About 1 in 5 Clinicians Considers Quitting Due to Pandemic: Survey

Damian McNamara

April 05, 2021

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

The COVID-19 pandemic continues to take its toll on the well-being and work satisfaction of healthcare providers, a new survey of more than 5000 clinicians at an academic medical center illustrates.

About 1 in 5 people reported considering leaving the workforce because of the challenges of working during the COVID-19 pandemic. In addition, 30% reported they are considering cutting back work hours.

"There are a substantial number of employees and trainees who are experiencing major stress and work disruptions because of the pandemic," lead author Rebecca K. Delaney, PhD, told Medscape Medical News. "It is particularly alarming that people who have spent 5 or more years in training for their specialty are struggling with their work, so much so that they have even considered leaving the workforce or reducing their hours."

"Being a caregiver adds another layer of difficulty for faculty, staff, and trainees who are trying to manage work and childcare," added Delaney, a researcher in the Department of Population Health Sciences, University of Utah in Salt Lake City.

The study was published online April 2 in JAMA Network Open.

"This looks like an excellent survey," Carol A Bernstein, MD, told Medscape Medical News when asked to comment. "I do not think it provides particularly new information as these challenges in the workplace, especially for women during COVID, have been well documented in the media and the medical literature to date."

"That said, to the extent that data helps drive solutions, I would hope that information such as this would be considered as strong further evidence that health care systems must pay close attention to the wellbeing of the workforce," added Bernstein, professor and vice chair of Faculty Development and Well-being, departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, New York City.

When the Pandemic Hits Home

A total of 42% of the American workforce rapidly transitioned to working from home at the onset of the COVID-19 pandemic. At the same time, many employees had to provide childcare and assistance with schoolwork. This placed a burden on many individuals at academic medical centers, and women in particular.

"Women comprise 74.9% of hospital employees, many of whom are essential clinical workers," the researchers note. "The extent of the needs and difficulties for these workers during the pandemic remain largely unknown."

To learn more, Delaney, senior author Angie Fagerlin, PhD, and their colleagues emailed a Qualtrics survey to 27,700 faculty, staff, and trainees at University of Utah Health. The survey was conducted August 5-20, 2020 as part of a quality improvement initiative. All responses were anonymous.

Survey questions included if, because of the pandemic, people had considered leaving the workforce, considered reducing their hours, or experienced reduced productivity. The researchers also asked about career impacts and potential solutions in terms of "work culture adaptations."

Respondents with children under age 18 also were asked about childcare options. Delaney and colleagues also inquired about race and ethnicity because they hypothesized that employees from underrepresented groups would likely experience the pandemic differently.

The mean age of the 5951 (21%) faculty, staff, and trainees who completed the survey was 40 years. A majority of respondents were women, reflecting the higher proportion of women within the health system.

A majority (86%) identified as white or European American. About two thirds of respondents (66%) were staff, 16% were faculty, and 13% were trainees.

COVID-19 Career Concerns

Overall, 1061 respondents (21%) "moderately or very seriously" considered leaving the workforce and 1505 (30%) considered reducing hours. Respondents who were younger, married, a member of an underrepresented racial/ethnic group, and worked in a clinical setting were more likely to consider leaving the workforce.

The survey showed 27% felt their productivity increased whereas 39% believed their productivity decreased.

Of the 2412 survey participants with children aged 18 years or younger, 66% reported that they did not have childcare fully available.

"Failure to address and provide for childcare has long been one of the many significant deficits in US health care systems," said Bernstein, lead author of a March 2021 report evaluating staff emotional support at Montefiore Medical Center during the pandemic in The Joint Commission Journal on Quality and Patient Safety.

Furthermore, 47% were "moderately or very seriously worried" about COVID-19 impacting their career development.

Women trainees were significantly more likely than male counterparts to consider leaving the workforce and reducing their workhours. Women in a faculty or trainee role were also more likely to worry about COVID-19's impact on their career compared with men and compared with women in staff positions.

"It was disheartening to have our data support the gender and racial/ethnic disparity that has been highlighted in the media during the pandemic," Delaney said. "Women and in some cases racial/ethnic groups that are underrepresented in medicine were most likely to consider leaving the workforce, reducing hours, and were worried about their career development.

"It is critical that we strategically address these important disparities," she said.

Women also are disproportionately affected by burnout, particularly during the pandemic, according to an analysis of Medscape's 'Death by 1000 Thousand Cuts': Physician Burnout and Suicide Report.

Furthermore, the COVID-19 pandemic has shifted the medical specialties now considered highest risk for burnout: critical care physicians rank first in the report, followed by rheumatologists and infectious disease specialists.

Potential Solutions

"Given the disproportionate impact COVID-19 has on employees of health systems, institutions must find ways to support their employees, both in terms of workplace cultural adaptations and assistance with familial responsibilities," the researchers note.

Telecommuting policies, scheduling flexibility, and expanding employee support programs are potential solutions. Institutional policies also could address the educational and direct care needs of employee children.

Limitations of the study include its generalizability beyond employees of University of Utah Health. Also, respondents included a lower proportion of racial and ethnic groups compared with national figures, "although this is mostly accounted for by the overall low population of such groups in the state of Utah," the researchers add.

"Our results suggest that respondents were struggling during the COVID-19 pandemic," the researchers note. "As a result, even after investing substantial amounts of time in years of training, many were considering leaving the workforce because of stress and caregiving responsibilities related to the pandemic."

The Jon M. Huntsman Presidential Endowed Chair supported the work with a financial award to Fagerlin. Delaney and Bernstein have disclosed no relevant financial relationships.

JAMA Netw. Open. Published online April 2, 2021. Full text

Damian McNamara is a staff journalist based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology and critical care. Follow Damian on Twitter:  @MedReporter.

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