Already struggling to help her rural patients access necessary care, the Covid-19 pandemic only further exacerbated a doctor's stress and feelings of burnout, eventually causing her heart to physically "break," Oliver Whang writes for the New York Times.

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

Why rural health care can be an 'all-encompassing job'

According to Whang, health care is often difficult to access in rural areas, and the few doctors who are available often must juggle several roles as they care for patients.

Kimberly Becher, a family physician at Community Care of West Virginia (CCWV), a federally qualified health center, is intimately familiar with the pressures of providing care to a rural population, especially one that is struggling with several social inequities, including food insecurity and high poverty rates.

As one of only two family doctors in Clay County, West Virginia, Becher has "an all-encompassing job," Whang writes. "She visits children in their living rooms to vaccinate them, organizes food drives and administers Suboxone to treat opioid addiction."

To help build up what she called "patient equity" in the county, Becher took on advisory roles with local government, increased the number of patients she saw, and made home visits to people who could not drive to her clinic.

She also worked seven days a week at the clinic and stayed up late at home to work on patients' charts and grant applications for food vouchers. However, even with her varied efforts, many of Becher's patients continued to struggle with poor health.

"You have no way to make that impact," she said, "and you're just looking at them like: 'I know your heart rate is going up. I'm sorry you can't get food. That really sucks.'"

A doctor's heart 'breaks'

When the Covid-19 pandemic hit, Becher began to face a new obstacle: a growing distrust of medical information about the coronavirus, vaccines, and more.

"She had begun encountering resistance to Covid science, which added to the strain on her, she said; patients she had seen for years were suddenly questioning her judgment," Whang writes.

As patients and neighbors continued to question information about Covid-19, Becher "joined more boards, saw more patients, considered running for a government seat, tried to channel her frustration," according to Whang.

Although Becher knew the amount of work she was taking on was unsustainable, her husband Mike said she couldn't stop since "[i]t was like, she was helping people, and if she didn't do it, then no one would."

To work out her frustrations, Becher, an avid runner, began to go on more frequent and longer runs, "raging down the road."

"She was mad about the widespread distrust of vaccines; mad about teachers who went to school even after testing positive for the virus; mad about the endemic food insecurity, the county's lack of affordable transportation, the high rate of fatty liver disease," Whang writes. But, "[m]ore than anything, Dr. Becher was mad at how she couldn't seem to do anything about any of it."

Then, in April 2021, while at a chess tournament with her son, Becher "suddenly felt as if she were having a heart attack." Barely able to see and her blood pressure dangerously high, she quickly made her way to an ED.

There, tests showed that she had takotsubo cardiomyopathy, a rare disease that causes the tip of the left ventricle to stretch. Another name for the condition is "broken heart syndrome," and its causes are still unknown. According to Whang, the condition usually occurs in older women who have recently experienced intense physical or emotional distress, such as the death of a loved one or a serious accident.

'At least now I know there's a cliff'

After her heart "broke," Becher abruptly stopped all the work she had been doing, quitting every board she was on and no longer seeing her patients. As she recovered on bed rest for a couple weeks, Becher said she tried to figure out what had gone wrong.

Initially, Becher said she was angry about her diagnosis, but "[q]uickly the anger faded, and I felt utterly mortified. I wasn't tough enough to follow the path I'd set myself on."

"No one put me in this position," Becher wrote in a blog post months later. "I applied to medical school, I sought a job in rural primary care and I poured my identity into it. Takotsubo's is typically caused by severe acute stress, something traumatic and abrupt. Mine was just from going to work every day and seemed super lame to me in the moment."

Over time, Becher realized that she had been severely overtaxing herself by taking on so many roles in an effort to care for her patients and improve their lives.

"Why had I said yes to doing so many home visits?" she wrote. "Why did I work so hard to make food accessible in this town that I don't even live in? … Why did I keep saying yes to everything anyone asked me to do?"

"I am shifting my focus toward helping other physicians learn from my mistakes, which means I have to actually tell my story," Becher wrote in a blog post from February. "I am definitely a work in progress, and I am always on the edge of a cliff, at risk of jumping back into being angry and putting myself in a position to be hurt again. But at least now I know there is a cliff."

Even before the pandemic, burnout was a significant problem among physicians. For example, a 2017 study of roughly 5,000 physicians found that around 44% experienced at least one sign of burnout. Similarly, a 2019 report from the National Academy of Medicine found that 54% of nurses and physicians were burned out.

Since then, the pandemic has only further exacerbated feelings of burnout among physicians and other health care workers. In fact, several studies have found that levels of burnout among health care professionals have significantly increased since the pandemic began.

In early 2022, Lisa Lavadie-Gomez, a family doctor in Iowa, had a health scare similarly to Becher and reached out to her to talk about their experiences during the pandemic and the struggle she was personally going through with burnout.

"The empathy and altruism wears you out to the point where you're depleted, and I was depleted," Lavadie-Gomez said during a conversation with Becher. "I'm taking care of people with my whole heart, yet I'm completely broken. How do you keep going amid the moral overwhelm?"

Since then, Lavadie-Gomez has decided to leave medicine in an effort to take care of her physical and mental health. "I will always be a doctor; that will never change," she said. "I will always have the same skills and empathy, care and ability to solve problems. I'm just choosing to use that energy somewhere else."

Similarly, in early 2022, Becher moved to a more administrative role at CCWV and now only works at the clinic one day a week. Currently, she is developing a support group for rural physicians through the Robert C. Byrd Center for Rural Health at Marshall University. (Whang, New York Times, 9/19)