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How the COVID-19 Pandemic Has Affected Physician Economic Burden and Workload

In results of a national survey, investigators pieced together a look at the psychological toll of the pandemic on physicians and identified the biggest stressors.

In addition to the 40 million cases worldwide and the million-plus lives claimed, the coronavirus disease 2019 (COVID-19) pandemic has also inflicted enormous strain on physicians and the business of health care in terms of economic burden and increased workload. A portion of health care facilities may be operating with severely limited resources, while some physicians are working 24/7 around the clock and burning out at a furious pace. Still, other practices have been unable to survive financially at all and have been forced to shutter.

In results of a national survey, presented virtually at ID Week 2020, investigators with the University of Alabama at Birmingham pieced together a look at the psychological toll of the pandemic on physicians and identified the biggest stressors.

"Early in the US pandemic, I noted the distress physicians expressed on social media and among work colleagues," Greer A. Burkholder, MD, MSPH, assistant professor at the University of Alabama at Birmingham, and presenting author of the study, told Contagion®. "At that time, there wasn't much in the academic literature regarding the impact of the pandemic on US healthcare workers. Healthcare workers are in an unprecedented situation and I think it is important we study the effects of the pandemic on physicians and other healthcare workers in a systematic way."

Using QualtricsXM software, the team developed a 31-question survey that covered everything from adverse economic impact (defined as selecting job loss, furlough, or reduced income as a stressor) to workload to compensation. The questionnaire, to be completed anonymously, was sent around via email, shared on physician professional and social media networks, and passed around #MedicalTwitter between May 14 and July 31, 2020.

A total of 295 of the 597 respondents (49%) reported some adverse economic impact, with the strongest impact being felt among emergency medicine (71%), anesthesiologists (63%), and surgeons (60%). Infectious disease specialists reported the least adverse economic impact (25%).

When stratified by geographic region, physicians in the Northeastern United States reported the least economic impact (28.1%) compared with the South, which saw the highest rate of economic impact (57.8%) (OR 3.44, 95% CI: 2.03-5.84).

Those medical professionals in the community setting saw more of an economic impact than those in federal or academic settings.

A total of 185 (31%) of respondents cited increased work hours as a key stressor, and 92% of that group reported that the additional hours were either partially or completely uncompensated.

The pandemic necessitated new roles and responsibilities for 212 of 584 respondents (36%), mostly among infectious diseases physicians (75%).

Overall, investigators determined that the pandemic has triggered an increased workload and the absorption of new roles and responsibilities

“The COVID-19 pandemic has increased physician workload, with approximately one-third of physicians taking on new responsibilities and a similar proportion reporting increased work hours. Much of this additional work is uncompensated due to the economic impact of the pandemic on the health care system,” the team concluded.

“Simultaneously, many physicians across the US have suffered adverse economic consequences, especially in the South. ID physicians have experienced higher workload but less economic impact, related to increased need for their expertise and new roles and responsibilities.”

Burkholder emphasized the need to recognize that these circumstances pose a risk for burnout and diminished well-being among US physicians.

"There is a general awareness that these types of stressors are occurring, however it is important to have actual data to illustrate how prevalent they are," he said.

The study, “Economic and workload impact of COVID-19 pandemic on physicians in the United States: Results of a national survey,” was presented virtually at ID Week 2020.