Background: The COVID-19 pandemic has disrupted healthcare and put enormous stress upon front-line healthcare workers. Physician trainees may be more vulnerable to poor mental health outcomes, including burnout and distress. The objective of this study was to compare mental health indices of attending physicians versus trainees during the COVID-19 pandemic.
Methods: A voluntary survey was emailed (6/21/2020-8/21/2020) to all physicians across a large healthcare system in the greater New York Metropolitan area. Physician trainees were defined as residents and fellows. The primary outcome was anxiety symptoms as measured by two items within the Patient Health Questionnaire (PHQ-4). Secondary outcomes were burnout and resilience as measured by the abbreviated Maslach Burnout Inventory (aMBI; Depersonalization and Emotional Exhaustion subscales), and Brief Resilience Scale (BRS), respectively.Descriptive statistics were summarized using mean and standard deviation (continuous), and frequency and percent (categorical). For outcomes of distress and burnout, continuous variables were compared across groups using the Mann Whitney U test and categorical variables were compared across groups using the Chi-Square test or Fisher’s Exact test, as appropriate. For resilience, categorical variables were compared using the Mann Whitney U test (2 groups) or Kruskal Wallis test (3+ groups).
Results: The sample was primarily attending physicians (79.93%), white (70.89%), and non-Hispanic (89.15%) with an even distribution of males and females (Table 1). Overall, those reporting anxiety (score of 3 or more on the 2 PHQ-4 anxiety items) were more likely to be younger (43.14 vs. 47.09, p=0.0109) and female (22.3% vs. 13.8%, p=0.0095). While trainees were more likely to be anxious (25.23% vs. 16.3%, p=0.0288, Table 2), experience emotional exhaustion (48.7% vs. 31.67, p=0.0008), and depersonalization (32.4% vs. 12.2%, p<0.0001), these differences were no longer significant when controlling for age, gender, race, ethnicity and marital status (OR: 1.21, 95% CI: 0.70, 2.11, Table 3).
Conclusions: Our study found high levels of anxiety, emotional exhaustion, and depersonalization among all physicians caring for patients during COVID-19. While trainees are at high risk for emotional distress during the pandemic, it appears that younger age and female gender are at increased risk. Further research is needed in designing and focusing programs to improve mental health in physicians particularly during periods of increased stress like the current COVID-19 pandemic.
