By Richard J. Baron, MD & Christine A. Sinsky, MD 

The COVID-19 pandemic is the biggest professional challenge most of us will ever face as physicians. It has been terrifying and heart-breaking, and has forced many of us to work outside our comfort zone, with one-third of physicians reporting higher levels of anxiety or depression due to COVID-19. While we look toward a new "normal" as more people get vaccinated, we sincerely wonder what this "new" will look like.

Recently, American Board of Internal Medicine (ABIM) staff spoke with dozens of doctors across internal medicine and its subspecialties about what they needed from us and how we can help. Several reported feelings of burnout and difficulty coping. After hearing the exhaustion in their voices, the desperation for the pandemic to end, and concern about their future, we determined that we -- and everyone in healthcare -- can take greater action to reshape the healthcare system to help physicians heal today and for the long-term.

As one course of action, the ABIM Board of Directors unanimously voted to extend Maintenance of Certification (MOC) requirements through 2022. Multiple factors influenced this decision. While MOC is intended to help physicians -- and their patients and colleagues -- know they are keeping their medical knowledge current, we know that during the pandemic physicians were obliged to spend a significant amount of time learning about the science of the novel coronavirus and new treatment regimens in caring for their patients.

But the most important factor in making the decision to extend deadlines was the well-being of physicians. That prompted us to wonder what else we could collectively do across the healthcare system. As the immediacy of COVID-19 wanes and physicians' grief and sorrow about the past year's battle surfaces, we have been thinking about the well-being of board-certified physicians -- but other members of the care team have also shared the enormous challenge of caring for patients and experienced the pandemic in deeply personal ways.

We heard CDC director Rochelle Walensky, MD, MPH, tear up as she described her recurring feeling of "impending doom" and the nightmare of being the last person to hold the hand of a dying COVID-19 patient unable to see loved ones. We fear our physicians may suffer PTSD when they take off their white coats after this pandemic has finally ended.

While vaccinations are increasing, so are state decisions to relax rules about mask use and indoor gatherings. Surges are on the rise, and physicians in some regions of the country once again face hospital beds filled with COVID-19 patients. Many physicians are vaccinated, which reduces concerns about personal safety, but there are still critical shortages of ICU staff, which adds to stress and feelings of burnout.

During the pandemic, clinical care has been transformed in many ways. For example, a larger proportion of ambulatory visits are virtual (though most are still in-person), and CMS and other agencies have modified long-standing policies to reduce preexisting constraints on team-based care. This has helped diminish feelings of burnout and fatigue, and allowed physicians to concentrate on patient care when it was needed most.

Even after the pandemic has passed, we must continue to preserve physicians' cognitive bandwidth and emotional health for the direct care of patients. Pre-COVID-19 physicians in ambulatory practice reported that they spent nearly two hours on electronic health record (EHR) and desk work for every one hour of direct patient care, with an additional one to two hours per day of mostly EHR work during their personal time on nights and weekends. The hours of administrative work saved during the pandemic should be preserved so physicians can take the time they need to heal from the crisis.

We now have an opportunity to take advantage of the lessons we learned in 2020 to further transform healthcare to achieve Quadruple Aim outcomes: better care for individuals, better health for the population, better experience for clinicians, and lower costs. In fact, many physicians report feeling relieved to be able to practice medicine again rather than spend the majority of their time filling out paperwork.

The pandemic has been referred to as a once-in-a-century event, and we certainly hope that's the case. But if it is, we may never see an opportunity to reshape the healthcare system like this again in our lives. We encourage all those in the healthcare system to look at what is within their control -- unnecessary paperwork, EHR servitude, and ways to improve teamwork -- and to make bold decisions in support of overburdened healthcare providers who will no doubt experience delayed PTSD and burnout when the crisis has ended.

But most of all, we need to find a way to help physicians heal. They need to process all they have seen in the past year -- the refrigerator trucks filled with dead COVID-19 victims, the desperate cries of patients unable to see loved ones, and the sorrow of virtual goodbyes -- and they need to be able to move forward knowing we have made changes that will help them in every way possible.