The COVID-19 pandemic has placed an extraordinary amount of stress on physicians and other health professionals. But those elevated levels of stress and burnout are not hitting all equally, according to the results of a national survey of more than 20,000 doctors and others working in health care.
Published in The Lancet open-access journal EClinicalMedicine, “Prevalence and correlates of stress and burnout among U.S. healthcare workers during the COVID-19 pandemic: A national cross-sectional survey study,” was co-written by researchers from the AMA and Hennepin Healthcare in Minneapolis.
Between May 28 and Oct. 1, 2020, using the AMA Coping with COVID-19 for Caregivers Survey, 42 health care organizations across the U.S. assessed their workers’ stress during the pandemic. The survey of 20,947 physicians and other workers found that 61% of those surveyed felt high fear of exposing themselves or their families to COVID-19 while 38% self-reported experiencing anxiety or depression. Another 43% suffered from work overload and 49% had burnout.
Stress scores were highest among nursing assistants, medical assistants, social workers and inpatient workers—such as nurses, respiratory therapists, nursing assistants and housekeepers—as well as among women, Black and Latinx health care workers. But odds of burnout were 40% lower in those who felt valued by their organizations, which was 46% of respondents.
Out of the 20,947 respondents, 3,128 were doctors and 303 were resident physicians. For physicians, about 30% experienced high stress, which was similar to the overall results of the survey. Half of physician respondents reported fear of exposure as the reason for their high stress compared to 60.76% overall. A quarter of physicians also experienced anxiety with 37.3% having work overload and 47.73% reporting symptoms of burnout. But 37% of physicians had a restored sense of purpose during the pandemic and 50% felt valued by their organization, which is slightly higher than the overall rate of 45.9%.
For resident physicians, 27% experienced high stress, of which 53.47% was attributed to fear of exposure. About 30% of residents also reported anxiety and work overload throughout the pandemic. Additionally, 50.5% of residents reported symptoms of burnout while 44.88% exhibited a sense of purpose and 42.9% felt valued by their organization—slightly lower than the overall rate.
Women were predominant in health-professional roles with high stress levels. For the study, those levels incorporated stress, fear of exposure, anxiety or depression, and workload. Such roles include nurses, nursing assistants, medical assistants and social workers.
Nearly half of women experienced burnout, the survey found. For men, 41.5% experienced burnout during the pandemic. Meanwhile, 61.2% of women feared exposure and transmission compared with 54% of men. And more common among women was self-reported prevalence of anxiety and depression—39.3% of women compared with 26.4% of men.
Additionally, 42.2% of women experienced increased stress due to work overload. For men, 37.7% experienced work overload. On the flip side, most men said they felt valued by their organizations—55.5%—compared with 45.9% of women.
For the 1,730 respondents who did not list a gender or identified as nonbinary, stress and burnout scores were substantially higher than among women or men.
Among Black and Latinx health professionals, increased stress was tied to fear of COVID-19 exposure. The survey found that 70.1% of Black and 74.4% of Latinx workers experienced fear of exposure, compared with 56% of white workers.
Stress summary scores were also higher among African American and Latinx health care workers. This is because they comprised large proportions of high stress-summary score roles such as nursing assistants, housekeepers, laboratory staff and medical assistants. Burnout rates, however, were slightly to moderately lower in these groups.
With almost half of workers indicating burnout, certain allied health professionals reported the highest rates—in the 60% range. Those were speech therapists, occupational therapists and social workers.
Self-reported mental health symptoms of increased anxiety and depression were also prevalent among these health workers—in the 50% range.
“Future studies should investigate the structural reforms needed to sustain our healthcare workers as valued human beings existing at the intersection of calling and crisis,” the study’s authors concluded.
The AMA offers resources to help physicians manage their own mental health and well-being during the COVID-19 pandemic and provides practical strategies for health system leadership to consider in support of their physicians and care teams during COVID-19.