Medical workforce fatigue is the other 'long COVID'

The emerging ‘long COVID’ in patients who are experiencing diverse long-term effects of infections with SARS-CoV2 provides increasing insight into what we need to learn to help support these patients. What I want to highlight, however, is different; the impact on our profession of working during the pandemic. 

This ‘long COVID’ is as important and in my view needs urgent attention. We all willingly worked harder than ever to prepare our facilities, staff and ourselves to manage patients presenting with potential COVID. We attended many many out of hours webinars to keep abreast of the issues (PPE being a notable recurring one) and up to date with the emerging evidence.

We helped keep our communities calm by providing consistent advice, face-to-face care wherever we could and telehealth where that was more appropriate. We managed children being off school, partners and family members being furloughed or made redundant, and supported colleagues who were anxious or frightened. We pivoted training programs, both undergraduate and postgraduate, to online formats and re-thought assessment modalities.

The result of this has been quite remarkable – Australia is one of the safest countries in the world to be in at the moment. The deadly second wave in Victoria notwithstanding, ‘Team Australia’ has achieved an outcome that is the envy of many. However, this has come at a cost which is increasingly visible in colleagues, which is fatigue and burnout.

Cancelled leave and disrupted previously-stable cross-border locum arrangements are taking their toll. Our work practices have changed fundamentally. No longer can we come to work with URTI symptoms, so colleagues are covering additional work.  Doctors who were working part time are now working more hours. The medical workforce in many rural and remote sites is exhausted. Regional workforces, while larger in number, are as fatigued and feeling the impact, for example, of no junior doctors from the UK and other countries. This is punching holes in rosters and will inevitably impact patient services. 

And here is the hard part. We know that the pandemic is not going to end any time soon. It will continue for at least another 12 months, and probably longer, even with the availability of effective vaccines. In summer we spend more time indoors in air conditioning and we know that this will potentially increase the risk of community transmission of SARS CoV2. Intermittent state border closures and management of local 'hot spots' will continue. Staying away from work with URTI symptoms is standard practice, and so cancelling patient appointments at short notice will continue, placing increased expectations on the staff who are at work.

There has never been a more important time for Commonwealth and state/territory health services to work collaboratively to develop a sustainable workforce plan that can support both primary and hospital services to get through the next twelve months and beyond. COVID-19 has fully exposed the fault lines in our current workforce arrangements.

In order to be able to continue to offer the full scope of high quality comprehensive primary care, including obstetrics in our smaller communities, we need agile state based fly-in services that can at short notice be deployed to sites where the workforce needs immediate support. We need to provide practical help to colleagues who are extremely fatigued and need a proper break.

Underpinning this is the national workforce imperative for a sustainable fit-for-purpose domestic healthcare workforce that serves rural, regional and remote Australia. This workforce must come from Australian medical graduates who willingly seek careers in these communities. To achieve this we need a joined-up approach that links recruitment of students from regional and rural areas, plenty of enriching and meaningful undergraduate exposure to regional and rural clinical work, and opportunities to undertake specialist training outside of metro. 

We urgently need collaboration between the Commonwealth and states/territories, new joined-up thinking between education and health providers and workforce agencies and a clear commitment to measurable outcomes that are about tangible improved health outcomes for people living in rural, regional and remote communities.   

Let’s take the opportunity now to prevent health workforce ‘long COVID’ from crippling our medical services.