Dr. Amy Nygaard ’03 Shares Experience with Transition to Psychiatric Telehealth, Physician Burnout

Now entering a second year of COVID-19, the pandemic has affected personal and professional lives on many different levels. Among those are the very people caring for the sick, treating patients who found themselves COVID-positive and in need of specialized attention. Around the world, these healthcare workers are the frontline foundation where a second year is taking a toll. 

Amy Nygaard, MD, a psychiatrist and a 2003 graduate of the University of Minnesota Medical School says, “We are seeing burnout, stress, anxiety, depression and grief among our healthcare workers. We are seeing secondary trauma, also called vicarious trauma or compassion fatigue, in our mental healthcare staff, as the demand for service is so high and clinicians so compassionate, that they are struggling to care for themselves.” 

Before becoming a board-certified psychiatrist who provides assessments, treatment planning and medication management for children and adolescents ages five to 17, Dr. Nygaard began her educational career at the University of Minnesota Medical School, Duluth Campus. She currently works in an outpatient clinic, seeing patients while also serving as the Chair of Outpatient Behavioral Health Services for HealthPartners and Regions Behavioral Health Clinics. She recently completed the Duke TMS (transcranial magnetic stimulation) fellowship and added TMS services for adults with treatment-resistant depression. 

“I've always enjoyed working with children and families,” she said. “I chose to support them through my practice in child and adolescent psychiatry. I find it very rewarding work.” 

Dr. Nygaard’s areas of interest focus on ADHD, eating disorders, anxiety and mood disorders like depression. Her collaborative approach with clients and families includes education and supportive therapy. She also practices motivational interviewing in partnership with families, therapists, primary care providers and schools, as the situation requires. 

“I take time to listen and help children and their families through what is often a challenging time,” she said. “Clients need someone who can meet with them consistently to determine ongoing efficacy and appropriateness of current medication and treatment plans. I aim to be that person.” 

In the past year, Dr. Nygaard says their services have transitioned from 99% outpatient care to more than 90% telehealth in response to the COVID-19 pandemic. Psychiatrists and those in the field of mental health are currently working to determine what the future of outpatient mental healthcare will be for organizations and for patients. The current challenge, Dr. Nygaard says, includes figuring out what mental health care will look like in the future. 

“We want to solve the issues,” Dr. Nygaard said. “Especially with CMS/reimbursement for telehealth care, clinician and patient preference, ongoing clinical learnings, the shortage of clinicians, the tsunami of patients who are struggling with mental health challenges, such as new anxiety, insomnia and depression as a result of the isolation and trauma of the COVID pandemic, and the political and cultural events of the past year.” 

Dr. Nygaard recognizes that the last year and a half has left indelible marks that ask for understanding and grace. She says mental health awareness and the profession of mental healthcare emphasizes a team approach that supports and encourages people to seek help. The pandemic tipped the horizon on how best to connect with patients, and mental healthcare doctors, like Dr. Nygaard, rose to right the world, to stabilize the horizon, for so many who are struggling. 

“In our mental health clinics, we transitioned our services to virtual care over a period of days, thus minimizing disruption of care and have been busy since,” she said. “We have seen our no-show rates decrease and our demand increase. We worked to provide services and options not only to our patients but also to create resources and support for our frontline clinicians and staff. I am proud to work in healthcare and have witnessed an unprecedented level of professionalism and dedication from our frontline healthcare workers. But, this level of commitment has not been without a cost.” 

For those in the medical field, they are experiencing a new tidal wave of the pandemic months after patients learn they are COVID-positive and seek treatment. “Some patients continue to struggle long after their diagnosis,” Dr Nygaard said. “A cohort study of patients six months after their acute infection found patients continued to suffer from fatigue, muscle weakness, sleep difficulties, anxiety and depression long after the acute COVID infection.” 

While this is an emerging reality, what does this mean for healthcare workers and the psychiatrists who want to give the support and treatment for anyone who courageously asks for it? Dr. Nygaard says it means that there is an unprecedented demand on their time and compassion that, for many, can turn into losing touch with personal care. The mental health of healthcare workers is under vise-like pressure to perform compassionate medicine because that is the heartbeat of the profession. However, in order to give care, she says, one must take care. 

“Put on your own oxygen mask first,” Dr. Nygaard said, in reference to healthcare workers feeling the fatigue and possibly unsure on how to best continue forward in this second year. “Schedule time to care for yourself. Plan PTO. Connect with supportive friends or family. Get outside. Breathe. Reconnect with an old hobby, or start a new one. Remember that you are not in this alone. If you are struggling, reach out to a friend, a colleague, a support line or EAP. I can’t emphasize this enough – you are not alone.” 

This month is Mental Health Month, and the University of Minnesota Foundation started a crowdfunding campaign to support medical student wellbeing. If you would like to support this fund, make a gift here or contact the Medical School, Duluth Campus Director of Development Elizabeth Simonson at esimonso@umn.edu.