Emergency physician stressors, concerns, and behavioral changes during COVID-19: A longitudinal study

Brigitte M Baumann; Richelle J Cooper; Anthony J Medak; Stephen Lim; Brian Chinnock; Remi Frazier; Brian W Roberts; Elissa S Epel; Robert M Rodriguez

doi:10.1111/acem.14219

Emergency physician stressors, concerns, and behavioral changes during COVID-19: A longitudinal study

Acad Emerg Med. 2021 Mar;28(3):314-324. doi: 10.1111/acem.14219. Epub 2021 Feb 16.

Authors

Brigitte M Baumann¹, Richelle J Cooper², Anthony J Medak³, Stephen Lim⁴, Brian Chinnock⁵, Remi Frazier⁶, Brian W Roberts¹, Elissa S Epel⁷, Robert M Rodriguez⁸

Affiliations

¹ Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, USA.
² Department of Emergency Medicine, University of California at Los Angeles School of Medicine, Los Angeles, California, USA.
³ Department of Emergency Medicine, University of California at San Diego School of Medicine, San Diego, California, USA.
⁴ Section of Emergency Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.
⁵ Department of Emergency Medicine, UCSF-Fresno Medical Education Program, Fresno, California, USA.
⁶ Academic Research Systems, University of California, San Francisco, California, USA.
⁷ Department of Psychiatry, University of California at San Francisco School of Medicine, San Francisco, California, USA.
⁸ Department of Emergency Medicine, University of California at San Francisco School of Medicine, San Francisco, California, USA.

Abstract

Objectives: The objective was to provide a longitudinal assessment of anxiety levels and work and home concerns of U.S. emergency physicians during the COVID-19 pandemic.

Methods: We performed a longitudinal, cross-sectional email survey of clinically active emergency physicians (attending, fellow, and resident) at seven academic emergency departments. Follow-up surveys were sent 4 to 6 weeks after the initial survey and assessed the following: COVID-19 patient exposure, availability of COVID-19 testing, levels of home and workplace anxiety/stress, changes in behaviors, and performance on a primary care posttraumatic stress disorder screen (PC-PTSD-5). Logistic regression explored factors associated with a high PC-PTSD-5 scale score (≥3), indicating increased risk for PTSD.

Results: Of the 426 surveyed initial respondents, 262 (61.5%) completed the follow-up survey. While 97.3% (255/262) reported treating suspected COVID-19 patients, most physicians (162/262, 61.8%) had not received testing themselves. In follow-up, respondents were most concerned about the relaxing of social distancing leading to a second wave (median score = 6, IQR = 4-7). Physicians reported a consistently high ability to order COVID-19 tests for patients (median score = 6, IQR = 5-7) and access to personal protective equipment (median score = 6, IQR = 5-6). Women physicians were more likely to score ≥ 3 than men on the PC-PTSD-5 screener on the initial survey (43.3% vs. 22.5%; Δ 20.8%, 95% confidence interval [CI] = 9.3% to 31.5%), and despite decreases in overall proportions, this discrepancy remained in follow-up (34.7% vs. 16.8%; Δ 17.9%, 95% CI = 7.1% to 28.1%). In examining the relationship between demographics, living situations, and institution location on having a PC-PTSD-5 score ≥ 3, only female sex was associated with a PC-PTSD-5 score ≥ 3 (adjusted odds ratio = 2.48, 95% CI = 1.28 to 4.79).

Conclusions: While exposure to suspected COVID-19 patients was nearly universal, stress levels in emergency physicians decreased with time. At both initial and follow-up assessments, women were more likely to test positive on the PC-PTSD-5 screener compared to men.

Keywords: COVID-19; emergency medicine; physicians; psychological; stress.

MeSH terms

COVID-19 Testing
COVID-19*
Cross-Sectional Studies
Female
Humans
Longitudinal Studies
Male
Pandemics
Physicians*
SARS-CoV-2
Surveys and Questionnaires