A Closer Look at Frontline Physicians

How has COVID-19 affected physicians? (survey)

“We are heroes in our community and lepers at home.”

There are many misconceptions about physicians and the challenges they face during the coronavirus outbreak. From financial struggles to worries about family to uncertainty for the future, we are all affected by living in a pandemic.

About the survey.

Study Objective: Our objective was to understand how physicians – who are already burned out and in short supply in normal periods – are being affected by COVID-19 both personally and professionally.

Participants

120,246 members of the Jackson + Coker physician database were invited to participate.
681 physicians completed the survey for a response rate of 0.56%.

Respondents represent all major specialties:

Behavioral Health.
Internal Medicine and Internal Medicine Subspecialties.
Surgery.
Anesthesiology.
Hospital-based Medicine.
Infectious Disease.
Pulmonary Medicine.
Diagnostic Medicine.
Women’s Medicine.
Musculoskeletal Medicine and Pediatrics.
- Each specialty reported caring for COVID-19 patients to some degree.

Executive summary.

Physicians are feeling, perhaps even more intimately, the same financial, emotional, physiological effects that all Americans are struggling with under COVID-19. Heroes at work, lepers at home, physicians are tasked with having all the answers and being strong when no one has the answers right now. Furthering that stress is the fact that physicians may not be able to seek comfort from family because of their possible exposure to COVID-19 patients.

This report provides the unaided raw emotions shared by physicians during this unprecedented time.

Additional data points collected:

Internal Med Subspecialists (21%), Surgery and Anesthesiology (45%), Women’s Specialists (18%) are all most likely to say they’ve had surgeries and procedures canceled.
Infectious Disease and Pulmonary specialists (15%) are most likely to have seen an increased number of cases.
Women’s Medicine Specialists are most likely to report a pay cut (27%) and reduced number of visits (49%). Internal Med Subspecialists are also likely to report a reduced number of visits (43%).
Behavioral Health (40%), Internal Med Subspecialists (26%), Internal Med Generalists (35%), and Musculoskeletal Med Specialists (29%) are most likely to be implementing telehealth.

"Professionally, financially, and physically I believe most of us are fine. Emotionally, many of us are juggled, racked, and drained. We are heroes in our community but lepers at home, now spending more time alone, with fewer kisses and hugs from our loved ones. Emergency medicine, an already stressful position, is now even more stressful. The hardest part is separating people from their families. People now sit outside in their car while we evaluate their loved ones. Patients admitted with suspicion for COVID-19 infection are allowed to briefly visit with them before being transferred to our COVID-19 unit, not realizing that this is the last time they might see their family. We evaluate their loved ones."

47% of physicians shared financial fears.

Student loan debt, pay cuts, and practice overhead weigh heavily.

"With people losing their health insurance as a result of not being able to work, and with the loss of elective surgeries and procedures, many physicians are being forced to take a pay cut. The general misconception is that physicians are wealthy but that is not necessarily true. We may be still paying our education loans back, or barely coming out of debt to start some mild degree of financial freedom. Even though COVID has put many people in the hospital there have been major cuts in pay in order to provide one mask per provider that is being reused over and over and losing Its efficiency. On top of that, we have to face the terrifying thoughts that we may bring COVID home to our families and potentially get them sick or worse, kill them. We don't have the luxury to wait in lines for countless hours for essentials such as toilet paper which has been gone from shelves for several weeks now. We wake up understanding every day that we have to attend to the sick at any price because that's our job, but this has affected us in a very unexpected and devastating way as it has many people who are still losing income themselves and terrified of the overall effects COVID is having on all of us."

"Being at home doing telemedicine has been very isolating. I had to quarantine as I was coughed on by a PUI when testing her without proper gear (she was positive). I am grateful that I am not in regular contact with ICU patients but feel guilty for not being part of the frontlines. This is the first time I have seen my husband afraid. My daughter is a third year medical student and she has been on the Health Department hotline for the PUI numbers. That has been like watching the news 24/7 with every sick patient being called in to our house. Some of them crashed while the staff was trying to get the PUI number. Financially, it has brought my practice to its knees. I am able to do enough telemedicine calls to pay my office manager and the utilities. I have not been paid for over a month and I have had to put the mortgage on hold for my office and my home."

"Significant drop in business, but I still need to be there for refills, reviewing labs & tests, calling patients with results, reading consults, dealing with calls, questions etc. There's always hours of this kind of unpaid work, as usual, but time at the office is much less. I can do some telephone visits, but some have to be seen in person, which increases risk. (l am in solo practice, internal medicine, part-time.) My rent, insurance, equipment etc. and my MA still have to be paid."

Already burdened, physicians have to take on more responsibilities to keep their practice afloat.

"So far 9 out of 10 of my obstetrical patients that I delivered in the last several weeks were COVID-19 positive. My office hours are about 10% of what they were pre-COVlD-19. My two secretaries have not come to work for two weeks. They are afraid to come to work even though they would be considered essential employees and hence allowed to work. After two weeks in the office alone, I am finally caught up with my work and the secretaries' work."

"Doing triple duty - my clinical job, admin's job of helping to figure out logistics / supplies, being a "student" at the same time preparing for the a major life-and-death "exam," worrying about my colleagues, & worrying about how to protect the family & the COMMUNITY. Additional time & stress for prepping & cleaning after the day. Daily additional "studying" time to review: journal articles for therapies, disease process, methods for saving PPE, new testing methods. Amidst this - having to read in-between the POLITICS & China's PROPAGANDA (that is also promoted by the US media & politicians)!!! Dealing with the disinformation already disseminated to the public!!"

Patient census is heavily impacted.

"It has lowered the number of patients coming into our practice. Patents have been scared and are unfortunately delaying care even for more urgent problems."

"l work at a university health center and we take care of students. We currently have no patients as the university is closed and the students are sheltering in place at home. We are doing administrative tasks in the meantime. We may be called to the frontline to help with the surge of patients in local hospitals. This virus has affected everyone."

Physicians younger than 65 (24%) are more likely to report practice anxiety.
Physicians younger than 45 (most likely to be employed) are more likely to mention RVUs, billing and
reimbursement (10%).

Telehealth is not a magic bullet if patients refuse technology.

"Less revenue due to less patients being seen. Patients are not embracing telehealth. Putting on PPE with seeing well patients in addition to sick patients in the parking lot, We have had at least four positive patients out of the first 25 symptomatic patients tested. Reusing PPE since we are a small practice and haven't seen any PPE through governmental agencies. Staffing changes..."

"We have split our practitioners and staff into 3 groups, sick clinic, well clinic and furlough. Once at the sick clinic you cannot come back to the well clinic. At the well clinic, we have 4 practitioners on any one day when we usually have 10 to 12 - although we are seeing less patients and not doing much telehealth (as our patient population is older and does not have the technology available) we are doing more phone calls, more drug refills and more trouble shooting covering our colleagues Who are out and in the sick clinic, doubling and tripling our non-patient contact work. This provides a different kind of fatigue and stress none of its are used to. We have 2 to 3 daily meetings we did not have before to update us on statistics and preparedness. (Our system is doing well and has utilized good foresight so we are as prepared as can be expected, especially considering we are a rural location). As most offices we were stretched thin before the pandemic, it is now even more so. We have a great staff, but you can feel the strain. The system has been supportive with having group and individual employee mental health counseling available."

33% of physicians expressed some type of emotional effect, stress or anxiety.

"l have lost an older brother and a childhood friend. My older brother had no preexisting conditions and was physically fit for his age. My childhood friend was married to a nurse, who practiced in NYC. She probably gave it to him. Both died alone. Both cannot be mourned with normal funerals, where friends and family can gather. We are not even sure we can collect their bodies from the hospital because the funeral homes in NY are overwhelmed. We are scared to travel in airports and public transportation in any way, for fear of being infected. I have lost friends and family and significant finances. Emotionally, I am a wreck and exhausted. Financially, soon I will be broken, if elective procedures and volumes from those type of studies don't come back soon. Physically, am alive and not afflicted with this disease, but I admit I am scared of it, and respect it highly and wish people would understand it is not a hoax and that social distancing, wearing masks and taking every precaution to be considerate of other people's spaces is so important in curtailing the lethality of this disease."

"It's been a time of extremely high stress. Worrying about patients that can't be seen, no income, worrying about paying bills, worrying about what practice will be like once I go back to work, worrying about my employees that I've laid off."

"Never in my life have felt this scared. I used to love what do, caring for patients but currently it's just fear, I physically feel sick and exhausted of thinking, afraid to bring this virus home and leave my children orphan and at the same time would like to help my patients but I can't as we don't have any treatment to give. I feel really frustrated about everything. Also the difficulty in getting adequate PPEs is exhausting."

"l am a physician in Urgent Care. We have completely had to restructure how we see patients. Now our day consists of words like "clean" and "dirty" zones relating to where PPE is worn. Now, I never know if a patient that I come in contact with briefly may suddenly decompensate or if they have one issue that seems not related to COVID-19, I always have to be alert and almost paranoid. Many people have been furloughed because some jobs are not needed during this time as some medical services have been reduced."

"l worry about certain patients who are suffering emotionally greatly from the isolation, or have become fearful and anxious watching news constantly. Some are in financial distress, and many have lost their jobs. Others have had to postpone surgeries, treatments like Botox for chronic migraines etc., and this prolongs their suffering. I don't really know what to do to help them. This weighs on me."

There's a general feeling of helplessness.

"Personally: Because of my age and co-morbidities I am in a high risk category. As a retired Army Physician, my wife stated it succinctly. ' You have survived 2 wars and a peacekeeping mission and you come home to be killed by a virus.' Ironic, isn't it? I think I would rather be killed by a bullet than drowning in my own exudate. That scares me. Medicine is my identity. I became a physician to help people and it appears my skills are no longer needed. That saddens me. I fear this Pandemic may result in the collapse of primary care. Financially, I'm OK because I'm a military retiree, even though my income has dropped 60%. This may be the time to finally retire completely from medicine. I'm afraid to look at my 401K and financial assets. I know I won't be able retire as comfortably as I would have back on February 12 2020, before the stock market tanked."

"The thought that my duty to help others might result in my death and the death of people close to me."

"For the first time in my career I've been afraid to go to work. I have been humbled by the power of this virus, I cannot rely on experience to test my patients. I sometimes feel helpless. I am exhausted physically and emotionally. My children are afraid for me. I am reading and studying every day to find ways to save my patients."

"In some ways practicing medicine today is like it was 100 years ago, without sophisticated tests or imaging. We guess, do our best, and feel somewhat helpless, trying not to think about the devastating financial impact of COVID."

"l still take call on urgent things in clinic and continue to see emergencies in the hospital. The hospital feels very different now. There' a foreboding sensation as I don my mask and walk the hallways, once full of supportive families, now quiet as everyone is at home. My clinic staff is working 8-12 hours per week instead of the usual 40+. We are all taking pay cuts, many are furloughed. I have stacks of charts of patients who need tubes, tonsils, sinus surgery, but we cannot do those procedures now. I am "practicing" medicine in ways we were really never trained for. How do you tell a mom her child's 7th ear infections doesn't warrant tubes right now and we don't know when it will? The sleepless nights are happening for us as well as for our patients and their families. Everyone is going through something."

"Financially, emotionally - the level of anxiety is to the roof. I feel helpless, I became immunocompromised recently. It kills me not been helping people at this time. I am depressed."

Safety: Lack of PPE makes a stressful job scary. Physicians feel dismissed.

"There's the underlying fear of exposure with every procedure. Even knowing that I have taken all precautions, still concerned when taking off PPE, concern that everyone else has done it properly and not exposed outside surfaces, concern that someone asymptomatic may be contagious."

"Once the hospital administration was convinced by physician leaders of the need for appropriate PPE, the stress and anxiety level has gone way down. Physicians at other locations have not been so fortunate. To be asked by bureaucrats working remotely to put your health and that of your colleagues, patients, and your family at risk because you are prevented from taking appropriate precautions by those same bureaucrats is horrendous. The stories I hear from other physicians is mind blowing."

"It's very different entering rooms of COVID-19 positive patients to say the least. Sometimes there's no N-95 masks and trying to preserve these items for procedures yet the patient coughing into the air directly into your examining personal space is concerning. Seeing previously healthy patients get intubated within 24 hours of admission reminds you how devastating this virus can be."

"The ability of adequate PPE is low and we have been forced to use and re-use our N-95s multiple times, sometimes over 8-10 times, to be supposedly sterilized with UV by our hospital. The full cover jumpsuits are limited. The regular surgical masks are counted and handed over by house supervisor at the beginning of the shift."

Uncertainty: Physicians are trained to have all the answers. COVID goes beyond their training.

"Patient volume significantly down but started telehealth. Having immunocompromised patients to deal with a threat which is still unclear in its natural course means getting constant questions/concerns from patients but it's not the questions volume, it's giving them a satisfactory answer which becomes challenging at times since the medical world is still fighting for the answers."

"As an emergency room physician the pandemic has altered our practice dramatically. Each new patient is another mystery waiting to unfold. Healthy thirty somethings with shortness of breath and young children are probably just having anxiety attacks, however they could also be the next 'needle in the haystack' that needs hospitalization, oxygen, and a ventilator. Elderly people, on the other hand, have every right to be anxious and have been avoiding coming to the hospital for anything, in fear that they might "pick it up" during their visit to the ED for an unrelated problem. Routine orders have gone from being routine to a series of careful, calculated steps to avoid contamination of our facility and coworkers."

"I'm a psychiatrist, doing more telehealth. In my employed position as a medical director for a residential treatment center I'm worrying about things I've never had to deal with — searching for PPE, trying to figure out how much we might need in case our patients get sick, figuring out how to pre-screen admissions for COVID-19, how to protect current patients and staff, spending a lot more of my time doing administrative things, trying to avoid hospitalizing the children."

"The virus has affected me personally, in that it has made me feel ineffective in many ways, in caring for my patients. While I am available by phone and video, to answer questions and handle problems, it is not the same as being with your patient. My income stopped a month ago. Savings are running low. Bills are always looming. I'm usually a positive person, but once in a while, the stress of the situation, lack of normal interaction, can cause some anxiety and depression, to starting to push their way in. Interacting with family and friends, via technology, can be very helpful to quiet those feelings. We all need to be more keenly aware of everyone's feelings and individual needs and concerns. Helping them cope will distract us from our own concerns and help them deal with theirs. Hold into the hope that this will soon pass, and we can gradually get closer to normal."

Distrust: There's a lack of trust among physicians for government agencies and administrators. Physicians feel the system is failing them.

"My wife is high risk and so I take extra precautions at home, get lunch via drive-thru, shop sparingly. Financially, it's a challenge. Emotionally, this is my duty. I contain my anxiety and fears. Patients deserve and require reassurance and a calm presentation. I give them regular updates on COVID-19, based upon quality evidenced based facts, not the alarmist speculations provided by the media in general. I totally disregard what the CDC proposes, having lost my confidence in them."

"Discouraging to watch the bureaucrats attempt to manage something they do not understand. Depressing to see the NIH and CDC so overcome that they refuse to accept any other ideas or specifically to look to any better ways. Better to die in the old way than to die in a new way that could be our fault. Angry, depressed."

"l cannot hug my mom or my kids, cannot console the little ones when they are feeling scared and tell them truthfully that everything will be ok because I may actually die. It feels like I am naked seeing patients without N95s or face shields and reused surgical masks yet I see the people in Wuhan and Italy, etc. wearing head to toe protection. PPES are scarce, no matter what the president believes. As a hospitalist seeing COVID-19 patients daily and listening to their lungs and hearts to guide their management, I am scared. CDC changes it's recommendations based on supply and not data and does not consider me at risk of infection since I am not intubating so my hospital shields itself for lack of PPE by saying they are following CDC guidelines. I feel like the federal government let us down big time. To make matters worse, my order of three measly N95 was confiscated by FEMA so it's like a slap in the face in the middle of trying to get up."

"As a general surgeon, most of what I do saves a life. It is frustrating to have an administrator have the final say as to what is necessary."

Physicians are burdened by COVID in their personal lives and responsible for healing it in their professional lives.

"Personally, it has made people look at me as if I am 'dirty' since I work in the hospital. Regardless of the appropriate PPE used and the fact that I shower and wash my clothing each night as soon as I get home, even my family members step back avoiding things like a hug which would be quite helpful at this time. The weight of knowing that if my family members get ill with this virus it will be directly attributable to me is a burden I would not wish on an enemy. Being kept at more than arm's length to have folks including spouses of all of us really sucks."

"Both my husband and I are ER doctors. We have 2 toddlers at home. We definitely are anxious and worried that we both may get sick, even die, and then our children would be left alone."

"My family is left at home alone, while I tackle the excruciating weight of this horrific virus."

Survey stats:

Physicians under 45 are more concerned about PPE (1 7%), employee’s health (6%), difficulties managing work with children at home (9%), establishing telemedicine platform (3%), say hospitals are not taking care of them (more concerned with profits) (5%).
Physicians under 65 more concerned they’ll pass it to family( 34%), more likely to be stressed (84%).
Physicians over 65 more likely to feel guilty for not being able to help (5%).

Physicians feel the practice of medicine is not what it used to be.

"I feel the compassionate care part of medicine is taking a backseat to clinical efficiency. The time to talk to patients and reassure them is so limited due to sheer numbers as well as the reality that we can't do much in terms of treatment. I never before sent bilateral infiltrates home. 1. Reduced office visits by 20% because of fear. 2, Staff fear. Mostly fear of being affected by an asymptomatic carrier. The lack of asymptomatic carrier prevalence data (i.e. the fear of the unknown) coupled with the constant drumbeat of the 'sky falling' media hype. 3. Virtual visit scramble, 'figuring it out as we go' is not a healthy way to initiate new policies and procedures..."

"I'm frontline as an anesthesiologist. The bread and butter of the hospital elective cases has gone away. however the high risk nature for emergent intubation has exponentially increased. We are faced with hospitals who don't want to support a service because they aren't getting the gravy train they used to have. It's short-sighted."

"Trying to stay open and afloat, we are only seeing about 25% normal volume in office with frequent cancellations on top of that. NO surgery. Tried to keep my staff fully employed, but had to cut 20% hours just to reduce the depth of red I am working in. Nothing to take home for my family for sure from the past 4 weeks. Applied for PPP… terrible blackhole experience with completed applications confirmation a week ago and still no follow-through. Will be accelerating retirement this year, as overhead is greatly exceeding expected reimbursement, and in the current environment, I can't even give my practice of 32 years away! Awful."

"It effected my history taking, clinical examination, investigation and patient management. All planned surgical procedures were postponed for fears of possible post-operative COVID-19 infection. The trust, care, patient-doctor relationship are badly hampered."

"Decimated it. Non-COVID patients have limited access to care which could lead to problems. COVID + cases require a lot more prep time and post-procedure cleaning time slowing down patient workflow."

"It's more stressful, more cumbersome to wear all PPE and do procedures in ED. We get our temps checked when we come in to work. Despite putting our lives on the line daily and risk to our families, our employer is cutting our pay, hours, and benefits which are temporarily put on hold, so we can continue to risk our lives at work first."

Physicians feel the practice of medicine is not what it used to be.

"We have created a second ED such that we have a COVID and non-COVID ED (that being said, with community spread, there's no guarantee that someone with COVID-19 won't end up in the non-COVID ED) - this has required nearly doubling our ED staff which has been done by pulling providers from outpatient areas whose clinics have been canceled and gone virtual, as well as pulling nursing staff from inpatient/OR/PACU areas as all elective procedures have been postponed. Our hospital census is down overall as we've become much more judicious in who gets admitted."

Physicians got into medicine to help, but to conquer COVID, patients must be accountable.

"l am very appreciative for all the good wishes from everybody regarding the work that we're doing on the frontlines. People need to realize the physicians are also affected financially, probably not as much as average Individual, but we are financially affected, everyone is, we're not immune. With regard to personally and emotionally seeing all the death tolls and all the sickness is something that we are used to but never become immune to. I think that one of the things that I hope people learn is that we take care of patients no matter what they do to themselves. We take care of the patients who develop lung cancer and continue to smoke, the patients who developed all the complications with obesity because they continue very unhealthy habits. As a physician and a fellow citizen, I wish that people would take more responsibility and truly care for the gift of life. I took an oath to save lives. I place myself in jeopardy and I don't mind as long as everyone does their job. Our soldiers are in a similar position."

"Professionally, as a surgeon, I have lost my career and livelihood. I have managed to pick up a few shifts working small emergency rooms, but they are extreme high-risk and not at all prepared for COVID-19. I come home to my family, knowing that I put them at risk - but what choice do I have? Doctors (and nurses) are disposable nowadays, and we don't qualify for the stimulus checks or unemployment. I wish I had never become a physician. And - then you see your neighbors not practicing social distancing, not taking any precautions - it's a joke."

In the wake of COVID, some physicians contemplate leaving medicine.

"It has been so draining emotionally both personally and professionally. Coping with uncertainty and still trying to comfort my patients and their families. Honestly have to say I'm looking for a way out of medicine at this point."

"Negatively! Financially problematic. Home stress (don't want to bring it home). Difficult on my employees too. I suspect many doctors might consider hanging it up early after this. I am not as interested in continuing past my retirement goals. I was. I might consider a different career path for the near future. The current practice environment for medicine was already causing lots of stress and resulted in the popular description of "burnout". The climate might be better described as an abusive career path. Doctors aren't burned out they just have an abusive job that only gets worse when the 'system' fails and we individually suffer for the 'systems' failures."

There are, however, silver linings for some physicians.

"These are very interesting times. I am amazed at how the hospital administrations, national and state governments have come together to fight this pandemic. Despite the PPE shortages, the hospital has done amazing things to restructure our staff and hospital to accommodate the influx of patients. I am warmed by the outpouring of professional help from around the country that have come alongside us. I am waiting for things to 'get back to normal' but do not think they ever will. Maybe this is a good thing, we have been forever changed."

"It's been very hard taking care of elderly parents and being terrified of them getting this illness. It affects us financially as we are working less hours. On a positive note, we are noticing that even with less we have more than enough. I feel we are valuing things that we were taking for granted. Going out for a walk now reminds me of my childhood. Getting to actually see neighbors and encouraging each other to keep exercising. Everybody seems much slower and present. Kids leaving positive messages written with colorful chalk. People are just more aware of each other. That seems different... I realized how much I missed that and how much that means to all of us. A sense of connection...The message is you see me and you actually know me."

"l worry for so many of my patients. My family is okay, and I have never felt that wasting energy considering horrific possibilities was particularly useful. We do what we can to protect ourselves, but I just can't obsess about it. If my regular hospital is overwhelmed, I will have to return to hospitalist work. I know that will have some catching up to do, as it has been several years since I have done that. Furthermore, I don't know how I would manage 12- hour shifts. I've become too used to the pace of the office and part-time work. But overall, think I am doing well. Inconvenienced, but otherwise we are very fortunate. If my kids were younger, I would be miserable, trying to direct their extra energy without the usual outlets."

"The practice ban had diminished my income to the point I cannot even cover my practice costs. As an engineer I developed a means for doctors who are caring for COVID-19 patients (myself included, to be protected from infection). This has been very gratifying, I rarely do a direct laryngoscopes these days, choosing instead to use a glide scope to reduce the risk of encountering aerosolized material from the airway."

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How has COVID-19 affected physicians? (survey)

“We are heroes in our community and lepers at home.”

About the survey.

Executive summary.

This report provides the unaided raw emotions shared by physicians during this unprecedented time.

47% of physicians shared financial fears.

Student loan debt, pay cuts, and practice overhead weigh heavily.

Already burdened, physicians have to take on more responsibilities to keep their practice afloat.

Patient census is heavily impacted.

Survey stats:

Telehealth is not a magic bullet if patients refuse technology.

33% of physicians expressed some type of emotional effect, stress or anxiety.

There's a general feeling of helplessness.

Safety: Lack of PPE makes a stressful job scary. Physicians feel dismissed.

Uncertainty: Physicians are trained to have all the answers. COVID goes beyond their training.

Distrust: There's a lack of trust among physicians for government agencies and administrators. Physicians feel the system is failing them.

Physicians are burdened by COVID in their personal lives and responsible for healing it in their professional lives.

Mental health among physicians.

Survey stats:

Physicians feel the practice of medicine is not what it used to be.

Physicians feel the practice of medicine is not what it used to be.

Physicians got into medicine to help, but to conquer COVID, patients must be accountable.

In the wake of COVID, some physicians contemplate leaving medicine.

There are, however, silver linings for some physicians.

We're on a mission to show our gratitude for healthcare workers.