Hospitals and health systems should acknowledge mental health issues openly and create an environment that fosters conversations around mental well-being. Today, perhaps, ever more than before, employees are calling for empathy and mental health support from employers. Leaders within these industries must make sure that their staff is being offered benefits that include access to mental and behavioral health support.

The pandemic was hard on all of us. But statistics have shown that the pressures of the pandemic may have hit physicians and healthcare workers the hardest. While employment is starting to return to pre-pandemic levels generally, the healthcare sector is lagging behind with a significant percentage of healthcare workers not returning to work. This is one of the factors that is causing a shortage of doctors. Some experts say that the US may soon be short almost 124,000 physicians. (See here for example). What are hospitals and medical practices doing to help ease the extreme mental strain of doctors and healthcare workers? What are hospitals and medical practices doing to help solve the scourge of physician and healthcare worker burnout? To address these questions, we are talking to hospital administrators, medical clinic executives, medical school experts, and experienced physicians who can share stories and insights from their experience about “How Hospitals and Medical Practices Are Helping To Reduce Physician and Healthcare Worker Burnout”. As a part of this series, I had the pleasure of interviewing Dr. Jorge Palacios, Sr. Digital Health Scientist, SilverCloud Health, part of Amwell.

In his role as Senior Digital Health Scientist, Dr. Jorge Palacios leads in the planning, execution, and dissemination of clinical research projects and the general research strategy at Amwell. Dr. Palacios works to ensure that the impact of the research reaches across the wider organization and focuses on building a strong evidence base that backs up its claims and allows for continuous innovation of its products. Dr. Palacios also works with external academic and clinical collaborators to disseminate the science of digital health further and help to advance the field.

Thank you so much for joining us in this interview series! I know that you are a very busy person. Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory?

Iwas always a curious and outgoing child. Growing up in Mexico City and London, what I remember most, aside from family and friends, is my love of books — especially books on random facts and figures. Whether it was dinosaurs, space, countries of the world, or sports, I could recite them easily since I re-read them so many times (by the way if you could fit our entire solar system into a teacup, our galaxy would be the size of North America!). I think my love of statistics certainly paved the way to what was to come later on in life.

What or who inspired you to pursue your career? We’d love to hear the story.

My career has certainly had its share of twists and turns. I did come from a family of physicians and psychologists, but first decided I’d study engineering and applied math’s (as I said, I loved statistics and numbers)! However, I soon determined I was not completely fulfilled and so made the decision to study medicine like my father and grandfather before me. I was always drawn to research and met brilliant scientists during my training, so I guess a Master’s degree and PhD in psychological medicine was the marriage of my passions — data, science, and human connection. The opportunity to enter the field of Digital Mental Health came almost serendipitously, and I felt it was the logical next step in my career, as well as an area I knew was going to keep me busy long into the future.

What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?

There is no shortage of projects that have me excited right now — which speaks not only to the excellence of our team, but to how fast-paced the field in general is now, so we certainly feel lucky to be a part of it.

One in particular that immediately comes to mind is our work using machine learning to predict clinical outcomes and feeding that information through UX design back to clinicians. I am leading a trial that will show how the prediction tool we built improves clinicans’ experiences using digital therapy and helps drive quicker decisions, ultimately helping the patients using the digital tools.

You are a successful leader. Which three character traits do you think were most instrumental to your success? Can you please share a story or example for each?

I think my desire to learn not only from books but from talking and listening to people, especially when sharing their passions, has been key for me. Removing cultural and language barriers through empathy and conversation has made me very tuned in into the needs of individuals and helped me see the bigger picture.

Over the course of my career, with few exceptions, I never say no to a new challenge, even if it’s completely outside my comfort zone. A friend once gifted me a book on always saying yes, saying it basically described what my outlook on life was — I do believe in embracing the opportunities we have, and being constantly grateful for them.

I have always looked for sources of inspiration, whether it’s the mentors I’ve had since my early days as a medical student, or the bright young people I manage today. Even on days when I am not feeling motivated, drawing on the lessons I continue to learn from them helps to keep me going — there’s so much work left to do!

Ok, thank you for all of that. Let’s now shift to the main focus of our interview about minimizing medical burnout. Let’s begin with a basic definition of terms so that all of us are on the same page. How do you define “Physician and Healthcare Worker Burnout”? Does it just mean poor job satisfaction? Can you explain?

At its core, burnout is tied directly to mental health and wellbeing. Burnout in physicians and healthcare workers overall has become exasperated due to the pandemic, but it’s an issue that’s been around long before COVID-19 began. New research shows healthcare worker burnout has resulted in a whopping 1.1 million registered nurse shortage. And before the pandemic, U.S. Surgeon General Dr. Vivek Murthy said burnout was already plaguing many healthcare workers. From cultural, societal, structural, and organizational burnout factors, that same research estimates a 54,100 to 139,000 physician shortage by 2033. The World Health Organization (WHO) has defined healthcare worker burnout as a ‘syndrome resulting from chronic workplace stress that has not been successfully managed’. Symptoms of burnout can range from feelings of reduced satisfaction and/or professional accomplishment, physical and emotional exhaustion, depersonalization, loss of motivation, exhaustion, anxiety, and depression to name a few. Overall, a person can still be passionate about a job but experience these significant burnout symptoms. This can come from a variety of factors. For example, healthcare workers were already dealing with stressful, long days prior to the pandemic. Now, many are forced to work even longer hours due to staffing shortages, which can ultimately take a toll on a person’s mental and physical well-being.

How would you define or describe the opposite of burnout?

The opposite of burnout is when employees feel their work environment brings them a sense of satisfaction and balance. Typically, workers who are not burned out feel their work supports or at least doesn’t distract from their overall physical and mental well-being and allows for productivity and growth in their careers. These workers feel their job works within their life, leaving them time to focus on their priorities beyond work. To ensure our physicians and other healthcare workers are not burning out, it’s paramount that their employers provide a work environment that supports their needs, allows them time to prioritize their personal mental and physical health and gives them the tools needed to do their jobs better.

From your experience, perspective, or research, what are the main causes of Physician and Healthcare Worker Burnout?

In general, the healthcare environment is a busy one. From long days, time restraints, and the emotional impact, it’s no wonder why physicians and healthcare workers are experiencing such high levels of burnout. In fact, one poll found overall physician burnout spiked from 42% in 2020 to 47% in 2021. All of this, coupled with lack of sleep, support, and mental health resources, as well as time pressures, chaotic environments, high pressure situations and low control over work pace, often result in high-stress work environments, staffing shortages, and unreasonable job expectations.

The high level of paperwork is another source of strife for many healthcare workers. Of the more than 15,000 physicians surveyed by Medscape, 59% cite too many bureaucratic tasks — such as electronic health record (EHR) charting — as the major contributor to burnout. While physicians and healthcare workers are burning the candle at both ends at work, another cause of burnout is guilt coming from not spending enough time with family or trying to juggle both a demanding work schedule and family time and responsibilities.

The effects of physician burnout are far-reaching, and it has been associated with an increase in medical errors. When looking at burnout-related turnover, it can cost as much as $17 billion annually in the U.S. alone. At the end of the day, we might look at physicians and healthcare workers as superheroes, but they’re just as susceptible to burnout as any other human being.

Have you seen burnout impact your own organization? Can you give a first-hand description of how burnout can impact the operations of an organization?

Burnout today permeates every company and every industry. While healthcare has been impacted more than other industries, as a company that supports leading healthcare organizations, there are inevitably people within our team who have or are experiencing burnout, as well. A burnt-out staff means less engaged employees, and it’s easy for one burnt-out employee to have a knock-on effect on their team members, through delayed task completion, lower morale, etc. Therefore, our organization prioritizes total employee wellness and is always looking for ways to support employee physical and mental health to prevent burnout or help employees overcome it should it present.

Does your practice currently offer any mental health resources for providers or clinical staff? We’d love to hear about it.

Yes. Amwell offers a variety of virtual and digital behavioral health tools and programs. We partner with many of the world’s top health plans and health systems. In some cases, our clients are choosing to use our services on their own staff as they recognize the importance of protecting the mental health of their providers. For example, St. Luke’s University Health Network started a program called “Supporting #StLukesStrong”, which features weekly virtual sessions for employees led by either a psychotherapist, a psychiatrist, or a chaplain trained in critical incident briefing. The program provides consistent, valuable mental health support to St. Luke’s frontline workers throughout every stage of the pandemic and continues to draw attendance with an average of 100 weekly attendees.

In my work I have found that streamlining operational efficiency with digital transformation and automated processes helps to ease the workload of providers and clinical staff. Has that been your experience as well? Do you think that streamlining operational efficiency can be one of the tools to minimize medical burnout? We’d love to hear your perspective.

Yes, digital tools and automated processes have been shown to dramatically reduce burnout and the burden on healthcare providers. At Amwell we believe in a hybrid care model that combines in-person, virtual, and automated care interactions. When we talk about automating care, we don’t mean care rendered by a chatbot, we mean the ability to automate many of the processes and many of the interactions where a patient doesn’t need to be in front of a doctor. This allows doctors to practice at the top of their license and focus more time delivering excellent patient care. For example, Spectrum Health uses our ED follow-up program — Amwell’s offerings go well beyond behavioral health — which provides patients with a virtual companion that performs frequent, automated, chat-based, empathetic check-ins, to help care teams catch problems earlier and intervene sooner. Using the program, Spectrum saw satisfaction improve from both nurses and social workers working in transition care. These providers could now focus their time on the patients who needed them most.

Fantastic. Here is the main question of our discussion. Can you share 5 things that hospitals and medical practices can do to reduce physician and healthcare worker burnout?

Digital mental health tools are an extremely effective solution for helping to reduce physician and healthcare worker burnout. These tools allow for access to personalized mental health programs that are tailored to each individual’s needs, and an online, digital format provides both privacy and flexibility, avoiding long wait times. This is key for physicians and healthcare workers seeking help amidst their often unpredictable and busy schedules. These platforms allow healthcare workers to have 24/7, confidential access to digital mental health services.

Hospitals and health systems should acknowledge mental health issues openly and create an environment that fosters conversations around mental well-being. Today, perhaps, ever more than before, employees are calling for empathy and mental health support from employers. Leaders within these industries must make sure that their staff is being offered benefits that include access to mental and behavioral health support.

To help combat burnout, creating a positive work environment is also key. For example, hospital and medical practice leaders can work with employees to learn what’s causing the burnout in the first place, i.e., not enough break time, short staffing, disrupted workflows, and come up with plans to tackle these issues. Ensuring employee voices are heard and changes are being made will ultimately create a more positive outlook with employees and improve burnout.

The electronic health record (EHR) has been a source of complaint by many healthcare workers for years, due to its lack of interoperability and sharing patient information between different networks. The struggle with EHR systems alone can be very frustrating, causing stress and burnout in healthcare workers and physicians. When implementing technology, health organizations should prioritize systems that are easy to use and integrate with existing provider workflows.

Encouraging healthcare workers and physicians to take time for themselves each day to get at least 30 minutes of exercise (walking, jogging, yoga, etc.) can help combat mental health struggles and reduce burnout. In fact, the Mayo Clinic found exercising 30 minutes three to five times a week significantly reduces depression and anxiety symptoms. While it’s true that many healthcare workers and physicians have busy schedules, even just a little exercise can be helpful, too. That same report found even just 10 to 15 minutes of movement can be beneficial.

What can concerned friends, colleagues, and life partners do to help someone they care about reverse burnout?

Encouraging friends, colleagues, and life partners to open up about what they’re going through can be difficult, but an important step in the process of helping them reverse their burnout. Instead of hounding a person with questions and telling them to get help, oftentimes people respond better to knowing a person is there for them and ready to listen to whatever they’re going through when they’re ready to share. Being a positive source and reducing stressors in a person’s life can be a key to ensuring someone you care about gets the help they need. Taking this a step further, sometimes more support is needed, and this is where a digital mental health solution can come into play. Digital mental health solutions such as internet-based Cognitive Behavioral Therapy (iCBT) have been clinically proven to be as effective as in-person care and alleviate long wait times for those seeking support. iCBT helps users become more aware of what they are feeling — whether it be depression, anxiety, etc., and take appropriate actions and next steps to alleviate their symptoms.

What are a few of the most common mistakes you have seen people make when they try to reverse burnout in themselves or others? What can they do to avoid those mistakes?

Oftentimes when a person is dealing with stress, they might ignore their symptoms all together which can only make the burnout worse. With that, ignoring a work environment that’s causing you stress and just assuming it will correct itself can also leave people in a rut with feelings like ‘there’s no way out’ or ‘it is what it is’. Unfortunately, this attitude can often make people turn to substances like drugs, alcohol, or even avoidance of work all together. To combat this, it’s important to put yourself first, assess the situation and environment that you’re in, and make the proper changes needed to ensure you’re tackling your burnout in the right way. For people who have friends, colleagues, or family struggling with burnout, it is important to recognize when more support is needed, and when it is time to seek help, especially with the accessibility that digital mental health tools can provide.

Can you share your favorite “Life Lesson Quote”? Why does that resonate with you so much?

The quote ‘happiness only real when shared’ attributed to Christopher McCandless (and itself an adaptation of a passage from Dr. Zhivago) always has resonated with me. I have modified it slightly over time, believing that happiness is best when shared. This means that whilst there are moments where being alone and meditating on life is highly rewarding, I have always come back to the fact that there is nothing better than sharing in the happiness that life can bring. This applies personally and professionally, and I am grateful I get to do something that has a positive influence on so many people, while working daily with people I enjoy and respect so much.

Ok, we are nearly done. Because of your role, you are a person of significant influence. If you could inspire a movement that would bring the most amount of good for the greatest number of people, what would that be? You never know what your idea can trigger.

I think we need to start by making everyone understand and accept that mental health is equally as important as physical health, that the system which has created a crisis needs to be fixed, and that we should not only ask for but demand more resources that help with dealing with mental health difficulties. If there is something that should cut across the political system and across all ideologies, it is our very human emotions, and how important it is to share, acknowledge, and deal with them in order to truly maximize our existence in this world.

How can our readers further follow your work online?

Much of my research and work has been published online. For readers who want to learn more about burnout, mental health, and the positive impact CBT and iCBT have on people struggling with mental health, readers are welcome to check out some of the research studies myself and my colleagues have published. You can also catch me as the host of a podcast about digital and mental health, called CBTalks, available on YouTube, Apple podcasts, Audible, and Spotify. Follow me on LinkedIn and follow SilverCloud Health and Amwell for more content and blogs from our wonderful Science team.

This was truly meaningful! Thank you so much for your time and for sharing your expertise!