Critical Care Physicians Report Emotional Distress During Coronavirus Pandemic

Survey data shows at least half of critical care physicians experienced emotional distress in the first nine months of the COVID-19 crisis.

In the critical care setting, emotional distress and staffing shortages have persisted during the coronavirus pandemic, a recent survey report says.

Critical care physicians are essential caregivers for seriously ill COVID-19 patients. They are not only well-positioned to assess emotional distress and shortages in the critical care setting but also pivotal personnel who can have a negative impact if they become burned out.

The survey report, which was published by Critical Care Medicine, is based on data collected from more than 2,300 critical care physicians in the spring of 2020 and more than 1,300 critical care physicians in the fall of 2020. The survey report has several key findings.

• In the spring survey, 67.6% of critical care physicians reported moderate or high levels of emotional distress. In the fall survey, 50.7% of critical care physicians reported moderate or high levels of emotional distress.
   
• Compared to their male counterparts, female physicians reported higher levels of emotional distress in both the spring and the fall surveys. In the spring survey, 75.0% of female physicians reported moderate or high emotional distress. In the fall survey, 67.7% of female physicians reported moderate or high emotional distress.
   
• Reported critical care staff shortages were nearly unchanged in the spring and fall surveys, with 48.3% of survey respondents reporting staff shortages in the spring and 46.5% reporting staff shortages in the fall.
   
• The worst staff shortage was among ICU-trained nurses, with 34.2% of survey respondents reporting ICU-trained nurse shortages in the spring and 33.1% of survey respondents reporting shortages in the fall.
   
• Reported shortages of personal protective equipment fell by more than half from the spring survey to the fall survey. In the spring survey, 52.7% of respondents reported PPE shortages. In the fall survey, 21.9% of respondents reported PPE shortages.

"Stress, staffing, and, to a lesser degree, personal protective equipment shortages faced by U.S. critical care physicians remain high. Stress levels were higher among women. Considering the persistence of these findings, rising levels of infection nationally raise concerns about the capacity of the U.S. critical care system to meet ongoing and future demands," the survey report's co-authors wrote.

Interpreting the data

The lead author of the survey report told HealthLeaders that the persistent moderate or high levels of emotional distress are troubling.

"It is very concerning, especially since this survey was conducted just at the start of the winter surge. We also found that this distress was similar across hotspots. This suggests that, at least in part, emotional distress is global and cumulative. As we face a new surge this is even more of a concern. That said, at least to some degree a contributor to emotional distress was risk to self. As many physicians are being vaccinated, this might help mitigate distress a little. However, there are other contributors to stress that are not affected by vaccines," said Bradley Gray, PhD, senior health services researcher at the American Board of Internal Medicine.

Having nearly half of critical care physicians reporting staff shortages is another area of concern, he said. "This finding was for ICU-trained staffing shortages. This is concerning because these are the people who really know what they are doing and not having enough of these specialized workers adds to the emotional distress of physicians and we presume other ICU-trained staff."

The relatively large reported shortage of ICU-trained nurses is likely having negative consequences, Gray said. "This is a major concern because ICU-trained nurses and critical care physicians play a pivotal role in the ICU. ICU-trained staff in general are the best equipped at dealing with COVID patients. Also, the degree to which non-ICU-trained nurses are being utilized taxes the ICU-trained staff including physicians because they likely must supervise and assist the non-ICU-trained nurses. That results in the ICU-trained nurses feeling a double burden."

The survey report found that at least half of critical care physicians experienced moderate or high levels of emotional distress for the first nine months of the pandemic. If this problem continues deep into 2021, the impact could be dramatic, he said.

"Bright red is my level of concern. Many states are experiencing increased hospitalization rates, and this will shoot up as the spring 2021 surge builds. Again, the emotional distress seems cumulative. When you look at what physicians are telling us, many are saying that the loosening of COVID restrictions in the face of a new surge is one factor that adds to emotional distress. I think these docs get frustrated that the only thing that seems to move the state policy needle is death and hospitalizations. We know the wave is coming, why can't we take steps now to reduce future deaths and hospitalizations?"

Related: Coronavirus: Tiered Staffing Recommended to Bolster Critical Care