COVID-19 and clinician wellbeing: challenges and opportunities
Authors: Bryant Adibe
Journal: The Lancet Public Health (2021)

Around the world, prevalence of burnout among health-care workers has become an increasingly serious public health crisis, threatening quality of care and patient safety.1Eaton L Health care workforce burn-out.Bull World Health Organ. 2019; 97: 585-586Crossref PubMed Scopus (24) Google Scholar The COVID-19 pandemic provides an opportunity to redefine a collective approach to wellbeing in health care, including how organisations engage with the people and communities that anchor their work. In the past year, health systems have faced unprecedented challenges related to the global COVID-19 pandemic, necessitating extraordinary organisational agility. As the longevity of the pandemic set in, the initial adrenaline and enthusiasm towards addressing a new challenge turned into disillusionment as clinicians struggled with exhaustion, burnout, and depression.2American Academy of Family PhysiciansCOVID-19 is increasing physician burnout.https://www.aafp.org/journals/fpm/blogs/inpractice/entry/covid_burnout_survey.htmlDate: Sept 18, 2020Date accessed: November 12, 2020Google Scholar The COVID-19 pandemic has also generated an economic crisis—the worst the world has faced since the Great Depression.3Gopinath G The great lockdown: worst economic downturn since the Great Depression. IMF Blog, April 14, 2020https://blogs.imf.org/2020/04/14/the-great-lockdown-worst-economic-downturn-since-the-great-depressionDate accessed: November 12, 2020Google Scholar Families have struggled for bare necessities and food banks around the world have been met with record levels of need.4Win TL Global food banks struggle to aid pandemic's 'new poor' as donations slow. Thomas Reuters Foundation News, July 6, 2020https://news.trust.org/item/20200706113353-pqcflDate accessed: January 21, 2021Google Scholar There has been a widening of the wealth-inequality gap, with limitations in remote-working opportunities disproportionately impacting low-income workers, particularly in developing economies.5Cugat G Narita F How COVID-19 will increase inequality in emerging markets and developing economies. IMF Blog, Oct 29, 2020https://blogs.imf.org/2020/10/29/how-covid-19-will-increase-inequality-in-emerging-markets-and-developing-economiesDate accessed: January 21, 2021Google Scholar This past year has also proven to be a pivotal one in international discourse regarding social justice, equity, and racism, with the death of George Floyd triggering discussions and protests regarding police brutality, human rights, and injustice. In this context, it is crucial to acknowledge that hospitals and health systems do not exist as islands. They are interconnected with the social, economic, and political forces that shape their communities and the world around them. According to developmental psychologist Urie Bronfenbrenner, a proper understanding of human development is only possible by taking into account four interconnected, socially integrative layers, each of which exerts formative pressure on the next, like a series of widening concentric circles.6Salazar MK Beaton R Ecological model of occupational stress. Application to urban firefighters.AAOHN J. 2000; 48: 470-479PubMed Google Scholar His ecological systems model was later adapted to address factors that drive occupational stress within organisations. This model shows that health-care organisations are part of a matrix. The issues facing their communities—while seemingly external—are actually shaping the culture and experiences internally. Health systems have the opportunity to acknowledge and address challenging emerging societal issues, helping to sculpt the economic and social landscape of the future. To meet the many challenges of health care in the 21st century, however, these organisations must redefine not only their connection to their local communities but also their partnerships with each other. If there is any great lesson from the COVID-19 pandemic, it is the power of strategic partnerships. Health-care organisations and their leaders have been collaborating internationally in new ways—sharing data, best practices, and effective strategies. Nowhere is this need for partnerships more important than in addressing the challenge of clinician wellbeing. Although few data are available from low-income and middle-income countries, burnout and suicide among health-care workers is an increasing public health crisis in many countries, made worse by the pandemic.7Anderson P Physicians experience highest suicide rate of any profession. Medscape, May 29, 2019https://www.medscape.com/viewarticle/896257Date accessed: November 12, 2020Google Scholar, 8Rukundo GZ Byakwaga H Kinengyere A et al.Prevalence and factors associated with suicide among medical professionals in low/middle-income countries: a systematic review protocol.BMJ Open. 2019; 9e028884Crossref PubMed Scopus (5) Google Scholar, 9The LancetPhysician burnout: a global crisis.Lancet. 2019; 394: 93Summary Full Text Full Text PDF PubMed Scopus (92) Google Scholar Deep-rooted stigmas and cultural practices can discourage individuals from seeking help for mental health issues.10Office of the Surgeon General (US)Center for Mental Health Services (US)National Institute of Mental Health (US)Culture counts: the influence of culture and society on mental health.in: Mental health: culture, race, and ethnicity: a supplement to Mental health: a report of the Surgeon General. Substance Abuse and Mental Health Services Administration (US), Rockville, MD2001: 23-50Google Scholar Too often the wellbeing of health-care workers is dismissed as an inconsequential issue. However, wellbeing should be seen as a value, not an issue. It is a value that health-care organisations show in their daily work and in their commitments to ideals such as equity, respect, and kindness. As long as such topics are seen as cursory issues, organisations will seek to trivialise their importance, seeking temporary, placating solutions. Reframing wellbeing as a core value can inform the long-term vision for health systems, helping them to respond to emerging social challenges and guiding decision-making at key moments. Importantly, it can encourage health-care organisations to work together to address the burnout crisis among their workforces and the social issues faced by their communities, inspiring leaders to engage with one another and their communities in new, impactful ways and to sculpt a more equitable, responsible, and compassionate tomorrow. I declare no competing interests.