Study shows that stress levels are high for ER doctors on and off the job

Lack of protective gear and social interaction among biggest worries

Before the coronavirus pandemic struck, Dr. Maria Raven liked to unwind after a long shift in the ER by hanging out with colleagues after work.

“We used to go out and get brunch after an overnight shift or people would grab a beer after work,” said Raven, the chief of emergency medicine at UCSF. “We can’t do that anymore.”

Now, like everyone else, they resort to virtual meetups. Combine that lack of in-person socializing with one of the most trying periods of her career, and the result is a level of stress even the most seasoned of ER doctors are struggling to handle, according to a new study.

Early last week, Robert Rodriguez — a professor of emergency medicine at UCSF — and several co-authors published a study that attempts for the first time to take stock of stress levels among emergency medicine physicians during the COVID-19 pandemic.

The study found that doctors in seven U.S. cities reported rising levels of anxiety and emotional exhaustion. Most of the 426 doctors surveyed also said their behavior toward family and friends had changed, with fewer signs of affection.

Male physicians rated the effect of the pandemic on both their work and home stress levels at a 5 on a scale of 1 to 7. The me

dian for women was six in both areas. Separate studies have indicated women continue to bear the brunt of household chores and childcare, which may help explain the disparity.

“At home, doctors are worried about exposing family members or roommates, possibly needing to self-quarantine, and the effects of excess social isolation because of their work on the front line,” Rodriguez said in a statement.

The study surveyed faculty, fellows and residents with a median age of 35 in California, Louisiana and New Jersey. Of respondents, 72% lived with a partner and about 39% had a child younger than 18.

The top concern among doctors was a lack of personal protective equipment (PPE) like masks and face shields, but many also said they were anxious about inadequate rapid testing for the virus, the possibility of discharged patients spreading the disease in their communities and the well being of their coworkers diagnosed with COVID-19.

“I think a lot of us go into the field knowing we have to be able to handle a lot of uncertainty, but this has presented a new level of uncertainty,” Raven said. “There’s so much we don’t know about COVID still.”

Perhaps surprisingly, the results suggest both doctors in and outside of cities with surging case counts experienced similar levels of anxiety.

“This suggests that the impact of COVID-19 on anxiety levels is pervasive and that measures to mitigate stress should be enacted universally,” Rodriguez said.

According to the survey, improving access to PPE, increasing the availability of rapid turnaround testing, clearly communicating protocol changes and making sure front-line health care workers have access to testing and personal leave could help limit anxiety.

“It’s a delicate balance between wanting to staff everything appropriately and still be prepared if we have a surge,” Raven said.

Her system’s occupational health services have been overwhelmed by demand among employees for testing, she added, so some faculty members with symptoms are getting tested in the emergency room where results are often available quickly, within a day. But she’s still hearing about some residents and nurses finding it difficult to get a test.

“That’s a huge source of stress,” she said.