The Impact of COVID-19 and the Rapid Adoption of Telehealth on Provider Burnout in a Pediatric Healthcare Organization

Background: Clinician burnout is a serious problem in healthcare, which could be exacerbated by the consequences of the ongoing global COVID-19 pandemic, including the abrupt shifts in clinical practice (e.g., rapid increase in telehealth services). It is within this context that we conducted a survey of clinicians at a safety-net pediatric hospital to understand how these factors may have affected providers’ experiences with and perceptions of burnout.

Methods: The brief structured questionnaire was designed by a multidisciplinary team and was sent to all 378 providers at CHOC Children’s in June 2020. Questions included demographics, experiences with and perceptions of burnout, and factors that may contribute to or mitigate burnout. After performing descriptive analyses, we used a binomial logistic regression model to test the primary hypotheses of this study: burnout is predicted by both providers’ perceptions of the impact of the COVID-19 pandemic and their perceptions of the consequent transition to telehealth. Provider burnout was measured by the statement, “I am experiencing burnout,” with response options on a Likert scale from Strongly agree to Strongly disagree. This was converted to a binary variable for our analyses. Of note, and as others have done, we chose not to use the 22-item validated measure of burnout to avoid over-burdening clinicians. The study was reviewed and approved by the CHOC Institutional Review Board (#200675).

Results: Eighty-four providers responded (22%), which is typical for surveys of clinicians. The majority of respondents identified as female (57%). Additionally, 70% of participants were between 35 and 54 years old, with about 10% <35 years and 20% >54 years. Almost all respondents (92%) were married or in a domestic partnership. Approximately 46% of respondents were Specialists, 33% General Pediatricians, and 20% Hospitalists. Fifty-six percent of respondents reported that they were experiencing burnout (N=84). Table 1 summarizes key descriptive results, and Figure 1 presents the results of the multivariable logistic regression model predicting self-reported provider burnout. The data show that, when controlling for the other variables in the model, the self-reported experience of burnout is predicted by three perceptions: COVID-19 has exacerbated provider burnout (p < 0.001), the benefits of telehealth do not outweigh the challenges (p=0.045), and there is insufficient institutional support to reduce burnout (p < 0.001). We also identified a statistically significant interaction, with those perceiving both sufficient institutional support and telehealth to be beneficial being less likely to report experiencing burnout (p=0.045).

Conclusion: Increased institutional support should be provided to clinicians both now, as clinical practice continues to evolve during the COVID-19 pandemic, and more proactively during the inevitable future periods of crisis in an effort to reduce clinician burnout in these difficult times. Future research should assess the effectiveness of different institutional measures on clinician wellbeing.