Wellness and Coping of Physicians Who Worked in ICUs During the Pandemic: A Multicenter Cross-Sectional North American Survey*
Authors: Burns Karen E. A. , Moss Marc , Lorens Edmund , Jose Elizabeth Karin Ann , Martin Claudio M. , Viglianti Elizabeth M. , Fox-Robichaud Alison , Mathews Kusum S. , Akgun Kathleen , Jain Snigdha , Gershengorn Hayley , Mehta Sangeeta , Han Jenny E. , Martin Gregory S. , Liebler Janice M. , Stapleton Renee D. , Trachuk Polina , Vranas Kelly C. , Chua Abigail , Herridge Margaret S. , Tsang Jennifer L. Y. , Biehl Michelle , Burnham Ellen L. , Chen Jen-Ting , Attia Engi F. , Mohamed Amira , Harkins Michelle S. , Soriano Sheryll M. , Maddux Aline , West Julia C. , Badke Andrew R. , Bagshaw Sean M. , Binnie Alexandra , Carlos W. Graham , Çoruh Başak , Crothers Kristina , D’Aragon Frederick , Denson Joshua Lee , Drover John W. , Eschun Gregg , Geagea Anna , Griesdale Donald , Hadler Rachel , Hancock Jennifer , Hasmatali Jovan , Kaul Bhavika , Kerlin Meeta Prasad , Kohn Rachel , Kutsogiannis D. James , Matson Scott M. , Morris Peter E. , Paunovic Bojan , Peltan Ithan D. , Piquette Dominique , Pirzadeh Mina , Pulchan Krishna , Schnapp Lynn M. , Sessler Curtis N. , Smith Heather , Sy Eric , Thirugnanam Subarna , McDonald Rachel K. , McPherson Katie A. , Kraft Monica , Spiegel Michelle , Dodek Peter M. ,   for the Diversity-Related Research Committee of the Women in Critical Care (WICC) Interest Group of the American Thoracic Society
Published: October 2022

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.