COVID Conjures Up Mixed Feelings for Critical Care Anesthesiologists

Critical care anesthesiologists said they were feeling more burned out, according to a pandemic-era survey.

In addition, women were much more likely to have burnout-related symptoms like muscle tension, fatigue, and sleeplessness. However, these anesthesiologists also reported feeling more of a sense of achievement on the job, and most said they believed they were contributing more to critical care than before COVID-19, reported Shahla Siddiqui, MBBS, MSc, of Beth Israel Deaconess Medical Center in Boston.

The researchers sent the survey to 1,400 American Society of Anesthesiologists (ASA) members trained in critical care, and 21.4% responded (average age 44; 30.8% women). Of those, 62.9% said their sense of burnout grew during the pandemic, Siddiqui explained in a presentation at the ASA annual meeting held virtually and in-person in San Diego.

A third reported moderate to severe anxiety, with woman significantly more likely to report symptoms such as sleeplessness and fatigue. About two-thirds of women reported muscle tension compared to under 40% of men. The gender gap was similar -- about two-thirds for women and under 40% for men -- for the symptom of being easily fatigued (P<0.001 for both).

Siddiqui told MedPage Today that her group launched the survey to update research into burnout among anesthesiologists, and gain insight into perceptions about bias and diversity in the field.

Previous data have pointed to a high rate of vulnerability to burnout in anesthesiology. A March 2020 survey of nearly 4,000 U.S. anesthesiologists found that 59.2% were at high risk of burnout, and 13.8% met criteria for burnout. Anesthesiologists who perceived a lack of support at work were especially vulnerable to burnout (odds ratio 6.7, 95% CI 5.3-8.5).

"It's not surprising to see the gender disparities in the level of anxiety expressed," commented Omonele O. Nwokolo, MD, of Memorial Hermann-Texas Medical Center in Houston, to MedPage Today.

"As other studies have shown, women are much more likely to be caregivers, particularly to children who are not eligible for vaccines and may not be as vigilant in protecting themselves. This could lead to conflict with work requirements and ability to keep the family safe," said Nwokolo, who was not involved in the study.

The current findings weren't all negative: 63.8% reported that their relative contribution to critical care had gone up during the pandemic, and 44% said they felt more achievement. However, "positive feelings were expressed significantly less often by women, which may reflect continued gender inequity in society, the work life imbalance borne by women, and their unequal emotional labor of caregiving," according to Siddiqui and colleagues.

They also asked participants about bias and diversity in critical care, and more than 40% of women reported a lack of diversity versus about 25% of men. More than 50% of women reported bias versus about a third of men (P<0.004 for both).

In regard to diversity, respondents complained about male domination in the field and failures of leadership to understand how to improve diversity. Participants also noted bias in the field toward women and minorities, as well as implicit bias. Several respondents angrily challenged the need for questions about bias, according to the researchers.

Finally, three-quarters of the respondents reported that institutional wellness resources weren't helpful. "We should be aware of these sentiments and do further studies as well as improve the work-life balance for women who have added responsibilities of home and child care," Siddiqui stated.

Nwokolo praised the survey-based study, adding that it was not a contradiction that anesthesiologists feel more valuable and more burned out at the same time.

"My takeaway is that many felt that they contributed more. This could be by working more hours, creating more protocols, and increased research in the face of the pandemic," said Nwokolo, who leads her department's diversity efforts. "Physicians faced with a huge task are rising to the occasion. However, the ongoing and seemingly cyclical nature of the pandemic and the death toll can explain the increase in burnout."

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