A recent survey (PDF) found 8 in 10 U.S. physicians were impacted in a variety of ways due to COVID-19 and that the pandemic continues to negatively impact the well-being of physicians and patients a year later.
The 2021 Survey of America’s Physicians, conducted by the Physicians Foundation, was implemented from the end of May through the start of June 2021 and received responses from more than 2,500 U.S. physicians.
Nearly half of physicians experienced reduced income in the past year, while nearly a third experienced reduced staff, and the majority, or 61%, of physicians reported experiencing burnout often, a nearly 53% increase since 2018. Even before the pandemic, physician burnout and mental health concerns were prevalent, according to Gary Price M.D., president of the Physicians Foundation.
“A bad situation has gotten worse,” Price said. For years, physicians have expressed frustrations over time-consuming and cumbersome processes that take their time and autonomy away from patient care, such as electronic health record-keeping and preapproval requirements for medications or diagnostic procedures. Some of these processes have since been simplified, but not enough—and then the pandemic hit.
While Price expected the pandemic to exacerbate physician stress, what he didn't anticipate were the shortages of personal protective equipment and the “politicization of the pandemic,” he said, all of which added an additional burden on doctors.
Female physicians reported frequent burnout more than men, possibly due in part to the dual roles they play at work and at home as primary homemakers or child caregivers. Price acknowledged that there is no doubt industrywide sexism and harassment against women also factor into the disparity in burnout rates between men and women.
More than half of physicians also experienced inappropriate feelings of anger or anxiety, but only 14% sought medical help. These feelings were more prevalent among primary care doctors and those employed by a hospital or health system, in part due to the potential for exposure to COVID-19 patients.
The survey noted that these findings have “shined a bright light on the stigma still associated with medical professionals seeking mental health care.” Many physicians feel they will be seen as incompetent doctors if they seek medical help, according to Price. They may feel they must be “perfect resources for their patients,” he said.
Historically, he explained, state regulatory bodies have contributed to this ingrained perception by asking questions on job or medical license applications that made physicians uncomfortable admitting to seeking help or feeling their job or license is at risk for doing so. Even though most states have since removed such probing questions, physicians might not be aware of the legal protections afforded to them, Price noted.
The survey also found that less than half of physicians would recommend medicine as a career, a number that has steadily dropped from the last recorded peak in 2014 through 2020, going up two percentage points this year.
Most physicians identified their family, friends and colleagues as most helpful to their mental health during the pandemic. For that reason, Price said, it’s critical to educate these groups on how to recognize signs of burnout or mental distress in physicians so that they can encourage them to seek help.
To that end, the Physicians Foundation runs the Vital Signs initiative and recently launched a template for physicians to develop personal crisis management plans, which have been shown to be used by doctors when they're in place.
More than 70% of physicians believe in a multipronged approach to addressing mental health in the field, according to the survey. Some solutions specified included therapy, peer support groups and evidence-based professional training to prevent mental strain and illness. It’s critical to teach students about burnout symptoms and prevention, Price said, before they’re in the field.
An “acknowledgment of what burnout looks like and what resources should be available in the future, that's got to be a critical part of any young physician’s training, somewhere along the line,” Price said. “Certainly before or early in residency at the latest.”
One-fifth of doctors surveyed reported knowing someone who considered, attempted or died by suicide since the start of the pandemic. Even before the pandemic, physicians had a high suicide rate, with roughly one doctor dying a day. Nearly a quarter of physicians surveyed said they’d like to retire in the next year.
While the survey—the questions on which were purposely limited to only seven to avoid adding to physician survey fatigue—did not include a racial breakdown of responses, Price imagines the results to be only worse for minority doctors, who already face unique challenges and barriers in the field.
In all, these findings reinforce concerns that have long plagued the industry; namely, that poor physician well-being is consistently linked to poor healthcare outcomes.
“It is in the public’s interest to help maintain physician well-being and lower levels of physician burnout because healthy, engaged physicians generally provide better care than unhealthy, disengaged physicians,” the survey stated.
“I don’t think the burnout problem is going to go away no matter what, at least not in the near future,” Price said.