The following is an edited transcript of an MDAdvantage podcast with Steve Adubato, PhD, and Ronnie Bochner, MD, obstetrician/gynecologist and President of the medical staff at Robert Wood Johnson University Hospital in New Brunswick, New Jersey. In this episode taped on May 19, 2022, Dr. Bochner speaks about the ramifications of shifting Center for Disease Control and Prevention (CDC) guidelines, the physician’s role in the future of healthcare and the impact that burnout has had on the careers of healthcare workers.
ADUBATO: Dr. Bochner, what are the major changes you’ve seen in the healthcare environment, post-COVID-19 pandemic, that potentially will change healthcare delivery forever?
BOCHNER: As President of the medical staff at Robert Wood Johnson University Hospital, I can say that we were surprised at how readily people resisted our efforts to prevent a major catastrophe when the pandemic first appeared. I was dismayed at our national leadership on multiple levels when they didn’t embrace the need to protect us. If this had been a foreign invader coming to our shores, the whole nation would have rallied against it. But we let this invisible invader reach our shores, and, most recently, it is responsible for over one million deaths in our country alone.
So, what I think has changed most post-pandemic is our realization that the public just doesn’t buy into much of what we think is important. They have political, religious and personal opinions that interfere with sound scientific principles. It’s hard to get the public to buy into what seems to us like a very clear issue and a very clear path.
ADUBATO: It is the nature of science to evolve, but that caused some people to say, “I tried to take direction from the CDC, but then the guidelines kept changing. I’m not sure who I’m supposed to trust.” Can you see that this can be the root of confusion and distrust?
BOCHNER: Yes, science is constantly changing as knowledge evolves. Those of us in healthcare know that when we are treating a sick individual, every day is part of a new journey, and, sometimes, the more we know, the more we have to change direction. The CDC relies on data, studies and outcomes—not on feelings, impressions or anything else. During the pandemic, data was constantly flowing in, bringing with it the need to change guidelines, and, yes, that can be confusing. The public wants black-and-white marching orders, and they don’t want them to vary. They want us to say, “This is what you do, and this is what you always do, and this is never going to change.” But that’s just not how healthcare works.
The CDC was designed for this type of national health emergency. Their mission is to react in real time to prevent mass casualties. But it’s been difficult to get the public to understand that as our knowledge evolves, our guidelines and recommendations are going to change.
ADUBATO: Early on in the pandemic, healthcare workers were seen as heroes. At some point that shifted, as some people resisted the direction of the pandemic guidelines. Do you believe that the perception of the medical profession has changed forever because of this?
BOCHNER: If you look at the eras before the pandemic, during the pandemic and then post-pandemic, I think you’ll see a return now to pre-pandemic attitudes. During the pandemic everybody needed doctors; they needed healthcare. They suddenly knew how to spell ventilator. They learned words like monoclonal antibodies. They learned about clinical trials. They learned about what we do every day— we were very much valued during the pandemic. Now we’re reverting back to where we were before the pandemic—when we were undervalued.
“During the pandemic, everybody needed doctors; they needed healthcare. Now we’re reverting back to where we were before the pandemic—when we were undervalued.”
ADUBATO: What are the implications for the profession of being undervalued?
BOCHNER: I see a change in expectations among our physicians coming out of training. They have a different view of the world now than I did 40 years ago. I think their view of healthcare now is that they have a job to do, and they do it. They work in shifts, and when the shift is over, they’re done. You see this even in TV shows focused on medical issues. Yes, we all take problems home with us, we want to solve problems, we want to use all the technology we have available to us to make healthcare better, but I think that we’re seeing a diffusion from the traditional model. This has been evolving over decades, and going forward we’re going to rely more heavily on allied health professionals.
At our facility we have more than 420 advanced practitioners—such as nurses and physician assistants. They’re playing more and more of a role in what we do, and we’ll be seeing a lot more of that as physicians take on a different role. Physicians won’t be in the trenches. They’ll be the ones who get the case when things are not going well. I think as healthcare evolves, and it’s constantly evolving, 20 years from now we’re going to look back and not recognize the medical world as we see it today.
ADUBATO: Does that concern you?
BOCHNER: It does not concern me because everything is an evolutionary process. If you don’t evolve, if you don’t adapt, you go the way of the dinosaur.
ADUBATO: As you observe how the profession is changing, how healthcare delivery is changing, how much do you see physician burnout?
BOCHNER: Quite a bit, unfortunately, and the pandemic really pushed a lot of people over the edge. First of all, we were not accustomed in peacetime to seeing mass casualties. Our intensive care unit (ICU) teams were not accustomed to seeing so many people die in a day, especially the younger people who normally would not die in an ICU setting. It was very disturbing. This was not war time; this was peacetime. We had intervention teams set up to deal with our staff because they needed healing themselves. They are made of the same biological material that our patients are made of.
We have about 2050 medical staff members, we have about 8000 nurses here at any given time, and many of them need healing. Many of them don’t realize they need healing, and they take it home, but their families notice it. We have some robust counseling sessions at our university, but the burnout is pervasive.
When I say burned out, I mean that they want to go in a different direction. They can’t heal themselves. They’re not happy. They’re not happy at home. They wake up at night; they don’t sleep well. They are unable to find solace from other activities that normally would have given them solace. They need to find some pleasure in their work, and the pleasure they used to find in their work is just not there anymore. We’ve seen doctors who would not have retired for another decade choose to hang it up and do something else because they are just burned out.
ADUBATO: How do you stay so positive?
BOCHNER: Healthcare is in my DNA. I’m doing what I was born to do. I’ve had my trials along the way. I’ve had my episodes where I said, How am I going to go on? Like everybody else who does what I do, I’m vulnerable. I’m a human and I have feelings. But I was able to overcome these things by realizing who it is I am, what it is I do, and what my mission is here on earth. I got through it that way. That works for me.
In the leadership role, I have a lot of people who must follow my lead, and I want them to see that you can be the most you can be and do the most you can do, and still enjoy your work. So, when I encounter physicians who are extraordinarily talented, and they say, I just can’t do this anymore, I want to help them. Between Rutgers University and Robert Wood Johnson University Hospital, we have some robust programs to help physicians. It’s okay to say that you’re tired of what you’re doing and you can’t do it anymore. If in talking to people you come to realize that you really shouldn’t be doing this anymore, that’s okay. Many people change their professions. But the majority of the people in healthcare really love what they do. We try to help them find their way again and find their inspiration.