Background: The HOMERuN (HOspital MEdicine Reengineering Network) Provider Wellness Workgroup, a national collaboration of academic hospitalist institutions, has been studying the landscape of hospitalist wellness during the COVID-19 pandemic. Burnout among hospital medicine clinicians during the peak of the COVID-19 pandemic has been well-described. As we enter a different phase of the pandemic, our workgroup sought to understand COVID-19 long-lasting effects on clinician well-being, the creation of institutional wellness resources, and hospitalist career prioritization.
Methods: Our workgroup conducted four synchronous virtual focus groups in October 2021. Focus groups included 16 total participants from 11 geographically diverse institutions. Focus group sessions were recorded, transcribed, and analyzed to identify themes related to the impact of COVID-19 on staffing and work burden, institutional support for wellness, effect on how hospitalists envision their careers, and impact on workplace attrition.
Results: Four interrelated themes about the impact of COVID-19 on hospitalists emerged: (1) Work burden and clinician burnout; (2) Patient mistrust and challenging interactions; (3) Moral Injury; and (4) Career Prioritization. All participants reported consistently higher patient census, up to 25% higher compared to before the pandemic. They noted less staffing and ancillary support during the pandemic’s peak, leading to increased fatigue and burnout. One participant remarked, “The problem isn’t COVID, it’s everything else.” All four groups perceived increased hostility toward the medical community and intensified patient distrust, resulting in more challenging patient interactions overall. Both of these themes also contributed to the third identified theme of moral injury. One participant remarked “COVID [is] the 9/11 of hospital medicine.” Participants agreed that clinicians have not had enough time or support to fully grapple with the psychological impact of the pandemic. Participants reported that although there has been increased respect and visibility for hospital medicine at their institutions, the support hospitalists received during the pandemic’s peak has waned with time, impacting their sense of value. Lastly, nearly all participants stated the pandemic’s toll has led their hospitalist colleagues to re-prioritize career aspirations, with many women in particular choosing to prioritize family over work. Others have been reluctant to take on academic or leadership roles due to the demands on their personal time.
Conclusions: Thematic analysis of our focus groups suggest that the COVID-19 pandemic still negatively affects the well-being of hospitalists. Hospitalists continue to grapple with work burden, challenging patient interactions, moral injury and career prioritization. The lack of sustainable and consistent institutional programs for clinician wellness contributes to these identified themes. Future efforts should focus on addressing work burden by increasing clinical support, improving engagement with mental health support, and investment in resources such as childcare and schedule flexibility. Regular evaluation of hospitalist well-being and programming will be important to identify ongoing needs as the pandemic and its impacts continue to evolve.
