UniHealth Foundation funds a clinical trial to study solutions that could reverberate nationally.
By Janice O’Leary
A crisis of emotional distress faces physicians across the nation, particularly in the wake of COVID-19. Even before the pandemic stretched the workload and resiliency of health care workers, job attrition and burnout rates among American doctors were skyrocketing, resulting in early retirement and, in the extreme, a tragically notable uptick in physician suicide. But there’s little question that the pandemic pushed burnout to the limit.
A 2022 survey done by medical staffing organization CHG Healthcare found that 43 percent of physicians changed jobs and 8 percent retired during the pandemic; 3 percent left medicine to pursue non-clinical careers. “Unsustainable levels of burnout and stress” was the top reason cited for how the pandemic affected doctors’ careers.
“Some national surveys have said as many as 60 percent of the physicians who retired this year did it earlier than planned, because of COVID-19,” says Jennifer Vanore, President and Chief Operating Officer at UniHealth Foundation, which has just awarded $2 million to Keck Medicine to study solutions to physician burnout.
Burnout among clinicians has been “a major topic of concern around the nation,” says Dr. John Brodhead, Associate Chief Medical Officer for Medical Services at Keck Hospitals, “even before the great resignation, because more than 40 percent of the doctors in the US are over age 50.” The state of California foresees a major shortfall of physicians by 2030, according to the 2019 California Future Healthcare Workforce Commission Report. Dr. Brodhead says he and his team realized “we better keep the doctors we already have and address what their issues are.”
Together with Chief Mental Health and Wellness Officer Dr. Steven Siegel, and in cooperation with USC’s Care for the Caregivers program, Dr. Brodhead has been part of the working group that received the $2 million grant from UniHealth—the largest grant the foundation has given USC, but also the largest grant the organization has ever awarded. It will fund a randomized clinical trial that will explore several approaches to improve the mental health and job satisfaction of clinicians.
“Mental health has risen significantly in the grant requests we’re getting,” says Vanore. “In 2015, it was just a handful. Now the majority have a mental health component.”
The concern about physician burnout is twofold, says Dr. Siegel. “There’s a rich literature and acknowledgement that physicians who are burned out make more mistakes, so it was initially about patient safety and building a better, safer health system.”
But during the pandemic, “the lens changed,” Dr. Siegel says. Reducing burnout “stopped being a tool only for patient safety and became an end unto itself, to take care of physician wellness. Having unhappy, overworked people is just bad.”
“With more and more regulatory and administrative burdens, it feels like the system of healthcare continues to ask more of the people who work in it, while making work harder for them. It takes a toll,” Siegel says. “People want to experience the joy of their trade and also want to feel valued and appreciated.”
“Layered on top of all that was the pandemic,” he adds. That made it very hard to live for everyone, and this segment had to just keep going. There was no mechanism to allow them to slow down. In fact, they had to speed up and care for even more people.”
When COVID-19 struck, “we pivoted from things we were planning to do” in this arena, says Dr. Brodhead. They designed interventions to help the physicians in the moment, through the Care for the Caregiver program, which is part of a national effort. But Keck Medicine took it a step further, and people noticed. The LA Business Journal awarded those efforts in 2020, naming Keck’s Care for the Caregiver example as the Educational Program of the Year.
Building on some of what they learned with those interventions and taking them further, this new study will address three major elements of physician burnout and demoralization: emotional stress, skill mastery, and workflow. Four hundred participants will participate in the trial, with 100 subjects in each arm, including one control group. “This grant is a way to add rigor to those interventions and be sure what we do is data-driven,” says Dr. Siegel.
“We’re so grateful,” says Dr. Brodhead, “to have the UniHealth Foundation validate our concerns and elevate the work.”
Through sessions with a licensed therapist over 12 weeks, one group will learn cognitive behavioral therapy to regulate emotions by reducing anxiety from chronic stress, depression, and demoralization as well as acceptance commitment therapy, which helps “you learn to live in reality without changing anything,” explains Dr. Siegel.
A second group will receive custom training using the electronic medical record (EMR) to become more effective and “really understand how it can be used to their benefit,” says Dr. Siegel. The third group will focus on improving workflow development. “They’ll get to work with the groups who design workflows and give feedback, such as why doing things a certain way might be stressful and what can be done to make them more efficient.
Dr. Siegel and his team expect the interventions will reduce depression and anxiety while increasing measures of resiliency. They also anticipate seeing a higher percentage of clinical notes completed on time, while reducing the time spent using the EMR and the need to later revise clinical notes. Ideally, they’ll see an increase perception of Keck Medicine as a positive work environment and a reduction in clinician departures.
As part of the department of Psychiatry and Behavorial Sciences at Keck, Dr. Siegel oversees wellness not just for the patient population at LAC+USC Hospital, but also across all academic departments and hospitals, USC students, faculty, and health care workers, which includes some 2,000 physicians and 7,000 other health-related employees. The study will be a cross-campus effort, including researchers from KSOM, the health system, Dornsife, and Viterbi.
The non-profit UniHealth Foundation typically supports initiatives in Southern California in three areas: population and community health, health care workforce, and health care delivery systems. About the grant, Vanore says, “There’s a reverberating effect of that kind of investment. This will be a pilot not just for USC physicians, but potentially for the next generation of doctors. While our mission is California-focused, the impact here could be much bigger.
California is historically ahead of the curve in the industry in research, practice, and policy. Its influence is real, and it’s proven.”