Physicians have been lauded – rightfully so – since the very beginning of this global pandemic. Working on the frontlines and putting themselves and their families at risk in order to serve others, it is difficult to entirely comprehend the sacrifices made by our nation’s health care workers. It is in some ways only now, a full year after this situation first unfolded, that we are truly able to appreciate and quantify the burden borne by health care professionals (and more will certainly come to light in the future). Both in terms of the impacts on physicians’ employment situations and the impacts on their health (both mental and physical), the COVID-19 pandemic has left a permanent mark on physicians.
At a time when physicians and health care workers have been needed the most, it is a bit counterintuitive to realize that they are being greatly undervalued. Recent studies indicate that nearly half of practicing physicians in the US have either lost their jobs, experienced a reduction in income, or were furloughed. Approximately 16,000 health care practices around the country have closed as a direct result of the pandemic, leaving thousands of health care providers and support staff without employment. Focusing only on physicians who were able to keep their jobs, 72% of them have had a reduction income. This is the result of the drastic decrease in appointments and procedures (more than 40% of adults in the US have skipped medical care due to COVID) as well as the movement to telemedicine. While no one is arguing that physicians who have reduced their income are now in desperate or destitute situations, it is important to remember the circumstances – they are in the most dangerous situation of any professional. Whether they are a hospitalist working the COVID unit or a specialized surgeon who does not necessarily face COVID head on, the fact is across the board they come in contact with so many people each day, making their job inherently risky. For this reason, the loss of employment or reduction in income adds insult to injury – we expect physicians to do the most and risk the most, but we do not recognize or reward that in any way.
In terms of the dangers and sacrifices faced by physicians, there are many factors to be considered that are not entirely obvious. To begin with, physicians (and all levels of health care workers) are of course in the most dangerous situation of all, directly caring for those who are COVID positive. Regardless of PPE and appropriate precautionary measures in place, there is still a great risk in doing this work. Importantly, this risk does not only apply to the physician, but also to the physician’s entire family and/or whomever she shares a home with. Countless physicians and health care workers have knowingly and willingly faced this dilemma with such strength of character, understanding that they are in many ways putting their oath as a doctor ahead of their own personal well-being (and that of their loved ones). Sadly, health care workers have certainly paid the price for this risk. As of December 2020, studies indicate that roughly 3,000 health care professionals have died from COVID (with most agreeing the figure is actually much higher). Among those who have not been afflicted by the disease itself, the majority of health care workers are facing significant effects nonetheless. Exhaustion and burnout are at an all-time high – since the start of the pandemic, the number of physicians who report feelings of burnout has increased almost 20%, and 37% of physicians reported that they would like to retire in the next year. These numbers certainly indicate that the pressures we have placed on health care providers are simply not sustainable under our current system. The effects on the mental health of health care workers should not be overlooked or diminished. For those working in COVID units, most have witnessed events that are deeply troubling, and not just on a few occasions, but rather every single day. Health care workers are trained, and in some ways accustomed to, witnessing death, but one thing is clear – none of them were prepared to witness the type of death that COVID created. Aside from the tragic suffering that those dying from COVID endure is the almost unbearable sadness of those people dying alone. With strict quarantine measures in place preventing the presence of loved ones, even at the very end, it has been all-too common for health care workers to step in, filling the role of “loved one” to someone who is actually a stranger. Often physicians and nurses will gather together in a room during a patient’s final moments, holding her hand through the barrier of PPE, just to be sure that person does not die completely alone. It is also common for health care workers to use their personal cell phones to Facetime with family members so they can see their loved one before they die. No one can be prepared for this level of sorrow in their workplace on a daily basis, and it has led to unprecedented levels of physician depression and suicide. Time will only tell us more about the lasting effects of all of this.
In a nation where a physician shortage was already the reality, it is daunting to think where the future of health care will lead. Will systemic changes take into account physician insights, and create a national health care system that puts priority on providers and patients, rather than policymakers and executives? One can only hope that with the benefit of hindsight, perhaps real change can be made to adequately care for our population while simultaneously taking care of our providers.