Caring for healthcare workers

Traditionally, medical professionals have approached their jobs with a great deal of pride and passion, and in turn received society’s gratitude for improving the health and wellness of communities. Yet the pandemic challenged those notions. In many jurisdictions, including my home country, Canada, medical professionals are under immense stress as the pandemic disrupts their ways of working, limits accessibility to their patients, and has made them the targets for those against government public health measures.

Healthcare leaders are aware that action is needed. A recent KPMG International survey of healthcare CEOs in eight jurisdictions found that supporting workforce wellness is among their top concerns. It would seem that these leaders have come to the realization that meeting the challenges of COVID-19, addressing the elective care backlog, and making healthcare resilient to future shocks cannot be done with exhausted, demoralized staff. Given the global interest in this topic, I’d like to highlight the work the Canadian Medical Association (CMA) is doing in the area of physician wellness and offer practical advice to associations, organizations or authorities looking to address this difficult issue.

Well before the pandemic emerged in early 2020, the CMA had made physician wellness a flagship issue, believing that supporting physician health and wellness means addressing the physical, mental, and social factors that can help prevent illness. “Excellent patient care needs health providers who are working at their best, which means they are supported to work in safe and health-promoting environments. Put simply, we need a vibrant and healthy workforce to support a strong and healthy community,” says Dr. Caroline Gérin-Lajoie, psychiatrist and Executive Vice President, Physician Wellness and Medical Culture for the Canadian Medical Association.

In 2018, the CMA launched its inaugural Physician Health Survey to recognize that physician health and wellness was an important priority, to respond to growing concern within the medical profession, and to address a critical knowledge gap in Canadian data on key indicators of physician health. While results of the next survey will be released in spring 2022, the 2018 study revealed that female physicians, residents (doctors-in-training) and early career physicians were at the highest risk for mental illness.¹⁰ A further sub-analysis also found that occupational predictors (career satisfaction, work-life integration and presenteeism) were stronger predictors of psychological variables than behavioral factors (exercise, nutrition).¹¹

In the first waves of the pandemic, frontline healthcare workers were experiencing emotional and moral distress from witnessing so many deaths, being unable to provide effective treatments, and having to comfort people who were dying without the presence of loved ones. And in the flurry of activity mid-pandemic, many healthcare workers experienced the additional distress of being redeployed to unfamiliar teams and having to acquire new skills with little support.¹¹  In response to these challenges, the CMA is providing practical support to all physicians and medical learners through:

• The Physician Wellness Hub¹², containing more than 400 resources for practitioners, leaders and educators, including articles, how-to guides, toolkits, videos, podcasts, and webinars on 27 topics such as burnout, resilience, and family matters. To-date, the CMA says user feedback on the hub has been overwhelmingly positive.
• The Wellness Connection¹³, a virtual safe space for physicians and medical learners to gather and discuss shared experiences, get support, seek advice and help each other. Since July 2020, almost 3,000 people have registered for these virtual peer support sessions.
• The Wellness Support Line¹⁴ providing confidential, 24/7 access to counselling and psychological services to provinces that did not already have a similar service. In its first year in operation during the pandemic, almost 500 physicians, medical learners, and their families accessed this service.
• The Pandemic Wellness Toolkit¹⁵ which includes a self-assessment tool and evidence-based wellness supports to encourage physicians to check their emotional and physical health and access the appropriate resources.
• The Sound Mind Podcast series offers conversations about physician wellness and medical culture.¹⁶ In 2021, these podcasts were downloaded more than 5,000 times.

But singular tactics to support physician wellness will not be enough to make a difference to the system structures and culture that drive stress and burnout in healthcare workers. In May 2021, the CMA launched Impact 2040,¹⁷ an ambitious 20-year plan that calls on physicians, medical learners, other health providers, patients, and policymakers to co-create a better future of health. A key pillar of this strategy is supporting the healthcare workforce, through which the CMA aims to build a new medical culture focused on physical and mental wellness and embracing equity and diversity.¹⁸ “A key strength of Impact 2040 is that it sees physical, psychological and cultural safety as equal dimensions of overall health. Each dimension requires clear language and criteria, standards, accountability, and research at the national level,” says Dr. Gérin-Lajoie.

With regard to the equity and diversity aspect of Impact 2040, the organization recognizes that creating a more inclusive culture contributes to fostering improved wellness. “We need to acknowledge the unique dynamics of learners and physicians from diverse cultural backgrounds who suffer from harassment. This takes extra cognitive effort to scan their environments for “safety”. They also feel they have to perform at an even higher level to prove themselves,” says Dr. Gérin-Lajoie.

The CMA wants physicians and those in training to thrive in learning and practice environments that are physically, psychologically and culturally safe, ensuring they have access to resources and supports to promote and maintain their health and wellness. A critical part of this ambition, the CMA realizes, is that physicians must be able to seek help without fear of reprisal. With this strategy in place, the CMA is now acting on it to drive change.

Armed with evidence on the impact of healthcare worker wellness upon patient outcomes, and in the face of workforce shortages, and attempting to keep up with increased demand, the time is now for healthcare systems and organizations around the world to act on this issue and put concrete plans in place to care for healthcare workers.

While the approach is Canadian-inspired, I think these lessons are universal – so here I offer some practical advice based on my observations and learning: