Abstract
The COVID-19 pandemic of 2020-2023 significantly affected emergency medical care. Physicians who regularly saw their patients by appointment were redeployed to emergency care, increasing their reported burnout. Understanding how the burnout of specialists increased from this redeployment during COVID-19 is relevant to finding ways to reduce redeployment burnout in these appointment-based physicians when preparing for future pandemics. In this regard, the findings concerning New York physicians serve as guidance for preparedness.
Keywords
COVID-19, Emergency medical care, Physicians, Redeployment
Effect of COVID-19 on Emergency Care
The COVID-19 pandemic of 2020-2023 significantly affected emergency care. Although emergency visits decreased for acute care, hospital admissions increased [1]. Those admitted with a COVID-19 diagnosis had symptoms with an increased severity from the pre-pandemic period in the areas of the world hardest hit by the pandemic [2] and generally [3]. To contend with these emergency cases, physicians who regularly saw patients by appointment only were redeployed to emergency care. A recent study [4] of a limited—but neither a scoping nor a systematic [5]—review by this author in which the statement “burnout resulting from COVID-19 emergencies treated by [medical specialty]” was individually searched for each of the fourteen medical specialties on Google Scholar found that redeployment increased the burnout of these physicians, some in more significant ways than others.
Burnout in Redeployed Physicians During COVID-19
The results of the recent study regarding the effect of COVID-19 redeployment of appointment-based physicians to emergency care concerns compiled information from the four most cited peer-reviewed articles for each specialty from a 30–31 March 2024 search (Table 1).
|
Medical Specialty |
Burnout Response |
|
Cardiology |
Unanticipated dissatisfaction and disengagement, leading to mass resignations |
|
Dermatology |
Women worried especially about their future, their family, and reduced compensation |
|
Endocrinology |
Dissatisfaction from reduced patient care; notable decline in operations performed |
|
Family medicine |
Women and those in the early stages of their careers are most affected |
|
Gastroenterology |
High turnover; women and younger physicians are most affected |
|
Internal medicine |
No mass resignations, teams worked together supported by the institutions |
|
Nephrology |
Little, but related to poor institutional support regarding equipment and remuneration |
|
Neurology |
Experienced by those who were reassigned as a feeling of disempowerment |
|
Obstetrics |
Younger members are most affected; retired members called back for deliveries |
|
Orthopedics |
Burnout related to few, mostly younger surgeons; resilience found prevalent |
|
Pediatrics |
Emergency work found the cause of chronic exhaustion and sleep disorders |
|
Plastic surgery |
Training hours had to be made up in six months; increase in the number of errors |
|
Psychiatry |
Residents, child and adult psychiatrists affected; telepsychiatry improves their health |
|
Radiology |
When strategies were developed, less burnout; without them, burnout increased |
Those most likely to experience burnout were women and physicians in the early stages of their careers, identified in dermatology [6,7], family medicine [8], gastroenterology [9], obstetrics [10], and orthopedics [11],—a finding confirmed by other studies [12,13]. In certain specialities, specifically Cardiology [14] and Gastroenterology [15], switching to emergency care resulted in a high turnover, leading to mass resignations. Cumulatively, one in five physicians intended to leave their practice because of COVID-19 [16]. Those with the least burnout had trained for emergency preparedness in their specialty or had devised solutions to improve patient care during the pandemic. Nephrologists [17] and radiologists [18] were most prepared, while psychiatrists [19] improved the use of telemedicine as a result of the pandemic. Teamwork was also found invaluable in the case of internal medicine [20]. A pivotal cause of redeployment burnout was inadequate support by the institution—the only reason that nephrologists experienced additional burnout [21]. This insufficient support could also include the specialist feeling disempowered, as with neurologists [22]. Regarding quality patient care, physicians experiencing additional burnout could register increased errors, as did plastic surgeons [23], a decline in operations performed, regarding endocrinologists [24], or fewer in-service physicians where, in the case of obstetricians, retired physicians returned to patient care [25]. An additional problem found most notable in pediatricians was chronic exhaustion along with sleep disorders [26].
Lessons in Preparedness from New York
The follow-up report is essential for enhancing institutional emergency management. In New York, which was particularly affected by COVID-19, institutional support, including stockpiling sufficient protective gear and equipment in affordable warehouses, was considered imperative, requiring transportation modes and supply chains to be flexible to meet the demand readily [27]. There was recognition of the importance of timely and accurate virus testing as New York physicians' were removed from emergency care when judged they had contracted the virus in caring for patients, although no tests were available then to confirm this supposition [28]. Planning for staffing and space by institutions was highlighted as necessary in another report based on the New York experience [29].
Strengths and Limitations
The strength of the recent study investigating burnout due to physician redeployment during the COVID-19 pandemic is that the examination extended to fourteen different medical specialties using the top four articles cited regarding “burnout resulting from COVID-19 emergencies treated by [medical specialty]”. Although careful to ensure objectivity, as only one author reviewed the various articles, bias may be a factor [30]. An additional limitation of this work is that it was neither a scoping nor a systematic review, which might have produced additional and different results.
Conclusion
Burnout was a universal experience of appointment-centered physicians redeployed to emergency care during the COVID-19 pandemic. Specialties practiced in crisis preparedness contended with this redeployment better than others, as did those who devised solutions to improve patient care. Institutional support is found imperative to reducing this burnout. Reports from the New York experience stress that institutional preparedness involves three essential aspects: i) readily available gear and equipment, ii) timely and accurate testing, and iii) staff and space planning. With this quality of institutional support, reducing burnout in redeployed physicians is possible for future pandemic preparedness.
References
2. Stirparo G, Oradini-Alacreu A, Migliori M, Villa GF, Botteri M, Fagoni N, et al. Public health impact of the COVID-19 pandemic on the emergency healthcare system. J Public Health (Oxf). 2022 Mar 7;44(1):e149-52.
3. Yeh CC, Chien CY, Lee TY, Liu CH. Effect of the COVID-19 Pandemic on Emergency Department Visits of Patients with an Emergent or Urgent Diagnosis. Int J Gen Med. 2022 May 4;15:4657-64.
4. Nash C. Burnout in Medical Specialists Redeployed to Emergency Care during the COVID-19 Pandemic. Emergency Care and Medicine. 2024 Jun 13;1(2):176-92.
5. Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018 Nov 19;18(1):143.
6. Shah P, Dorrell DN, Feldman SR, Huang WW. The impact of the coronavirus disease 2019 pandemic on dermatologist burnout: a survey study. Dermatol Online J. 2021 Jun 15;27(6):1.
7. Helm MF, Kimball AB, Butt M, Stuckey H, Costigan H, Shinkai K, et al. Challenges for dermatologists during the COVID-19 pandemic: A qualitative study. Int J Womens Dermatol. 2022 Mar 25;8(1):e013.
8. Kılıç OH, Anıl M, Varol U, Sofuoğlu Z, Coban I, Gülmez H, et al. Factors affecting burnout in physicians during COVID-19 pandemic. Ege Tıp Dergisi. 2021 Jun 30;60(2):136-44.
9. Lacy BE, Cangemi DJ, Burke CA. Burnout in Gastrointestinal Providers. Am J Gastroenterol. 2024 Jul;119(7):1218-21.
10. Bogaert KC, Lieb WE, Glazer KB, Wang E, Stone JL, Howell EA. Stress and the Psychological Impact of the COVID-19 Pandemic on Frontline Obstetrics and Gynecology Providers. Am J Perinatol. 2022 Oct;29(14):1596-1604.
11. Mavrogenis AF, Scarlat MM. Stress, anxiety, and burnout of orthopaedic surgeons in COVID-19 pandemic. Int Orthop. 2022 May;46(5):931-5.
12. Miljeteig I, Forthun I, Hufthammer KO, Engelund IE, Schanche E, Schaufel M, et al. Priority-setting dilemmas, moral distress and support experienced by nurses and physicians in the early phase of the COVID-19 pandemic in Norway. Nurs Ethics. 2021 Feb;28(1):66-81.
13. Spiers J, Buszewicz M, Chew-Graham C, Dunning A, Taylor AK, Gopfert A, et al. What challenges did junior doctors face while working during the COVID-19 pandemic? A qualitative study. BMJ Open. 2021 Dec 13;11(12):e056122.
14. Josephson RA, Gillombardo CB. Cardiovascular services in Covid-19 - Impact of the pandemic and lessons learned. Prog Cardiovasc Dis. 2023 Jan-Feb;76:12-9.
15. Shen JJ. Psychosocio-economic impacts of COVID-19 on gastroenterology and endoscopy practice. Gastroenterol Rep (Oxf). 2021 Apr 10;9(3):205-11.
16. Abbasi J. Pushed to Their Limits, 1 in 5 Physicians Intends to Leave Practice. JAMA. 2022 Apr 19;327(15):1435-7.
17. Nair D, Brereton L, Hoge C, Plantinga LC, Agrawal V, Soman SS, et al; National Kidney Foundation Education Committee. Burnout Among Nephrologists in the United States: A Survey Study. Kidney Med. 2022 Jan 12;4(3):100407.
18. Coppola F, Faggioni L, Neri E, Grassi R, Miele V. Impact of the COVID-19 outbreak on the profession and psychological wellbeing of radiologists: a nationwide online survey. Insights Imaging. 2021 Feb 17;12(1):23.
19. Yellowlees P. Impact of COVID-19 on Mental Health Care Practitioners. Psychiatr Clin North Am. 2022 Mar;45(1):109-21.
20. Rodríguez-Madrid MN, Pastor-Moreno G, Albert-Lopez E, Pastor-Valero M. "You knew you had to be there, it had to be done": Experiences of health professionals who faced the COVID-19 pandemic in one public hospital in Spain. Front Public Health. 2023 Apr 20;11:1089565.
21. Selvaskandan H, Nimmo A, Savino M, Afuwape S, Brand S, Graham-Brown M, et al. Burnout and long COVID among the UK nephrology workforce: results from a national survey investigating the impact of COVID-19 on working lives. Clin Kidney J. 2021 Dec 13;15(3):517-26.
22. Ayele R, Macchi ZA, Dini M, Bock M, Katz M, Pantilat SZ,et al. Experience of Community Neurologists Providing Care for Patients With Neurodegenerative Illness During the COVID-19 Pandemic. Neurology. 2021 Sep 7;97(10):e988-95.
23. Crowe CS, Lopez J, Morrison SD, Drolet BC, Janis JE; Resident Council Wellness and Education Study Group. The Effects of the COVID-19 Pandemic on Resident Education and Wellness: A National Survey of Plastic Surgery Residents. Plast Reconstr Surg. 2021 Sep 1;148(3):462e-74e.
24. Manzella A, Kravchenko T, Kheng M, Chao J, Laird AM, Pitt HA, et al. Effects of the COVID-19 pandemic on endocrine operations in the United States. Am J Surg. 2024 Feb;228:22-9.
25. Schmitt N, Mattern E, Cignacco E, Seliger G, König-Bachmann M, Striebich S, et al. Effects of the Covid-19 pandemic on maternity staff in 2020 - a scoping review. BMC Health Serv Res. 2021 Dec 27;21(1):1364.
26. Nigri L, Carrasco-Sanz A, Pop TL, Giardino I, Vural M, Ferrara P, et al. Burnout in Primary Care Pediatrics and the Additional Burden from the COVID-19 Pandemic. J Pediatr. 2023 Sep;260:113447.
27. Jarrett M, Garrick R, Gaeta A, Lombardi D, Mayo R, McNulty P, et al. Pandemic Preparedness: COVID-19 Lessons Learned in New York's Hospitals. Jt Comm J Qual Patient Saf. 2022 Sep;48(9):475-91.
28. Shapiro LI, Kajita GR, Arnsten JH, Tomer Y. Toward better preparedness for the next pandemic. J Clin Invest. 2020 Sep 1;130(9):4543-45.
29. Keeley C, Jimenez J, Jackson H, Boudourakis L, Salway RJ, Cineas N, et al. Staffing Up For The Surge: Expanding The New York City Public Hospital Workforce During The COVID-19 Pandemic. Health Aff (Millwood). 2020 Aug;39(8):1426-30.
30. Yarborough M. Moving towards less biased research. BMJ Open Sci. 2021 Jan 17;5(1):e100116.