Multicenter Study

. 2022 Dec 1;50(12):1689-1700.

doi: 10.1097/CCM.0000000000005674. Epub 2022 Oct 27.

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

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.

PMID: 36300945
PMCID: PMC9668381
DOI: 10.1097/CCM.0000000000005674

Multicenter Study

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

Karen E A Burns et al. Crit Care Med. 2022.

. 2022 Dec 1;50(12):1689-1700.

doi: 10.1097/CCM.0000000000005674. Epub 2022 Oct 27.

Authors

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.

PMID: 36300945
PMCID: PMC9668381
DOI: 10.1097/CCM.0000000000005674

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.

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Conflict of interest statement

Dr. Burns disclosed that the Canadian Critical Care Society (CCSS) paid for the statistical analyses. Dr. Lorens received funding from the CCCS. Drs. Lorens and Kerlin disclosed work for hire. Drs. Viglianti, Kohn, Peltan, and Schnapp received support for article research from the National Institutes of Health (NIH). Dr. Fox-Robichaud’s institution received funding from the Canadian Institutes of Health Research and Hamilton Academic Hospitals. Dr. Mathews’ institution received funding from the National Heart, Lung, and Blood Institute (NHLBI); he received funding from Roivant/Kinevant Sciences. Dr. Jain is supported by the National Institute on Aging (NIA) T32AG019134, the Pepper Scholar Award from Yale Claude D. Pepper Older American Independence Center (P30AG021342), NIA of the NIH GEMSSTAR Award (R03AG078942), Parker B. Francis Fellowship Award, and Yale Physician-Scientist Development Award. Drs. Akgun and Crothers disclosed government work. Dr. Gershengorn received funding from the American Thoracic Society (ATS), Gilead Sciences, and Southeastern Critical Care Summit. Dr. Martin’s institution received funding from BARDA; he received funding from Genetech. Dr. Stapleton disclosed that she is chair of DSMB for Altimmune and a member of the ATS Board of Directors 2019–2021 (elected to Chair the Critical Care Assembly which includes a position on the Board). Dr. Attia’s institution received funding from the NHBLI (NHLBI K23 HL129888 and R03 [pending]), the Centers for Aids Research, and Pediatric HIV/AIDS Cohort Study. Dr. Maddux’s institution received funding from the National Institute of Child Health and Human Development (K23HD096018) and the Francis Family Foundation. Dr. Bagshaw received funding from Baxter and Bioporto. Dr. Crothers’ institution received funding from the NIH and Veteran’s Affairs. Dr. Peltan’s institution received funding from Regeneron and Asahi Kasei Pharma; he received funding from the NIH (K23GM129661) and Janssen. Dr. Schnapp received funding from UptoDate and Elsevier. Dr. Kraft’s institution received funding from the NIH, the American Lung Association, Sanofi, and AstraZeneca Consulting; she received funding from Sanofi, Astra-Zeneca, Chiesi Speaking, and UptoDate; she disclosed she is a cofounder and Chief Medical Officer of RaeSedo LLC. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

**Figure 1.**
Responses to the Stanford professional fulfillment index. Depicts physician responses to each of the questions in the three domains of the Stanford professional fulfillment (23) including professional fulfillment six items), work exhaustion (four items), and interpersonal disengagement (six items).

**Figure 2.**
Physicians’ use of coping strategies during the pandemic. Depicts physician’s self-reported use of each of the 14 coping strategies included in the Brief Cope (24) instrument.

See this image and copyright information in PMC

Comment in

The Smoldering Embers of Physician Burnout: The Pandemic Within the Pandemic.
Chalfin DB. Chalfin DB. Crit Care Med. 2022 Dec 1;50(12):1819-1821. doi: 10.1097/CCM.0000000000005694. Epub 2022 Nov 17. Crit Care Med. 2022. PMID: 36394397 No abstract available.

References

1. Burns KEA, Fox-Robichaud A, Lorens E, et al. ; Canadian Critical Care Society: Gender differences in career satisfaction, moral distress, and incivility: A national, cross-sectional survey of Canadian critical care physicians. Can J Anaesth. 2019; 66:503–511 - PubMed
1. Hossain F: Moral distress among healthcare providers and mistrust among patients during COVID-19 in Bangladesh. Dev World Bioeth. 2021; 21:187–192 - PMC - PubMed
1. Hines SE, Chin KH, Glick DR, et al. : Trends in moral injury, distress, and resilience factors among healthcare workers at the beginning of the COVID-19 pandemic. Int J Environ Res Public Health. 2021; 18:E488. - PMC - PubMed
1. Dodek PM, Cheung EO, Burns KEA, et al. : Moral distress and other wellness measures in Canadian critical care physicians. Ann Am Thorac Soc. 2021; 18:1343–1351 - PubMed
1. Bruce CR, Miller SM, Zimmerman JL: A qualitative study exploring moral distress in the ICU team: The importance of unit functionality and intrateam dynamics. Crit Care Med. 2015; 43:823–831 - PubMed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical