Critical Care Physicians Treating COVID-19 Patients Report Continued High Levels of Stress and Staff and PPE Shortages

Philadelphia, PA – Critical care physicians working with COVID-19 patients continue to struggle with significant levels of stress and ongoing staffing and PPE shortages nearly twelve months into the pandemic, according to a study by researchers with the American Board of Internal Medicine (ABIM), Harvard Medical School, and Harvard T.H. Chan School of Public Health. The study also found that female physicians report significantly higher levels of stress than their male counterparts.

The new study, entitled "Changes in Stress and Workplace Shortages Reported by US Critical Care Physicians Treating COVID-19 Patients," published today in Critical Care Medicine. The study is based on a survey of 1,356 physicians conducted from October 23 through November 16, 2020. It is benchmarked against a similar survey of these physicians taken in the spring of 2020.

While slightly fewer critical care physicians reported moderate to extreme stress (68% in the spring, 51% in the fall) the levels are still dangerously high for frontline health workers. The list of stressors included risk of exposing friends and family members to COVID-19; high case fatality rates; providing care to patients who are isolated from their families; the emotional well-being of staff and colleagues; and personal risk of exposure.

According to the study, while conditions have improved for frontline physicians, shortages in key staff, such as ICU-trained nurses, remain a concern, especially in COVID hotspots. Reports of shortages have declined by about half, but PPE and testing shortages remain alarming. Twenty percent of respondents reported shortages of N95 masks. Sixteen percent of physicians reported COVID-19 testing delays. Shortages of medication and equipment, such as ventilators, have been largely eliminated, according to the physicians surveyed.

The study also provided evidence of a link between reports of shortages and reports of emotional distress and physical exhaustion. Ten percent more female physicians than male physicians reported high levels of stress.

Taken just before the case surge around the holidays, the survey notes that "the high levels of both physical and emotional distress reported by critical care physicians raise concerns about how these physicians will fare as the levels of infection continue to surge in many parts of the country (e.g., the share of physicians in a hotspot rose from 18.5% to 65.4% comparing the beginning to the end of the fall 2020 survey period), and continue to spike through the winter and holiday season."

"Large shares of critical care physicians are still experiencing significant levels of stress and shortages, most particularly in terms of staffing, and that, if not addressed, there is a risk that patient care might suffer as the pandemic accelerates," according to the study.

"Critical care physicians are at a breaking point that might threaten the ability of the health care system to care for the thousands of new COVID-19 patients who are being admitted to ICUs throughout the country," said Bradley M. Gray, PhD, lead author of the study and Senior Health Services Researcher for ABIM.

Taking that very high stress level into account, the ABIM Board of Directors announced in early March a decision to extend all Maintenance of Certification (MOC) requirement deadlines through the end of 2022. Physicians practicing in disciplines hardest hit by COVID-19 – critical care medicine, infectious disease, hospital medicine and pulmonary disease – will have their deadlines extended another year, until the end of 2023.

ABIM and the ABIM Foundation have also each contributed funds to #GetUsPPE to facilitate the delivery of more than 50,000 pieces of PPE to frontline physicians. If you're a physician experiencing a PPE shortage, you can be matched with a donor at getusppe.org.

Read more research from ABIM and other organizations about board certification, MOC and physician assessment.

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Internists and subspecialists who earn and maintain board certification from the American Board of Internal Medicine (ABIM) differentiate themselves every day through their specialized knowledge and commitment to continual learning in service of their patients. Established as an independent nonprofit more than 80 years ago, ABIM continues to be driven by doctors who want to achieve higher standards for better care in a rapidly changing world. Visit ABIM's blog to learn more and follow ABIM on Facebook, Twitter and Instagram. ABIM is a member of the American Board of Medical Specialties.