ObjectivesTo estimate the impact of the SARS-CoV-2 (COVID-19) pandemic on levels of burnout among physicians in Ontario, Canada, and to understand physician perceptions of the contributors and solutions to burnout.DesignRepeated cross-sectional survey.SettingActive and retired physicians, residents and medical students in Canada’s largest province were invited to participate in an online survey via an email newsletter.ParticipantsIn the first survey wave (March 2020), 1400 members responded (representing 76.3% of those who could be confirmed to have received the survey and 3.1% of total membership). In the second wave (March 2021), 2638 responded (75.9% of confirmed survey recipients and 5.8% of membership).Key outcome measureLevel of burnout was assessed using a validated, single-item, self-defined burnout measure where options ranged from 1 (no symptoms of burnout) to 5 (completely burned out).ResultsThe overall rate of high levels of burnout (self-reported levels 4–5) increased from 28.0% in 2020 (99% CI: 24.3% to 31.7%) to 34.7% in 2021 (99% CI: 31.8% to 37.7%), a 1-year increase of 6.8 percentage points (p<0.01). After a full year of practising during the COVID-19 pandemic, respondents ranked ‘patient expectations/patient accountability’, ‘reporting and administrative obligations’ and ‘practice environment’ as the three factors that contributed most to burnout. Respondents ranked ‘streamline and reduce required documentation/administrative work’, ‘provide fair compensation’ and ‘improve work–life balance’ as the three most important solutions.ConclusionsDuring the first 12 months of the COVID-19 pandemic in Ontario, prevalence of high levels of burnout had significantly increased. The contributors and solutions ranked highest by physicians were system-level or organisational in nature.

BACKGROUND The COVID-19 pandemic yielded extraordinary stressors and well-being challenges for physicians. OBJECTIVE We sent light-touch SMS messages to improve well-being in Ontario physicians and sought to determine which types of messages were most effective. METHODS We conducted a randomized longitudinal study with three trial arms for comparison of changes. All residents and practicing physician members of the Ontario Medical Association with available mobile numbers were randomly assigned to a trial arm: messages with well-being resources, stories from fellow Ontario physicians, or combined resources and stories. Baseline and endline data were collected through online surveys primarily using the short Warwick-Edinburgh Mental Wellbeing Scale, with single-item ‘pulse surveys’ delivered via SMS weekly through the intervention. RESULTS 3,356 and 1,230 participants completed the baseline and endline surveys, respectively. Of these, 614 participants also completed the endline survey and were included in our analyses. There were no significant differences in well-being, happiness, anxiety, life satisfaction, or worthwhileness across treatment groups, nor in how helpful participants found the messages. Participants in the resources-only trial arm were more likely (p=0.036) to report reading the messages compared to members in other groups. CONCLUSIONS Texts with stories from peer physicians and referral to well-being resources alone or in combination were not superior to each other in improving physicians’ well-being. Our findings support the notion that interventions focused on individual physicians alone are unlikely to address poor well-being and burnout among physicians. Further research is needed on the use of digital-based interventions in relation to well-being and burnout, particularly as health human resource well-being and sustainability are key to post-pandemic recovery efforts. CLINICALTRIAL ClinicalTrials.gov NCT04803812