COVID-19 Pandemic Short Interval National Survey Gauging Psychological Distress Among Physicians (COPING Survey): A Longitudinal Survey

Background It has become ubiquitous to describe the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and the global measures to decrease mortality rates of Coronavirus Disease (COVID-19) as 'unprecedented'. The Public Health Agency of Canada (PHAC) models released on April 8th predict that even with strict epidemiologic controls 934,000-1,879,000 people will be infected in Canada and 11,000- 22,000 will die. Disturbingly, the European and United States experience demonstrates that health care systems in industrialized countries are at risk of becoming overwhelmed. It has long been recognized that physicians are at risk for burnout, which can negatively affect their ability to care for patients, their colleagues and themselves. Infectious disease pandemics present many of the same challenges for physicians as natural disasters and mass casualty events, with the addition of a prolonged time frame, potential need for isolation away from family, and concern of becoming infected or infecting loved ones. During the 2003 severe acute respiratory syndrome (SARS) outbreak, 18-57% of health care workers (HCWs) experienced measurable psychological distress. Even 1-2 years following the SARS pandemic HCWs in Ontario experienced high levels of burnout (19-30%), psychological distress (30-45%), and PTSD symptoms (8-13%). Despite the overall high rates, there are several mitigating factors that may decrease the rate or severity of psychological distress and burnout.

Given that these studies generally measure burnout and psychological distress at one or two cross-sectional time points, it is difficult to tell how burnout develops over time. Additionally, the bulk of the studies assessed HCWs following natural disasters, which tend to present as a single time point with one large wave of patients. The current crisis is distinct in its sustained level of demand on HCWs with potential for multiple waves of patients or a sustained high number of patients outstripping the health care system resources for months at a time. This study seeks to investigate the rates of burnout assessed at multiple time points during the COVID-19 pandemic. Further, this study seeks to determine the relationship between patient numbers, mitigating factors, and exacerbating factors and the rates of burnout at various time points.

Objectives

1. What are the rates of psychological distress and burnout among physicians and residents throughout the COVID-19 pandemic?
2. What baseline factors are associated with reductions and increases in psychological distress and burnout over time (trajectories)?

Methods This study will be a national longitudinal survey of physicians in Canada. The sampling frame will be all physicians currently practicing in Canada, whether they hold a full, provisional, or post-graduate in-training license. The survey will be distributed by: 1. Advertisements on Twitter, 2. Provincial physician associations, and 3. National specialty groups for higher risk specialties (anesthesia, critical care, emergency medicine). Recipients will be directed to the survey site hosted by Redcap. Cross-sectional results of the initial survey to give immediate feedback to provincial and national organizations about the threat of physician burnout and psychological distress. Longitudinal results will analyze how burnout and distress change over time and will analyze the relationship to mitigating and exacerbating factors.