Pandemic takes a toll on physician mental health

Stress, depression and exhaustion from the COVID-19 pandemic took a toll on family medicine physicians in Kansas, a new study found.

More than half of family doctors surveyed last year – 50.4% – reported at least one sign of burnout, experienced emotional exhaustion or felt a higher level of personal stress, especially those who treated confirmed or presumed-positive COVID-19 patients.

“This is very serious,” said lead author Samuel Ofei-Dodoo, PhD, MPH, CPH, an assistant professor and researcher at University of Kansas School of Medicine-Wichita in the Department of Family and Community Medicine. Ofei-Dodoo, along with fellow researchers Colleen Loo-Gross, MD, MPH, and Rick Kellerman, MD, published their findings in the May-June 2021 edition of the Journal of the American Board of Family Medicine.

Physicians who treated confirmed or presumptive COVID-19 patients were four times more likely to report at least one manifestation of professional burnout and three times more likely to experience emotional exhaustion than those who did not treat COVID-19 patients, Ofei-Dodoo said.

“Family physicians were on the front lines of the pandemic,” he said. “During COVID last year, things became very, very stressful, very fast. We know people are leaving the medical profession. They are taking early retirement – they want to quit because they are burning out. It is important for us to tackle this head on.”

Before the pandemic, KUSM-W researchers had already found that nearly half of Wichita-area physicians were experiencing signs of burnout, which is associated with symptoms of depression, fatigue, suicidal ideation and intentions to leave the medical profession via early retirement or career change. That study, published in May 2019, found that 49.5% of MSSC physicians surveyed exhibited signs of burnout, a slightly higher rate than physicians nationally.

“It was already an area of concern,” Ofei-Dodoo said.

It’s important to note, however, as COVID-19 variants seem poised to ramp up infections across the U.S. again, this latest study was conducted in May and June of 2020, when COVID-19 was still new and physicians didn’t know a lot about it yet.

“There was a lot of fear and uncertainty,” Kellerman said. “I don’t think we can take these results and say we would have gotten the same had we done it in November and December, certainly not February or March 2021 when most of us were vaccinated by then.”

What stood out last year was that physicians were scared – worried about getting sick themselves, and scared of transmitting the virus to their families. Another surprising side result was the level of anxiety among doctors who had not treated COVID-19 patients. Their stress levels were ratcheted up compared to doctors treating COVID-19 patients and becoming more familiar with it. The fear of the unknown had a profound effect on many physicians, Ofei-Dodoo said.

Still, before the COVID-19 pandemic, the risk of burnout and stress-related problems such as depression and anxiety in physicians had been identified as an important area of public health concern, researchers said.

Physicians, compared with the general population, are at higher risk of experiencing symptoms of burnout and a dissatisfaction with work-life balance, the authors wrote. This is especially true for family physicians, along with those in emergency and internal medicine, particularly in rural areas.

“Physicians with burnout are more likely to experience motor vehicle accidents, mood disorders, and substance and alcohol abuse,” the authors wrote. Other studies have shown that burnout also is associated with an increased risk of medical errors and malpractice, with decreases in quality of care, productivity and patient satisfaction.

Researchers said this latest study should serve as a tool to determining wellness interventions and developing physician support systems, including wellness and mental health support initiatives at local, state and national levels.

Even now, Ofei-Dodoo and colleagues are spearheading studies to help physicians deal with stress and burnout. One study, which was funded by the Via Christi Foundation and is currently under review to be published, revolved around a mindfulness-based stress reduction program.

Researchers found there was a significant reduction in measures of anxiety and stress, as well as improvements in resilience and compassion. Ofei-Dodoo said he’s also working on a yoga-centric intervention to reduce stress and is writing a paper on that as well.

“We are local. We are doing everything to help folks in Kansas,” Ofei-Dodoo said. “Organizations like the Medical Society help by recognizing the emotional effect stress has on physicians and their well-being, and ensuring appropriate programs are in place to provide emotional, mental and physical help and social support.”