“Heroes Work Here” is spelled out in large letters at the entrance to UConn Health in Farmington in recognition of the health care workers who are on the front line during the Covid-19 pandemic. Cloe Poisson / CT Mirror.org

“Healthcare heroes,” “We love our healthcare workers,” and large red hearts line the lawns throughout Connecticut. Now one year after the start of the COVID-19 pandemic, news coverage is filled with language like “back to normal” and “when this ends.” In the past 20 years, we have lived through SARS, H1N1, MERS, and Ebola. Experts like Dr. Anthony Fauci have been clear: there are likely more pandemics on the horizon.

Garrett Fontaine

Though these other diseases have not affected the public as much as COVID-19, all of them got the attention of healthcare workers who had to prepare for them. Having the appropriate healthcare workforce is an essential element of preparedness. The next epidemic, which threatens our nation’s newest physicians, has silently been brewing. The name of this epidemic is burnout.

Burnout is a constellation of symptoms including emotional exhaustion, cynicism, and detachment towards patients. The epidemic of burnout predates the COVID-19 pandemic. A 2014 study by the Mayo Clinic and Association of American Medical Colleges found that approximately half of medical students and residents in the U.S. were experiencing burnout.

This is especially concerning because burnout is costly. A 2019 analysis in the Annals of Internal Medicine estimated the economic impact of burnout to be $4.6 billion, attributable to turnover and reduction in number of hours they work. Beyond the financial impact, burnout reduces quality of care and patient safety. The prospect of half the medical students and residents across the country providing lower quality care is not something we can afford in normal times. This is doubly alarming considering the U.S. is already experiencing a growing physician shortage.

Simply put, these pre-pandemic figures illustrate that we have too few doctors and an alarming proportion of doctors in training are at risk of burnout. With a raging pandemic on our hands and relative certainty of more to come, we must address these issues.

There many factors that contribute to burnout. First, grading: studies show that schools with pass/fail grading have lower burnout rates. Second, access to mental health resources: few medical students who experience depression seek psychiatric treatment. Many factors prevent students from seeking help including include lack of time, lack of confidentiality, cost and fear of documentation on academic record. Third, student loan debt: the average graduating medical student has over $200,000 in medical school debt. These numbers do not account for interest accrual or costs for pre-medical education.

As physicians, we learn to diagnose, implement treatment, and monitor for resolution of the disease process. Why should our approach to burnout be any different? For the diagnostic step, it is important for programs to identify the extent of the problem. Programs should perform standardized assessment tools at standardized intervals. This step will also allow assessment of any intervention.

Now for the treatment. Established recommendations on addressing burnout in medical school include: arranging visits with mental health counselors for all entering students, teaching stress management, resilience, and mindfulness skills, subsidizing on-campus fitness centers, and funding student-run wellness activities. To alleviate the financial burden of medical training, legislators must take action to erase student loan debt for doctors or at the least reduce it to a level that achieves parity with other graduate level degrees. Legislators, medical schools, and residency programs must act rapidly if we want to assure we can meet the country’s physician need and be prepared to tackle whatever health crisis emerges next.

Garrett Fontaine is an Incoming Family Medicine Resident from Simsbury.

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