Wellness and Coping of Physicians Who Worked in ICUs During the Pandemic: A Multicenter Cross-Sectional North American Survey*

Abstract

Few surveys have focused on physician moral distress, burnout, and professional fulfilment. We assessed physician wellness and coping during the COVID-19 pandemic.DESIGN: Cross-sectional survey using four validated instruments. SETTING:Sixty-two sites in Canada and the United States. SUBJECTS:Attending physicians (adult, pediatric; intensivist, nonintensivist) who worked in North American ICUs. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS:We analysed 431 questionnaires (43.3% response rate) from 25 states and eight provinces. Respondents were predominantly male (229 [55.6%]) and in practice for 11.8 ± 9.8 years. Compared with prepandemic, respondents reported significant intrapandemic increases in days worked/mo, ICU bed occupancy, and self-reported moral distress (240 [56.9%]) and burnout (259 [63.8%]). Of the 10 top-ranked items that incited moral distress, most pertained to regulatory/organizational (n = 6) or local/institutional (n = 2) issues or both (n = 2). Average moral distress (95.6 ± 66.9), professional fulfilment (6.5 ± 2.1), and burnout scores (3.6 ± 2.0) were moderate with 227 physicians (54.6%) meeting burnout criteria. A significant dose-response existed between COVID-19 patient volume and moral distress scores. Physicians who worked more days/mo and more scheduled in-house nightshifts, especially combined with more unscheduled in-house nightshifts, experienced significantly more moral distress. One in five physicians used at least one maladaptive coping strategy. We identified four coping profiles (active/social, avoidant, mixed/ ambivalent, infrequent) that were associated with significant differences across all wellness measures. CONCLUSIONS: Despite moderate intrapandemic moral distress and burnout, physicians experienced moderate professional fulfilment. However, one in five physicians used at least one maladaptive coping strategy. We highlight potentially modifiable factors at individual, institutional, and regulatory levels to enhance physician wellness.

Resource allocation

“…In short-lived disasters, this strategy has proven it's worth [11]. However, the COVID pandemic has shown that there may be a very steep price to pay when such an approach is taken over long periods of time: psychopathologies, which may express both during the acute phase [12,13] and after the event [14–16,17 ▪ ].…”

The Smoldering Embers of Physician Burnout: The Pandemic Within the Pandemic*

“…Although the findings from Burns et al (6) help to highlight the scope and breadth of this issue, one should recognize the limitations of the study by Burns et al (6). The results themselves may not be representative of the behavior, attributes, and responses of all physicians who care and cared for critically ill patients during the pandemic, as the majority of those who responded were male, university hospital-based physicians, who had been practicing for a mean of approximately 10 years.…”

“…In this issue of Critical Care Medicine , Burns et al (6), on behalf of the Diversity-Related Committee of the Women in Critical Care interest group of the American Thoracic Society, assessed wellness and coping strategies in physicians who cared for critically ill adults and children during the COVID-19, via a survey of attending physicians who worked in adult and PICUs. They observed, similar in part to observations from others, that almost all physicians reported more time worked per month, a higher patient census under their care, increased physical and emotional exhaustion, and lower levels of professional fulfillment.…”

“…Perhaps counterintuitively, stress levels did not differ between intensivists and other noncritical care physicians who were called upon to provide ICU care during the pandemic during times of high demand and shortages. However, most alarming was the fact that about 20% of physicians reported maladaptive, personally dangerous coping strategies, such as excessive self-blame, avoidance tactics, and abuse of alcohol and drugs (6).…”

Surprisingly Few Avoidable Harms From Pandemic Strain in Multihospital U.S. Survey: Resilient Hospitals or Respondent Bias?*

“…They can throw light on where, how, and why hospital strain manifested and pinpoint potential contributors to patient harm and guide future research and action. Surveys have helped capture care variations (11) and providers’ coping strategies from burnout (12) during the pandemic. However, surveys have their own limitations: their results are as best as the survey tool used and the respondents surveyed.…”