key: cord-0984185-w6n35585
authors: Levine, Heidi; Baranchuk, Nadia; Li, Timmy; Garra, Gabrielle; Nagarajan, Mohanapriya Sayeen; Garg, Nidhi
title: An emergency medicine physician well-being study focusing on gender differences and years of practice during the COVID-19 pandemic
date: 2022-03-03
journal: Am J Emerg Med
DOI: 10.1016/j.ajem.2022.02.055
sha: e2233d649a2eecc7bfc492c43c8bd8e04316cf88
doc_id: 984185
cord_uid: w6n35585

nan

During the COVID-19 pandemic, physicians experienced multiple stressors, anxiety, and depression [2] [3] [4] [5] [6] . Educational systems in critical resilience skills must be developed by organizations to support physicians in coping with these issues. [10] . Hospital wellness systems and physician groups, focusing on increased engagement and resiliency have been expanding. [11] [12] [13] .

Studies have not examined the psychological effects of the pandemic on gender differences and years of experience for EM physicians [18] [19] [20] [21] . Our goal was to assess how the COVID-19 pandemic affected physicians' well-being, focusing on these determinants.

The descriptive survey study involved all EM attending physicians in our health system. A 25item anonymous online survey was sent to 477 EM physicians assessing their wellbeing during the COVID-19 pandemic. Email distribution included 14 hospitals over six months. Our Institutional Review Board approved this study with a waiver of informed consent. No identifiers were collected. Participation was voluntary. No compensation was offered.

Descriptive statistics, including frequencies and proportions, are reported for all survey items for the total study sample, and are stratified by physician gender (female vs. male) and years of experience (<11 years vs. ≥11 years). Chi-square tests, or Fisher's exact tests were used to assess differences in survey responses by gender and years of experience. A p-value of <0.05 was considered statistically significant. All analyses were conducted using SAS 9.4 (SAS Institute, Cary, North Carolina, United States). Table 1 shows emotional wellness survey results. During the pandemic, more females had difficulties with depression, appetite, concentration and sleep. Females were more emotional. They felt easily irritated, cried, and lashed out more than males. Female physicians had more changes in appetite. They ate and hydrated less during their shifts. One study on women stressed with high cortisol levels found they ate more on the day they were stressed than on their control day [25] . Stress and depression are connected to poor nutritional choices [27] . Concentration issues were more common in female EM physicians and physicians with less than 11 years in practice. Females had more sleep disturbances during the pandemic. Only thirteen percent used more sleep aids. A few revealed aids were ineffective. Alcohol use was higher in females and those with less than 11 years of experience. A link exists between substance abuse and high stress. Substance abuse, associated with stress or depression, is associated with physician suicide [40-42). Table 2 presents intellectual and physical wellness survey results. Forty percent of physicians worked out less. Close to half did exercise, with males comprising the majority. Table 3 details questions on independent, academic learning during the pandemic (Table 3) . Routinely, 83.1% of physicians listened to the news or other social media for pandemic updates.

Poor wellbeing, including depression, anxiety, poor quality of life, stress and high level of burnout, are associated with more self-reported errors [23] as well as decreased quality of patients' care, malpractice risk and early retirement [6, 24] . To de-stress, males mostly exercised and females shopped online. For other activities, gender or years of practice were not impacted (Table 1) . Physical appearance was not a concern, more in females and less experienced physicians. Table 4 displays environmental and spiritual wellness results. Environmentally, more than fifty percent of physicians were worried about safety due to reuse of their N95 mask, mostly females. N95 mask reuse leads to decreased effectiveness in protection against contracting the COVID-19 virus [43] . With increased potential transmission, stress levels increase. Religious practices were unchanged. Females, more than males, had empathy changes. A study using the Jefferson Scale of Empathy showed females commonly score higher than males, suggesting females are more empathetic than males [44] . Most providers did not lose empathy towards their patients. Maintaining empathy is essential in preventing burnout [45] . Our study found that physician wellness was negatively affected by the pandemic, particularly in female EM physicians. There has been a paucity of studies investigating gender and years of practice differences in relation to the impact that the COVID-19 pandemic has had on EM physicians' well-being. Female physicians and physicians who have been in practice less than 11 years are more likely to have negative effects. J o u r n a l P r e -p r o o f 0 (0.0%) 0 (0.0%) *Stratified analysis excludes two respondents who identified as "Other" gender. **p-values derived from chi-square tests or Fisher's exact tests where appropriate. ***Response options are not mutually exclusive. Note: some column percentages may not sum to 100% due to rounding. J o u r n a l P r e -p r o o f 

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