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

Karen E A Burns; Marc Moss; Edmund Lorens; Elizabeth Karin Ann Jose; Claudio M Martin; Elizabeth M Viglianti; Alison Fox-Robichaud; Kusum S Mathews; Kathleen Akgun; Snigdha Jain; Hayley Gershengorn; Sangeeta Mehta; Jenny E Han; Gregory S Martin; Janice M Liebler; Renee D Stapleton; Polina Trachuk; Kelly C Vranas; Abigail Chua; Margaret S Herridge; Jennifer L Y Tsang; Michelle Biehl; Ellen L Burnham; Jen-Ting Chen; Engi F Attia; Amira Mohamed; Michelle S Harkins; Sheryll M Soriano; Aline Maddux; Julia C West; Andrew R Badke; Sean M Bagshaw; Alexandra Binnie; W Graham Carlos; Başak Çoruh; Kristina Crothers; Frederick D'Aragon; Joshua Lee Denson; John W Drover; Gregg Eschun; Anna Geagea; Donald Griesdale; Rachel Hadler; Jennifer Hancock; Jovan Hasmatali; Bhavika Kaul; Meeta Prasad Kerlin; Rachel Kohn; D James Kutsogiannis; Scott M Matson; Peter E Morris; Bojan Paunovic; Ithan D Peltan; Dominique Piquette; Mina Pirzadeh; Krishna Pulchan; Lynn M Schnapp; Curtis N Sessler; Heather Smith; Eric Sy; Subarna Thirugnanam; Rachel K McDonald; Katie A McPherson; Monica Kraft; Michelle Spiegel; Peter M Dodek; Diversity-Related Research Committee of the Women in Critical Care (WICC) Interest Group of the American Thoracic Society

doi:10.1097/CCM.0000000000005674

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

Crit Care Med. 2022 Dec 1;50(12):1689-1700. doi: 10.1097/CCM.0000000000005674. Epub 2022 Oct 27.

Authors

Karen E A Burns^{1

2}, Marc Moss³, Edmund Lorens², Elizabeth Karin Ann Jose⁴, Claudio M Martin⁵, Elizabeth M Viglianti⁶, Alison Fox-Robichaud⁷, Kusum S Mathews⁸, Kathleen Akgun⁹, Snigdha Jain¹⁰, Hayley Gershengorn¹¹, Sangeeta Mehta^{2

12}, Jenny E Han¹³, Gregory S Martin¹³, Janice M Liebler¹⁴, Renee D Stapleton¹⁵, Polina Trachuk¹⁶, Kelly C Vranas¹⁷, Abigail Chua¹⁸, Margaret S Herridge^{2

19}, Jennifer L Y Tsang²⁰, Michelle Biehl²¹, Ellen L Burnham²², Jen-Ting Chen²³, Engi F Attia²⁴, Amira Mohamed²⁵, Michelle S Harkins²⁶, Sheryll M Soriano²⁷, Aline Maddux³, Julia C West²⁸, Andrew R Badke²⁹, Sean M Bagshaw³⁰, Alexandra Binnie³¹, W Graham Carlos³², Başak Çoruh³³, Kristina Crothers³⁴, Frederick D'Aragon³⁵, Joshua Lee Denson³⁶, John W Drover³⁷, Gregg Eschun³⁸, Anna Geagea³⁹, Donald Griesdale⁴⁰, Rachel Hadler⁴¹, Jennifer Hancock⁴², Jovan Hasmatali⁴³, Bhavika Kaul⁴⁴, Meeta Prasad Kerlin⁴⁵, Rachel Kohn⁴⁵, D James Kutsogiannis⁴⁶, Scott M Matson⁴⁷, Peter E Morris⁴⁸, Bojan Paunovic⁴⁹, Ithan D Peltan⁵⁰, Dominique Piquette⁵¹, Mina Pirzadeh⁶, Krishna Pulchan⁵², Lynn M Schnapp^{53

54}, Curtis N Sessler⁵⁵, Heather Smith⁵⁶, Eric Sy⁵⁷, Subarna Thirugnanam⁵⁸, Rachel K McDonald⁵⁹, Katie A McPherson⁶⁰, Monica Kraft⁶¹, Michelle Spiegel⁶², Peter M Dodek⁶³; Diversity-Related Research Committee of the Women in Critical Care (WICC) Interest Group of the American Thoracic Society

Affiliations

¹ Unity Health Toronto - St. Michaels Hospital, Toronto, ON, Canada.
² Department of Medicine and the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
³ University of Colorado - Anschutz Medical Campus and Children's Hospital of Colorado, Aurora, CO.
⁴ Royal College of Surgeons of Ireland - Bahrain Campus, Adiiya, Bahrain.
⁵ Division of Critical Care, London Health Sciences, London Health Sciences Centre, London, ON, Canada.
⁶ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.
⁷ Division of Critical Care, McMaster University, Department of Medicine, Hamilton, ON, Canada.
⁸ Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
⁹ Section of Pulmonary, Critical Care & Sleep Medicine, VA Connecticut Healthcare System, West Haven, CT.
¹⁰ Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT.
¹¹ Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL.
¹² Sinai Health, Toronto, ON, Canada.
¹³ Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA.
¹⁴ Division of Pulmonary, Critical Care and Sleep Medicine, University of Southern California, Los Angeles, CA.
¹⁵ Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Vermont Larner College of Medicine, Burlington, VT.
¹⁶ Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, New York University Langone Health, New York, NY.
¹⁷ Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health & Science University, Portland, OR.
¹⁸ Stony Brook School of Medicine, Stony Brook, NY.
¹⁹ Interdepartmental Division of Critical Care Medicine, University of Toronto, University Health Network, Toronto, ON, Canada.
²⁰ Niagara Health, St. Catharines, ON, Canada.
²¹ Departments of Critical Care Medicine and Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
²² Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Bronx, NY.
²³ Harborview Medical Center, University of Washington, Seattle, WA.
²⁴ Division of Critical Care Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
²⁵ Division of Pulmonary, Critical Care and Sleep, Department of Internal Medicine, Montefiore Medical Center, Bronx, NY.
²⁶ Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of New Mexico, Albuquerque, NM.
²⁷ OSF Medical Group Pulmonary and Critical Care Division, Order of St Francis (OSF) Healthcare, Peoria, IL.
²⁸ Department of Pediatrics, Section of Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
²⁹ Pulmonary and Critical Care, LDS Hospital, Intermountain Healthcare, Salt Lake City, UT.
³⁰ Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada.
³¹ Department of Critical Care Medicine at William Osler Health System, William Osler Health System, Toronto, ON, Canada.
³² Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
³³ Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA.
³⁴ Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Veterans Affairs Puget Sound Health Care, Seattle, WA.
³⁵ Department of Anesthesia, University de Sherbrooke, Sherbrooke, QC, Canada.
³⁶ Section of Pulmonary Diseases, Critical Care, and Environmental Medicine, Tulane University School of Medicine, New Orleans, LA.
³⁷ Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.
³⁸ Section of Critical Care, University of Manitoba, Winnipeg, MB, Canada.
³⁹ Division of Critical Care, Department of Medicine, North York General Hospital, Toronto, ON, Canada.
⁴⁰ Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia. Vancouver, BC, Canada.
⁴¹ Department of Anesthesia, University of Iowa Hospital and Clinics, Iowa City, IA.
⁴² Department of Critical Care, Dalhousie University, Halifax, NS.
⁴³ Department of Critical Care, Health Sciences Centre, Winnipeg, MB, Canada.
⁴⁴ Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA.
⁴⁵ Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
⁴⁶ Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
⁴⁷ Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS.
⁴⁸ University of Kentucky College of Medicine, Lexington, KY.
⁴⁹ Department of Internal Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada.
⁵⁰ Division of Pulmonary/Critical Care Medicine, Department of Medicine, Intermountain Healthcare, Salt Lake City, UT.
⁵¹ Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
⁵² Division of Critical Care Medicine, Horizon Health Network, Fredericton, NB, Canada.
⁵³ Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
⁵⁴ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
⁵⁵ Department of Medicine, Section of Critical Care, Virginia Commonwealth University Health System, Richmond, VA.
⁵⁶ Grace Hospital, Winnipeg, MB, Canada.
⁵⁷ Regina General Hospital, Regina, SK, Canada.
⁵⁸ Markham Stouffville Hospital, Markham, ON, Canada.
⁵⁹ Washington University School of Medicine, St. Louis, MO.
⁶⁰ Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
⁶¹ University of Arizona College of Medicine, Tucson, AZ.
⁶² Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, SC.
⁶³ St Pauls Hospital, Vancouver, BC, Canada.

Abstract

Objectives: 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.

Publication types

Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adaptation, Psychological
Adult
Burnout, Professional* / epidemiology
COVID-19*
Child
Cross-Sectional Studies
Female
Humans
Intensive Care Units
Male
North America
Pandemics
Physicians*
Surveys and Questionnaires
United States / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding