Physician Income Drops, Burnout Spikes Globally in Pandemic

Marcia Frellick

September 11, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Responses from physicians in eight countries show profound effects from COVID-19 on their personal and professional lives, according to the results of a Medscape survey.

More than 7500 physicians ― nearly 5000 in the United States, and others in Brazil, France, Germany, Mexico, Portugal, Spain, and the United Kingdom ― responded to questions about their struggles to save patients and how the pandemic has changed their income and their lives at home and at work.

The pain was evident in this response from an emergency medicine physician in Spain: "It has been the worst time in my life ever, in both my personal and professional life."

Conversely, some reported positive effects.

An internist in Brazil wrote: "I feel more proud of my career than ever before."

One Quarter of US Physicians Considering Earlier Retirement

Physicians in the United States were asked what career changes, if any, they were considering in light of their experience with COVID-19. Although a little more than half (51%) said they were not planning any changes, 25% answered, "retiring earlier than previously planned," and 12% answered, "a career change away from medicine."

The number of physicians reporting an income drop was highest in Brazil (63% reported a drop), followed by the United States (62%), Mexico (56%), Portugal (49%), Germany (42%), France (41%), and Spain (31%). The question was not asked in the United Kingdom survey.

In the United States, the size of the drop has been substantial: 9% lost 76% – 100% of their income; 14% lost 51% – 75%; 28% lost 26% – 50%; 33% lost 11% – 25%; and 15% lost 1% – 10%.

The US specialists with the largest drop in income were ophthalmologists, who lost 51%, followed by allergists (46%), plastic surgeons (46%), and otolaryngologists (45%).

"I'm looking for a new profession due to economic impact," an otolaryngologist in the United States said. "We are at risk while essentially using our private savings to keep our practice solvent."

More than half of US physicians (54%) have personally treated patients with COVID-19. Percentages were higher in France, Spain, and the United Kingdom (percentages ranged from 60% – 68%).

The United States led all eight countries in treating patients with COVID-19 via telemedicine, at 26%. Germany had the lowest telemedicine percentage, at 10%.

Burnout Intensifies

About two thirds of US physicians (64%) said that burnout had intensified during the crisis (70% of female physicians and 61% of male physicians said it had).

Many factors are feeding the burnout.

A critical care physician in the United States responded, "It is terrible to see people arriving at their rooms and assuming they were going to die soon; to see people saying goodbye to their families before dying or before being intubated."

In all eight countries, a substantial percentage of physicians reported they "sometimes, often or always" treated patients with COVID-19 without the proper personal protective equipment. Spain had by far the largest percentage who answered that way (67%), followed by France (45%), Mexico (40%), the United Kingdom (34%), Brazil and Germany (28% each); and the United States and Portugal (23% each).

A US rheumatologist wrote: "The fact that we were sent to take care of infectious patients without proper protection equipment made me feel we were betrayed in this fight."

Sense of duty to volunteer to treat COVID-19 patients varied substantially among countries, from 69% who felt that way in Spain to 40% in Brazil. Half (50%) in the United States felt that way.

"Altruism must take second place where a real and present threat exists to my own personal existence," one US internist wrote.

Numbers Personally Infected

One fifth of physicians in Spain and the United Kingdom had personally been infected with the virus. Brazil, France, and Mexico had the next highest numbers, with 13% – 15% of physicians infected; 5% – 6% in the United States, Germany, and Portugal said they had been infected.

The percentage of physicians who reported that immediate family members had been infected ranged from 25% in Spain to 6% in Portugal. Among US physicians, 9% reported that family members had been diagnosed with COVID-19.

In the United States, 44% of respondents who had family living with them at home during the pandemic reported that relationships at home were more stressed because of stay-at-home guidelines and social distancing. Almost half (47%) said there had been no change, and 9% said relationships were less stressed.

Eating Is Coping Mechanism of Choice

Physicians were asked what they were doing more of during the pandemic, and food seemed to be the top source of comfort in all eight countries.

Table. What Physicians are Doing More of in the Pandemic (%)

Country More eating More alcohol More Rx stimulants/medication
Brazil 43 26 9
France 22 13 9
Germany 20 15 4
Mexico 31 16 11
Portugal 28 13 5
Spain 25 14 9
United Kingdom 27 20 3
United States 29 19 2


Loneliness Reports Differ Across Globe

Portugal had the highest percentage (51%) of physicians reporting increased loneliness. Next were Brazil (48%), the United States (46%), the United Kingdom (42%), France (41%), Spain and Mexico (40% each), and Germany (32%).

All eight countries lacked workplace activities to help physicians with grief. More than half (55%) of UK physicians reported having such activities available at their workplace, whereas only 25% of physicians in Germany did; 12% – 24% of respondents across the countries were unsure about the offerings.

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune and and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.

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