There have been several recent studies showing the toll of the Covid-19 pandemic on the well-being of specialists in different healthcare sectors [1]. That it has caused a prolonged increase in workload and stress is hardly surprising [2], but in Europe, to date, there has been little action taken to improve the situation, either at the national or local level. Allain et al. [3] pointed out the high prevalence of job strain among emergency physicians and Cottey et al [4], in a recent survey, identified a clear need for well-being interventions for emergency medicine (EM) physicians. Yet, the chronic problems faced by EM specialists, such as understaffing, limited resources, overcrowding and lack of recognition of the speciality, have been greatly exacerbated by the pandemic [5].
The study by Petrino et al. [6] published in this issue reporting the results of a survey into burnout among EM specialists highlights some of the alarming results of the previous inaction. They found that burnout was reported by 62% of the responders with at least one symptom of the syndrome, and by 31.2% with two. This level means that these healthcare workers deserve professional clinical evaluation and support. However, the survey showed that only 41.4% of responders reported having access to psychological support, either face to face or at a distance.
Worrying, too, is the finding that burnout affects younger EM specialists and trainees more highly than those who are older and more experienced. Negative experiences during training can lead to burnout and depression later in careers. And yet these are the EM professionals of tomorrow – if they stay in the field. Responders in the burnout group were far more likely to report that they were thinking of leaving their workplaces than were those who had no burnout. And, of course, the understaffing this may provoke, if it happens, will only make matters worse.
Burnout in healthcare professionals can lead to alcohol [7,8] and drug abuse, and even suicide [9]. Post-traumatic stress disorder is another common manifestation of burnout [10], and this can have devastating long-term consequences for the individual. While the negative effect of burnout on healthcare professionals is damaging to their wellbeing, being cared for by an overworked, stressed EM worker has a negative effect on patients too. Depersonalisation, one of three major indicators of burnout syndrome, manifests itself in a distant or indifferent attitude to work. This in turn may lead to cynical or callous behaviour towards patients and their families, as well as reducing productivity and efficiency. Burnout among healthcare professionals can also lead to a lower quality of care, an increase in medical errors, and even higher patient mortality rates [11].
Although they are disturbing, none of the findings of this survey was remotely surprising to us. EM specialists have been first-line responders during the pandemic, providing triage of patients in extremely difficult and pressurised circumstances where, additionally, the spread of infection has to be prevented. The need to wear personal protective equipment and the resulting fear of being infected themselves has been a supplementary burden that may still be insufficiently recognised.
Healthcare authorities quite rightly put patient satisfaction and wellbeing at the top of their priority list. Yet the overwhelming evidence is that medical professionals have unmet needs too and that these are growing exponentially. An important social determinant of health is the exposure – or the lack of it – to stressful living conditions. It would be difficult to find a group of people who were more subjected to stress during the pandemic than were EM specialists.
At the time of writing, we still have no idea whether we are seeing the beginning of the end of the pandemic, or just a temporary lull. But whatever happens next, one thing is quite clear: EM specialists have shouldered a particularly heavy burden and are suffering as a result. Urgent measures to reduce burnout and, therefore, to encourage those thinking of leaving the profession to reconsider are needed. Many interventions have been shown to be effective in decreasing burnout, and we were disappointed to see how few appear to be being implemented at present. The pandemic has shown how essential they are [12]. Let’s use this moment of relative calm to introduce them so that we can be ready next time.
Acknowledgements
Conflicts of interest
There are no conflicts of interest.
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