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November 28, 2022

Charted: The pandemic's 'alarming toll' on primary care physicians

Daily Briefing

    More than half of physicians said their workloads increased during the pandemic, which led to high stress and burnout that impacted quality of care, according to a new global survey from the Commonwealth Fund.

    Your two-pronged approach to addressing—and preventing—physician burnout

    How burnout is affecting primary care physicians around the world

    The Commonwealth Fund surveyed primary care physicians from 10 high-income countries, including the United States, France, Canada, and Germany. The survey was conducted between February and September 2022 and included almost 10,000 respondents.

    Overall, the survey found that most physicians across the 10 countries reported that their workload increased since the beginning of the pandemic. In the United States, 65% of primary care physicians said their workload had "increased somewhat" or "increased a lot" compared to before the pandemic.

    Compared to older physicians, younger physicians were more likely to report having stressful jobs, experiencing emotional distress, or experiencing burnout. In the United States, 63% of physicians under 55 said their job was "very" or "extremely" stressful compared to 54% of those 55 and older.

    Similarly, 61% of younger American physicians said they experienced emotional distress, and 50% said they were burnt out. In comparison, 46% of older physicians said they experienced emotional distress, and 39% said they were burnt out.

    Although younger physicians were more likely than older physicians to seek mental health care, the overall rate of physicians seeking treatment was low. The percentage of physicians who sought treatment for their mental health problems ranged from 6% in Germany to 23% among young physicians in New Zealand.

    Stress and burnout also affected physicians' ability to provide care. Primary care physicians who reported stress, emotional distress, or burnout were significantly more likely to say that their quality of care declined "somewhat" or "a lot" during the pandemic.

    In the United States, 28% of physicians who experienced mental distress said their quality of care worsened compared to just 8% of physicians who did not experience mental distress. In general, reports of worsening care among physicians experiencing stress, emotional distress, or burnout ranged from 16% in Switzerland and 55% in Sweden.

    Although older physicians were less likely to experience mental distress than younger physicians, older physicians were much more likely to say that they intend to stop seeing patients within the next three years.

    Across all 10 countries, between 31% and 67% of physicians ages 55 and older said they intended to stop seeing patients in the near future compared to between 4% and 20% of younger physicians. In the United States, 14% of younger physicians said they would soon stop seeing patients compared to 45% of older physicians.

    How to support primary care physicians going forward

    "The pandemic is taking an alarming toll on the well-being of our primary care workforce," said David Blumenthal, president of the Commonwealth Fund.

    According to Munira Gunka, senior researcher for international health policy and practice innovations at the Commonwealth Fund, the survey's findings show that "all health systems need to prioritize the well-being of the primary care workforce."

    To ensure physicians are supported and can practice in healthy work environments, the Commonwealth Fund offered several recommendations, including:

    1. Ensuring physicians have access to mental health services

    The United States has made some progress on this front. Currently, the National Academy of Medicine has developed a "national plan" that builds on the U.S. Surgeon General's advisory on burnout among health care workers from earlier this year.

    The plan aims to support health care workers' mental and behavioral well-being through several strategies, including recruiting additional mental health professionals specifically for the health care workforce.

    2. Increasing government investment in primary care

    "In the United States, increasing Medicare and Medicaid reimbursement for primary care services could help draw more medical school graduates into the field, as could loan forgiveness programs," the survey's authors wrote.

    Several other countries have also planned their own investments into primary care. For example, Australia has committed $750 million to improving primary care and recently established a Strengthening Medicare Taskforce to garner new recommendations.

    In 2019, the United Kingdom implemented several broad initiatives aimed at expanding the number of general practitioners. Some of these initiatives include enhanced recruitment efforts among junior physicians, international recruitment, and the creation of multidisciplinary teams.

    3. Looking to other countries for potential solutions

    "International comparisons allow the public, policymakers, and health care leaders to see alternative approaches to addressing common problems, including the primary care crisis," the survey's authors wrote.

    By looking to other countries for solutions, the United States can see what works and what doesn't to strengthen its primary care system. (Joseph, STAT, 11/17; Gunja et al., The Commonwealth Fund, 11/17)

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