It’s no secret that burnout is a reality for many rural providers — and the COVID-19 pandemic has only added to the burden. Even before COVID-19 entered the scene, healthcare providers were experiencing a decline in their well-being “at epidemic levels,” says Scott Finkel, national accounts executive for CompHealth's permanent placement division. “In addition to alarming rates of anxiety, stress, and depression, they were committing suicide at levels that exceeded any other group in our nation.”
A couple of years before the pandemic began, 43.7% of physicians reported experiencing burnout. At the time, this was described as a “widespread” problem. But in a Medical Economics survey conducted in mid-2020, 71% of providers said yes when asked, “Do you feel burned out right now?” Additionally, 65% said the pandemic has made their burnout worse. And a full 73% said burnout has made them consider stepping away from practicing medicine. These results should grab the attention of every rural healthcare leader who is concerned about provider retention and well-being.
What burnout feels like
Dr. Dike Drummond, founder of The Happy MD, is a coach and consultant who focuses on physician burnout. He describes burnout as “a disorder of energy metabolism.” If a physician charted their energy levels on a graph, he says, burnout occurs when energy levels plummet and drop below zero. “In burnout, what happens is your energy level assumes a downward spiral, crashing towards the ground. You dropped below zero.”
One symptom of burnout is physical and emotional exhaustion. This can manifest as feeling tired and drained most of the time. Other physical effects can include feeling unwell, frequent headaches, back pain, muscle aches, and changes in appetite or sleep habits.
Another burnout symptom is often called “compassion fatigue.” This may appear as cynicism or sarcastic venting. “Providers are frustrated, bothered, and snarky about patients and their families,” Finkel says. “Some may feel they just need to vent to keep going.”
Finally, burned-out providers begin to feel a lack of efficacy — where providers could be saying things like, “What’s the use?’ or “I’m concerned that if things don’t change, I’m going to make a mistake, and someone is going to get hurt.”
This is truly an awful place to be. Dr. Drummond says some providers wake up thinking, “Maybe if I'm lucky, I'll get hit by a car on the way to work today and I won't have to see patients.” This is a huge red flag. If your inner voice is saying things like this, says Dr. Drummond, it’s time to step back, take some time off, and figure out how to mitigate the factors that are causing burnout. “Because you never do get hit by a car on the way to work. You still have a full slate of patients when you get in there.”
How rural healthcare organizations can address burnout
Healthcare leaders can take meaningful action to tackle provider burnout at rural hospitals, from very small things that make an impact for individuals to wide-sweeping initiatives that have the ability to impact health systems as a whole. Here are four ways healthcare leaders can address clinician burnout.
1. Ask providers what they are experiencing and what they need
“One of the most successful things we’ve seen a variety of facilities implement are different ways to collect feedback — whether it’s surveys, focus groups, or even one-on-one discussions,” Finkel says. “Talking with your people and getting their feedback is often the first step in implementing positive changes.”
2. Empower providers to take the lead
Many organizations have found success in establishing wellness committees led by providers. This gives providers the ability to come up with tools and resources to address specific wellness issues in the organization.
“Inside any organization of any size, you have a minority of the doctors, nurses, and other staff that say, ‘You know, we need to do something to have each other’s backs more effectively, and if we set up a committee or a structure to do that, I would be willing to play a role,’” Dr. Drummond says.
3. Establish systems that provide support
When rural healthcare organizations develop systems to address well-being, it signals to providers that their own wellness is important. “We’ve seen this done with facilities that have support lines, onsite mental health counseling, and employee groups dedicated to wellness,” Finkel says.
“Get a crisis hotline up and running so nobody falls by the wayside,” says Dr. Drummond. Just as important as implementing the hotline is promoting it. Dr. Drummond says the crisis phone number should be everywhere — fridge magnets, office flyers, bathroom posters — so it is easily accessible when needed.
4. Offer simple gestures
Little efforts can make a big difference.For example, creating a meditation room may give providers a quiet space to decompress. “Sometimes it is something as small as a note or another way of recognizing someone’s effort. One administrative group took time to write personal notes to their providers thanking them for their efforts,” Finkel says.
Healing the healers
Many factors contribute to provider burnout, which can make the issue seem complicated and insurmountable. But healthcare organizations can take tangible steps to address provider burnout at rural hospitals, making a meaningful difference in the lives of their clinicians.