A reflection on burnout in health care – and a reminder that what you do matters

Aspiring to be a medical provider has always been considered a lofty goal held dear to us in our formative years. Attaining this goal was not for the weak hearted; long hours of studying, enduring the stress of medical school, Step 1 and 2, match day, residency and fellowship, board tests, MOC, the list goes on and on. But the bright light of becoming a practicing physician/health care provider drew us forward.

Practicing medicine today may not match the expectations of our youth. The reality of long hours, managing practices and reimbursement, and coping with the fragility of our patients takes a cumulative toll over time. We were trained on how to deliver the best care possible; we never trained on how to deal with the other stressors of practicing medicine. Provider burnout has been a very real, poorly addressed problem for at least a decade. Symptoms of burnout in health care providers have been increasing: emotional exhaustion, compassion fatigue, decreased sense of accomplishment and job satisfaction. 

Pediatricians, though not immune to these stressors, seemed to fare better than our colleagues. Approximately 35% of pediatricians experience symptoms of burnout, compared to 50% among all physicians. Maybe our expectations were different, or maybe we were able to see hope in the smiles of our patients. During my career as a neonatologist, on the days that I carried the highest stress, I would refocus and center myself by rounding on patients. Patient care was truly my saving grace. 

However, as we clumsily navigated burnout, 2020 threw us another curve ball: Covid-19. Although we cannot blame the pandemic for the underpinning of dissatisfaction in medicine, we certainly saw an escalation of symptoms and for the first time we saw the public’s trust in pediatricians and pediatric providers fade. As we nobly educated parents on the benefits of adhering to the guidelines put in place to minimize the pandemic’s reach, we were met with skepticism, anger, and even threats. Though a political schism has been growing in our country for the last few years, we were not prepared for it to reach into our profession with an erosion in trust and faith. It rocked us to our core. 

One of our local pediatricians shared these examples from his practice: 
After asking permission to share what I have learned about the COVID vaccine, and after two lines about the vaccine, dad stated “you better stop there or we’re finding a new doctor”. When visiting with a mom about the flu vaccine she replied, “we already took your COVID vaccine, we’re not doing anything else”. The worst comment probably was a father that stated, “he would rather have his whole family die than shoot that junk into their arms”. He went on to describe how we have all listened to the lies of the media, and we needed to learn about the real sources of information out there

These are interactions that were, until now, rare. Now they are now an anticipated part of a pediatric health care provider’s day.

There is no doubt that fear and exhaustion are feeding the paranoia associated with these outbursts. As pediatricians we built a career on being calm, reasonable and welcoming. These traits will continue to serve us well, if we can find the inner strength to battle the current onslaught. We must find a way to take care of ourselves first. As it has been said so many times, having an empty tank leaves you no ability to be there for others. Historically, health care providers have been terrible at self-help: just like studying for Step 1 in medical school, we push our insecurities and needs aside and buckled down to the overwhelming task at hand. However, if we have learned anything from this pandemic it is that we need to treat ourselves better, in order to treat our patients. 

I have the honor of serving as the President of the WCAAP. One of the reasons I find involvement with the WCAAP so rewarding is that I am part of a team that is truly dedicated to creating positive change in our state: change for the kids and families of Washington—and for providers as well. As a team we work hard to combat misinformation on vaccinations and are working closely with our school leaders to grow confidence and compliance in the Covid-19 vaccine. We will not let the suffering endured by our patients and their families during the pandemic go unchecked. Separately and together the social determinants of health and the child and adolescent behavioral health crisis must be addressed in a meaningful and measurable way. And finally, we are committed to supporting all pediatric providers as we navigate this new reality. Being a part of this team is part of my healing process, my rejuvenation.

I will not pretend to have the answers to all these issues. In fact, I am probably one of the worst when it comes to self-help. But this is my truth: Since completing my fellowship in 1992 and entering practice, I have seen many changes in medicine and in the practice of medicine. Most of the changes were valuable, but none came without a price. I have also been challenged in ways that I could never have imagined. I have struggled to be there for my family while pursuing a medical career. And I had to navigate the fact that as I aged, my ability to manage 24 hours shifts in a busy level 4 NICU waned. But, in the face of all this turmoil, what I actually remember is the dad who gifted me a Mont Blanc pen to sign the discharge order (back in the day when we actually signed on paper) for his 24-week premature son. I remember calling mom into the hospital at 3 am because I did not think that Evan, her 23-week preterm son, would make it through the night. His high school graduation announcement sits framed on my desk. Despite medicine being ever changing, I would do it again in a heartbeat. We are part of a noble profession and we do make a difference. Never forget that.

Thank you for all you do for Washington’s children, adolescents and families.

Michael Barsotti, MD, FAAP
President, Washington Chapter of the American Academy of Pediatrics