimate these professionals are stretched to their limits, whether it's obvious to the leaders of the organizations.”
Hospitals and health systems can help their staff by reducing some administrative burdens and streamlining workflows. McClafferty said they also need to do whatever they can to make sure that staffing is as robust as possible. “That’s just a huge stressor right now,” she said.
“I would pay serious attention to staffing and listen to what people are telling you they need,” McClafferty said.
Doctors in pediatrics and other healthcare workers have stayed later to ensure shifts are covered, but that comes with a cost, she said.
Pediatricians, along with many other healthcare workers, are increasingly concerned with their safety in hospitals. Those concerns were only magnified after a nurse and a social worker were shot and killed at a Dallas hospital last week.
McClafferty said those in pediatrics want to know, “Is my organization honestly looking out for me? What are they bringing to the table that I can safely and in a healthy way do this job?”
At a time when most health systems are aggressively seeking talent, McClafferty offered a practical perspective, beyond caring for the well-being of pediatricians: good people could opt to leave the organization.
“People are actively being recruited to other places,” she said. “People are figuring out how much more they have to give. They are looking at their options very seriously.”
Pediatricians need to be encouraged to say when they are overwhelmed and need a break. Historically, McClafferty said saying no has “historically been viewed very negatively.”
“There’s this stigma of expressing fatigue or expressing the desire to take care of yourself,” she said. “That’s a big part of the underlying meaning of this work. It’s to systematically educate and try to lift this stigma. The cost of moving down this path is extraordinarily high for the profession and the organization.”
McClafferty said progress is being made. There is growing awareness about the importance of physician well-being and mental health.
“Our intention wasn’t for this to be that everything is bad and there's nothing we can do,” she said. “Quite the opposite. A lot of people are invested in this.”
Healthcare leaders can’t underestimate the stress on their doctors in pediatrics.
“I think that leaders need to be very aware of this problem,” McClafferty said. “You don’t have to fix everything. You have to listen and be aware and engaged with your team. Pay attention to how your people are doing.”