Early on in the COVID-19 pandemic, videos pinged around the internet of people going outdoors at 7 p.m. each day to applaud health care workers as an expression of gratitude.
Gestures of appreciation mean a lot to health care workers, says Carriedelle Fusco, nurse practitioner with Mountain Area Health and Education Center Family Health Centers. “The gratitude that I have felt has allowed me to keep doing the work I’ve been doing,” she says.
Yet gratitude alone isn’t enough for health care workers to keep their tanks full, so to speak. They also need support for psychological burdens they continue to experience two years into a pandemic. A meta-analysis of 65 studies involving nearly 100,000 health care workers, published in the journal PLOS One in March 2021, found a high prevalence of anxiety, depression and post-traumatic stress disorder among providers.
“I want the people in health care to know we do hard work and that hard work can be hard on our mental health,” says Fusco. “Asking for help and getting some help is extremely important. And it is the right thing to do.”
‘A black mark’
Seeking mental health support can be stigmatized in the culture at large. But for health care providers, the stigma associated with experiencing a mood disorder or feeling overwhelmed can be even more pronounced.
“There’s a lot of stigma for physicians and residents seeking support for mental health counseling or therapy,” says Western Carolina Medical Society director of development Amy Barcomb. “Particularly for the residents, they are concerned they will get reported [for experiencing mental health issues], even if it’s not in any way affecting the level of care that they’re giving their patients. They worry that it’ll be a black mark on their record.”
The fear that acknowledging mental suffering could have repercussions for their career may keep health care providers from seeking professional care for treatable conditions like depression and anxiety. This has been true even before the pandemic: In a 2015 study published in the journal Academic Medicine, only one-third of medical students who described themselves as burned out had sought mental health services in the last 12 months.
That study also found that students who sought mental health support “were twice as likely to report having observed supervisors negatively judge students who sought care” and “more likely to have observed peers reveal a student’s emotional/mental health problem to others.”
Keeping abreast of at-times rapidly changing COVID-19 information, as well as navigating misinformation among patients, has been “very challenging” for health care providers, says Dr. Brian Asbill, a cardiologist with Mission Health.
“Our health care providers are just like the rest of us,” he explains. “We’re feeling the same fear, uncertainty and stress that the patients are feeling. … We’re stretched thin, and compounded with that is this sense that we are supposed to be the ones with the answers.”
Two years into the pandemic, with so many health care workers struggling, more resources are available for those who are suffering.
The Western Carolina Medical Society has been addressing mental well-being among health care providers since 2015, when the professional organization debuted a Healthy Healer Program “in response to what we were hearing from members who reported feeling burned out,” says Barcomb.
Burnout is defined by the World Health Organization as “chronic workplace stress that has not been successfully managed.” The definition explains, “It is characterized by three dimensions: 1) feelings of energy depletion and exhaustion; 2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job, and 3) a sense of ineffectiveness and lack of accomplishment.”
Prior to COVID, the Western Carolina Medical Society’s program held one or two burnout prevention retreats each year for members and their significant others. The society also contracts with mental health care providers who offer a 15% discount to members.
The pandemic led the organization to increase its resources. In July 2020, the nonprofit N.C. Health Care Foundation, an affiliate of the N.C. Health Care Association, awarded a COVID-19 Fill the Gap Response Fund grant of $24,000 to the society to provide free coaching and therapy to its members. (AdventHealth and Mission Health/HCA provided funding to the Healthy Healer Program for 2021; AdventHealth and MAHEC are currently underwriting these services.) Barcomb says “an uptick” in requests for these free services started in 2021 and has remained consistent.
“We contract with five therapists and two coaches, and it’s completely confidential,” explains Barcomb. The therapist or coach invoices the Western Carolina Medical Society directly in order to preserve anonymity for the patient, she says. (Barcomb says there are currently open spots available for both.)
In mid-March, Dr. Robyn Tiger, founder of the physician wellness program StressFreeMD, began to provide group coaching for residents and for women in the Western Carolina Medical Society. For one recent coaching session, she says 14 doctors registered and 12 attended. And another group coaching session for physician assistants will take place in April.
The Western Carolina Medical Society also hosts “affinity groups,” which are gatherings for members of similar backgrounds. One affinity group is for Black providers, one is for women in medicine, and another is for early-career physicians and physician assistants. Throughout the pandemic, these affinity groups have continued to meet online and inperson, when it was safe to do so, in order to validate each other’s experiences and provide support, says Barcomb.
‘Best version of you’
Asbill, the cardiologist, who is also an expert in lifestyle medicine, and Tiger are speaking to local health care providers next month. The duo are teaching a workshop called “Self-Care for Healthcare: A Lifestyle Medicine Workshop” at MAHEC on Saturday, April 30.
Through education about the principles of lifestyle medicine, which includes learning coping mechanisms for stress, improving sleep health and fostering social connectedness, Tiger and Asbill hope to teach health care providers practices to foster positive mental health for themselves.
Burnout can lead to a lack of self-worth as well as cynicism about the future, explains Tiger. “I’ve heard someone say that [doctors are] glorified entry clerks for insurance companies — which speaks to the cynicism,” says Asbill. There are aspects of working in the medical field that require broader structural change to address provider burnout, but experts like Asbill and Tiger focus on what providers can change in their own lives.
Tiger says she coaches health care providers on being the healthiest version of themselves at all times, which includes managing stress and eating healthfully. ‘“How can you walk into that 12-hour shift being the best version of you?” she asks.
The “Self-Care for Healthcare: A Lifestyle Medicine Workshop” workshop is intended for physicians, nurse practitioners, physician assistants, medical students and residents. Participants will receive continuing education credits through MAHEC.
“We would love for as many local health care professionals as possible to attend and learn about how they can care for themselves,” Tiger says.