Burnout, Depression, Anxiety, and Stress Among Family Physicians in Kansas Responding to the COVID-19 Pandemic

Samuel Ofei-Dodoo, PhD, MPA, MA; Colleen Loo-Gross, MD, MPH; Rick Kellerman, MD


J Am Board Fam Med. 2021;34(3):522-530. 

In This Article

Abstract and Introduction


Introduction: COVID-19 has spread rapidly, with vast global implications. This study assessed how family physicians in Kansas were responding to COVID-19 and the effects of the pandemic on their well-being.

Methods: The authors conducted a cross-sectional survey of 113 family physicians in Kansas between May 22, 2020 and June 25, 2020. The study participants completed an anonymous, 36-item survey assessing their concerns about being exposed to COVID-19 and levels of personal depression, anxiety, stress, and burnout in addition to demographic information.

Results: There was a 45.6% response rate, with 50.4% (n = 57) of the respondents reporting manifestations of burnout. The physicians who personally treated any presumptive or confirmed COVID-19 patient, compared with those who did not, were more likely to report at least 1 manifestation of burnout, experience emotional exhaustion, and feel a higher level of personal stress.

Conclusion: Our findings demonstrate that the COVID-19 pandemic may be taking an emotional toll on family physicians in Kansas. This study provides a baseline from which to continue further monitoring of outcomes. Data can help drive initiatives at local, state, and national levels to help diminish the negative impact of the COVID-19 pandemic on physicians.


Since its introduction into the human population in late 2019, the novel coronavirus infectious disease (COVID-19) has spread rapidly, with vast global implications. The outbreak was designated a pandemic by the World Health Organization (WHO) on March 11, 2020.[1] By November 24, 2020, over 58 million total confirmed cases and 1,388,528 total deaths had been reported globally, with the United States alone accounting for 12,175,921 confirmed cases and 255,958 deaths.[2,3] The number of cases began to rise sharply in Midwestern states during November, affecting more small towns and rural areas, with daily case rates surpassing 4600 per 100,000 population in the state of Kansas, compared with just over 2000 per 100,000 at the beginning of October 2020.[3] As the world continues to struggle with the widespread infection, it is important to consider the short-term and long-term effects on the health care system and workforce.

Before the COVID-19 pandemic, the risk of burnout and stress-related problems such as depression and anxiety in physicians had been identified as an important area of public health concern. As compared with the general population, physicians are at higher risk of experiencing symptoms of burnout as well as dissatisfaction with work-life balance.[4] Among different specialties, physicians practicing family medicine tend to have higher rates of burnout symptoms, along with those in emergency medicine and internal medicine.[4] In addition, burnout among family physicians has been shown to have notable variation by state, indicating the need to further assess trends in specific regions.[5] In Kansas, previous literature has identified the significant presence of burnout in the rural practice setting, which is notable given the geographic nature of the state.[6] Nearly one half of Kansas physicians experience symptoms of burnout, such as emotional exhaustion, cynicism, and reduced professional efficiency, and are more likely to report thoughts of suicidal ideation, screen positive for depression, and report high degrees of fatigue.[7,8]

The implications of burnout in clinicians are well documented. Physicians with burnout are more likely to experience motor vehicle accidents, mood disorders, and substance and alcohol abuse.[9] Furthermore, studies have shown that burnout is associated with an increased risk of medical errors and malpractice, with decreases in quality of care, productivity, and patient satisfaction.[10,11] Health care professionals experiencing burnout and other forms of emotional distress have a stronger intention of leaving the medical profession via early retirement and/or career change.[12,13] Physician wellness has become an increasingly vital topic given both the personal and professional implications.

Health care professionals, including those in primary care specialties such as family medicine, are among those working the front lines in response to the COVID-19 pandemic. Previous literature has shown the association of infectious disease outbreaks with adverse effects on the mental health of health care workers.[14–16] Initial studies have shown that this concern has emerged with the COVID-19 outbreak, and additional research is warranted given the unprecedented, enduring nature of this pandemic.[17–19] Primary care physicians are at risk of encountering additional stressors given the significant changes to clinical practice as a result of COVID-19, such as the financial impact associated with decreases in routine medical visits and shifts to telemedicine. Given that the global community continues to be affected by the worsening spread of COVID-19, it is prudent to assess the effects on physician well-being and to ensure appropriate programs are in place to provide emotional, mental health, and social support for health care workers. The purpose of this study was to assess the effects of the COVID-19 pandemic on burnout and other types of emotional distress among family physicians in Kansas, many of whom are members of the University of Kansas School of Medicine Department of Family and Community Medicine's practice-based research network. These family physicians work collaboratively through research and quality improvement activities to improve the health of Kansans.