Spiroscout - Blog by Sol

Pulmonologist burnout: statistics and suggestions to cope

Thu, 31 Mar 2022 15:43:51 +0000

Burnout is a problem that affects many people. And the COVID-19 pandemic greatly increased it among pulmonologists and other respiratory specialists who provide critical care.

To the overload work caring for coronavirus patients we need to add the limited resources, the longer work shifts, the lack of sleep, the imbalance between personal and professional life, and, of course, the stress involved in being constantly exposed to the disease. How do all these factors affect pulmonologists?

The portrait in figures

The document “Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2020” published by the Mayo Clinic, and work-life integration satisfaction among physicians and other non-health professionals.

This study involved 7510 physicians. Of thosespecialties related to COVID-19, 38.2% reported having suffered more than one burnout symptom in 2020. Overall, compared to other professionals, the risk of burnout among physicians was OR, 1.41; 95% CI, 1.25 to 1.58 and their degree of satisfaction with work-life balance was OR, 0.71; 95% CI, 0.64 to 0.79.

And what is the situation among pulmonologists? According to the data provided by the report of the survey carried out in 2021 by Medscape, this is how the participating doctors who practice this specialty feel:

61% of the 12,339 respondents were male.
82% felt happier outside of work before the pandemic.
47% feel happier outside of work currently.
32% experienced burnout or depression.
37% consider that burnout impacts them strongly.
Some of the mentioned factors that contribute most to pulmonologists burnout were:

58% perform too many bureaucratic tasks.
39 % Insufficient compensation/or reimbursement.
38% spend a lot of time at work

Surprisingly, pulmonologists are not looking to make more money (only 13% acknowledged that this would make them feel better) but their focus is on finding the balance between personal and professional life (52%).
However, their answers to the question that if they would accept a salary reduction in order to achieve such a balance slightly contradicts the above: 51% answered no. And despite the lack of time for their personal life, 63% consider they have a happy marriage.

You will have already noticed that the solution to most burnout risks is reaching balance, but how to find it?

Strategies to cope with burnout

Since external factors are so difficult to control, it is necessary to find a way to govern what happens inside. Thus, it is advisable strategy and stick to it; it seems like a simple solution, but tell me: are you clear about yours? I don't mean isolated ideas, but a set of guidelines so coherent that you could even stop reading this for a moment to put them in writing, in whatever you have at hand.

To defeat burnout, I will not suggest what you already know: eat healthy, exercise often or seek professional therapeutic help; those are effective measures, but most people fail to carry them out as they would like to. Do you know why? Because they don't have a map. To get to a place you need a map that show the destination, the road to follow and the intermediate stops. Make your own!

And preferably put it in writing; not to remember what needs to be done, but so that you can assess whether you have reached your goals to balance your life. When these are not materialized in words, it is easy to feel that one does not advance, but after a while, review them and you will be surprised to notice what you have achieved.

In addition, for this to be practical it must be flexible. Make all the required adjustments until you find the right dose of habits and practices that give you the greatest therapeutic effects to combat burnout.

One more thing to keep burnout under control: take advantage of technology to make your daily work easier and faster. The SpiroScout is an ultrasonic spirometer that allows to perform fast, accurate, reliable tests, and it generates reports that are easy to interpret and graphical trends to easy follow, Besides you can claim the following CPT codes*:

Code 94010. $36.00. Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation.**

Code 94060. $62.00. Bronchodilation responsiveness, pre-and post-bronchodilator administration.

Code 94150. $26.00. Vital capacity, total (separate procedure).

Code 94200. $26.00. Maximum breathing capacity, maximal voluntary ventilation.

Code 94375. $40.00. Respiratory flow volume loop.

Click here to find out how to take advantage of this ally in your daily practice.

*CPT codes and reimbursements are provided as an example only and constitute no promise by Schiller or its subsidiaries regarding coverage or payment.

** CPT Code 94010 is the most commonly used in the market.

REFERENCES

Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2020 https://www.mayoclinicproceedings.org/article/S0025-6196(21)00872-7/fulltext

Medscape Pulmonologist Lifestyle, Happiness & Burnout Report 2021 https://www.medscape.com/slideshow/2021-lifestyle-pulmonologist-6013523#8

Pulmonary arterial hypertension: patient stratification and therapeutic advances

Mon, 28 Mar 2022 14:43:23 +0000

Pulmonary arterial hypertension (PAH) is a global problem with elevated morbidity and mortality because it complicates many diseases related to the cardiopulmonary system. And this risk is even higher due to the high prevalence of congenital heart disease: there are an estimated 25 cases of pulmonary arterial hypertension related to congenital heart disease per million inhabitants worldwide.

PAH can occur due to heart disease, as we already said, but it can also occur due to clots or other chronic diseases. The remodeling of the pulmonary vasculature and the progressive increase of the pulmonary vascular load that are characteristic of this syndrome, generate hypertrophy and remodeling of the right ventricle that, without treatment, are fatal.

Stratifying patients

The 2015 Guidelines s for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology – European Respiratory Society (ESC/ERS, respectively) indicate that it is a priority to stratify patients effectively and promptly in order to choose the most appropriate therapy for each case.

On the other hand, there are currently five clinical classifications (or groups) of pulmonary arterial hypertension:

1 Pulmonary Arterial Hypertension (PAH). The cause is the reduction or stiffness of the pulmonary arteries, which forces the right side of the heart to work harder.

2 Pulmonary hypertension due to left heart disease. The cause may be a problem with a valve (mitral or aortic) on the left side of the heart or a failure of the left ventricle.

3 Pulmonary hypertension due to lung disease. When the patient has a lung disease (e.g. COPD) or some other disease that causes hypoxia.

4 Pulmonary hypertension caused by chronic clots. The common treatment is surgery or medications that help dissolve clots.

5 Cryptogenic pulmonary hypertension. Which is when the physician cannot determine the origin of the problem. Among the conditions that are usually associated with this type of hypertension we can mention kidney disease, metabolic disorders, inflammatory disorders or blood disorders, among others.

Although the predictive capacity provided by stratification methods has improved over time using machine learning algorithms, the aforementioned ESC/ERS 2015 Guidelines suggest evaluating the risk of patients periodically since there is no a unique variable that offers enough diagnostic and prognosis information.

That is why it is necessary the physician establishes a multidimensional treatment strategy that includes various tests such as echocardiography, CT scans, spirometry and pulmonary function tests, among other useful tools.

Sotatercept, a hope?

To the already known treatments, for example, diuretics to promote euvolemia or anticoagulant therapy (now only indicated for idiopathic PAH), one more option is added.

It is a PULSAR trial (published in April 2021) in which the efficacy of sotatercept, a new fusion protein composed of the extracellular domain of the human activin receptor type IIA fused with the Fc domain of human igG1, was tested. In other words, this compound binds the activines and the growth differentiation factors to try to restore the balance in the growth promoting signals and the growth inhibitors.

The trial lasted 24 weeks in which 106 adults receiving baseline therapy for pulmonary arterial hypertension were randomly selected. They were given subcutaneous sotatercept at a dose of 0.3 mg per kilogram of body weight every 3 weeks or 0.7 mg per kilogram every 3 weeks or a placebo. The primary endpoint was the change in pulmonary vascular resistance from trial initiation to week 24.

This trial demonstrated that sotatercept reduces pulmonary vascular resistance in patients receiving background monotherapy, double therapy, or triple therapy, including those receiving prostacyclin infusion therapy. Decreased pulmonary vascular resistance in the sotatercept groups was achieved by reducing mean pulmonary arterial pressure, without causing a substantial change in cardiac output or pulmonary artery wedge pressure.

Preclinical evidence suggests that sotatercept has a direct effect on pulmonary vascular remodeling, which may explain its clinical effect on pulmonary artery pressure. Although there is still a long way to go, these initial results are good news for PAH patients.

REFERENCIAS Pulmonary Arterial Hypertension: https://www.nejm.org/doi/full/10.1056/NEJMra2000348,
Sotatercept for the Treatment of Pulmonary Arterial Hypertension,
2015 Guidelines s for the Diagnosis and Treatment of Pulmonary Hypertension