Burnout and Commitment to Primary Care: Lessons From the Early Impacts of COVID-19 on the Workplace Stress of Primary Care Practice Teams

Erin L. Kelly; Amy Cunningham; Randa Sifri; Oriana Pando; Kelsey Smith; Christine Arenson

doi:10.1370/afm.2775

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RE: Burnout and Commitment to Primary Care: Lessons From the Early Impacts of COVID-19 on the Workplace Stress of Primary Care Practice Teams
Brij R Nayak and Lorraine S Wallace

Published on: 12 April 2022
RE: Burnout and Commitment to Primary Care: Lessons From the Early Impacts of COVID-19 on the Workplace Stress of Primary Care Practice Teams
Matthew J Dressel and Lorraine S Wallace

Published on: 11 April 2022
RE: More analysis not needed. Solutions/interventions are.
John Frey

Published on: 25 January 2022

Published on: (12 April 2022)
Page navigation anchor for RE: Burnout and Commitment to Primary Care: Lessons From the Early Impacts of COVID-19 on the Workplace Stress of Primary Care Practice Teams
RE: Burnout and Commitment to Primary Care: Lessons From the Early Impacts of COVID-19 on the Workplace Stress of Primary Care Practice Teams
Brij R Nayak, Undergraduate, The Ohio State University
Other Contributors:
Lorraine S Wallace, Associate Professor—College of Medicine
There is little doubt that the ongoing COVID-19 pandemic has negatively impacted stress and burnout levels among the healthcare workforce, including primary care practice teams. Even prior to the onset of the COVID-19 pandemic, burnout among primary care providers was a serious concern.1 Although COVID-19 initially caused a large amount of acute stress, swift practice changes and collaboration among team members contributed to increased camaraderie during the early stages of the pandemic. Unfortunately, as Dr. Kelly and colleagues discuss, the COVID-19 pandemic has now become a long-term stressor which could ultimately lead to widespread systemic primary care burnout.

As showcased in Dr. Kelly’s study, the onset of the COVID-19 pandemic resulted in swift changes in clinical care and altered our understanding as to how to best support the primary care workforce. As I continued to ponder your study findings, I wondered if differences in stress and burnout risk would emerge across factors such as geographical location, private or public practice settings and/or years of individual clinical experience? For instance, given that COVID-19 infection and vaccination rates varied substantially across rural versus urban areas in the US, can we assume that primary care practice team members experienced different levels of stress and burnout related to geographic location? Additionally, I am curious if the authors believe that there is a threshold of support in relation to stres...
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There is little doubt that the ongoing COVID-19 pandemic has negatively impacted stress and burnout levels among the healthcare workforce, including primary care practice teams. Even prior to the onset of the COVID-19 pandemic, burnout among primary care providers was a serious concern.1 Although COVID-19 initially caused a large amount of acute stress, swift practice changes and collaboration among team members contributed to increased camaraderie during the early stages of the pandemic. Unfortunately, as Dr. Kelly and colleagues discuss, the COVID-19 pandemic has now become a long-term stressor which could ultimately lead to widespread systemic primary care burnout.

As showcased in Dr. Kelly’s study, the onset of the COVID-19 pandemic resulted in swift changes in clinical care and altered our understanding as to how to best support the primary care workforce. As I continued to ponder your study findings, I wondered if differences in stress and burnout risk would emerge across factors such as geographical location, private or public practice settings and/or years of individual clinical experience? For instance, given that COVID-19 infection and vaccination rates varied substantially across rural versus urban areas in the US, can we assume that primary care practice team members experienced different levels of stress and burnout related to geographic location? Additionally, I am curious if the authors believe that there is a threshold of support in relation to stress management and burnout. Thank you for writing such an informative piece of great relevance to both present and future US primary care delivery.

Reference

1. Eden AR, Jabbarpour Y, Morgan ZJ, Dai M, Coffman M, Bazemore A. Gender differences in personal and organizational mechanisms to address burnout among family physicians. J Am Board Fam Med. 2020;33(3):446-451. 10.3122/jabfm.2020.03.190344
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Competing Interests: None declared.
Published on: (11 April 2022)
Page navigation anchor for RE: Burnout and Commitment to Primary Care: Lessons From the Early Impacts of COVID-19 on the Workplace Stress of Primary Care Practice Teams
RE: Burnout and Commitment to Primary Care: Lessons From the Early Impacts of COVID-19 on the Workplace Stress of Primary Care Practice Teams
Matthew J Dressel, Undergraduate, The Ohio State University
Other Contributors:
Lorraine S Wallace, Associate Professor—College of Medicine
While your study included a relatively small number of primary care professionals from a single northeastern health care system, your findings explicitly portray widespread COVID-19 pandemic challenges faced by this population. I read your study with great interest as I was aware of the widespread concern regarding systemic burnout among healthcare professionals even prior to the onset of the COVID-19 pandemic. Notably, an emerging literature details that anxiety, stress and burnout affect primary care professionals in not only the United States, but throughout the world.1-3

Given that data collection occurred over an eight-week time period at the onset of the COVID-19 pandemic (May-July 2020), I am interested in knowing whether your team intends to conduct a follow-up study? Although the qualitative study design did not allow for comparative analyses, I am curious as to whether burnout and commitment to primary care vary across professional roles (e.g., physician versus medical assistant/nurse). Recognizing the sheer length of the COVID-19 pandemic, I am interested in knowing the long-term effects on primary care providers’ anxiety, stress and burnout as a function of professional role and supports in place. As many early COVID-19 safety protocols (e.g., masking) remain in place in clinical settings, I feel that longitudinal studies are warranted to fully understand how primary care teams have continued to adapt and respond to the ongoing pandemic.

Referenc...
Show More

While your study included a relatively small number of primary care professionals from a single northeastern health care system, your findings explicitly portray widespread COVID-19 pandemic challenges faced by this population. I read your study with great interest as I was aware of the widespread concern regarding systemic burnout among healthcare professionals even prior to the onset of the COVID-19 pandemic. Notably, an emerging literature details that anxiety, stress and burnout affect primary care professionals in not only the United States, but throughout the world.1-3

Given that data collection occurred over an eight-week time period at the onset of the COVID-19 pandemic (May-July 2020), I am interested in knowing whether your team intends to conduct a follow-up study? Although the qualitative study design did not allow for comparative analyses, I am curious as to whether burnout and commitment to primary care vary across professional roles (e.g., physician versus medical assistant/nurse). Recognizing the sheer length of the COVID-19 pandemic, I am interested in knowing the long-term effects on primary care providers’ anxiety, stress and burnout as a function of professional role and supports in place. As many early COVID-19 safety protocols (e.g., masking) remain in place in clinical settings, I feel that longitudinal studies are warranted to fully understand how primary care teams have continued to adapt and respond to the ongoing pandemic.

References
1. Norful AA, He Y, Rosenfeld A, Abraham CM, Chang B. Mitigating primary care provider burnout with interdisciplinary dyads and shared care delivery. J Eval Clin Pract. 2021; online ahead of print. 10.1111/jep.13642

2. Dominic C, Gopal DP, Sidhu A. 'It's like juggling fire daily': Well-being, workload and burnout in the British NHS—A survey of 721 physicians. Work. 2021;70(2):395-403. 10.3233/WOR-205337

3. Galanis P, Vraka I, Fragkou D, Bilali A, Kaitelidou D. Nurses' burnout and associated risk factors during the COVID-19 pandemic: A systematic review and meta-analysis. J Adv Nurs. 2021;77(8):3286-3302. 10.1111/jan.14839
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Competing Interests: None declared.
Published on: (25 January 2022)
Page navigation anchor for RE: More analysis not needed. Solutions/interventions are.
RE: More analysis not needed. Solutions/interventions are.
John Frey, Family Physician, The University of Wisconsin Department of Family Medicine and Community Health
In the past two years, the literature - both medical and popular press - repeatedly describes the terrible state of primary care clinicians, staff and practices. Parsing that state of affairs into more and more details is not really going to be helpful. Bold steps must be taken to change the control, support and communication among clinicians and staff and support the autonomy necessary to make changes in their practices. Hospital and system owned practices need to feel that they have the ability to redesign their work based on their resources, staff and community, not be protocol driven from some office in a 10 story building. Clinicians are better at holding Themselves accountable to their own goals and processes than following checklist medicine, staff being moved without discussion and other examples of top down management. Primary care clinicians have to be able to individualize care not just for each patient but for an entire practice. Edwards and colleagues (Health Aff (Millwood). 2021 Jun;40(6):928-936.. Cultural And Structural Features Of Zero-Burnout Primary Care Practices) showed the way to reform through their analysis of zero burnout practices. Health policy researchers should stop focusing on the pathology of what is falling apart and engage in innovations that might work. Corporate health care will push back hard on that, but we don't' need more studies about why clinicians are in distress, we need hopeful, and radical, solutions. We already kno...
Show More

In the past two years, the literature - both medical and popular press - repeatedly describes the terrible state of primary care clinicians, staff and practices. Parsing that state of affairs into more and more details is not really going to be helpful. Bold steps must be taken to change the control, support and communication among clinicians and staff and support the autonomy necessary to make changes in their practices. Hospital and system owned practices need to feel that they have the ability to redesign their work based on their resources, staff and community, not be protocol driven from some office in a 10 story building. Clinicians are better at holding Themselves accountable to their own goals and processes than following checklist medicine, staff being moved without discussion and other examples of top down management. Primary care clinicians have to be able to individualize care not just for each patient but for an entire practice. Edwards and colleagues (Health Aff (Millwood). 2021 Jun;40(6):928-936.. Cultural And Structural Features Of Zero-Burnout Primary Care Practices) showed the way to reform through their analysis of zero burnout practices. Health policy researchers should stop focusing on the pathology of what is falling apart and engage in innovations that might work. Corporate health care will push back hard on that, but we don't' need more studies about why clinicians are in distress, we need hopeful, and radical, solutions. We already know what they are.
Show Less

Competing Interests: None declared.