Abstract
Frontline rural physicians in Canada are vulnerable to the psychological impacts of the COVID-19 pandemic considering their high pre-pandemic burnout rates as compared to their urban counterparts. This study aims to understand the psychological impacts of the COVID-19 pandemic on rural family physicians engaged in full-time primary care practice in Ontario and the stressors behind any identified challenges. Recruitment combined purposive, convenience, and snowball sampling. Twenty-five rural physicians participated in this study. Participants completed a questionnaire containing Patient Health Questionnaire-2 (depression), General Anxiety Disorder-2 (anxiety), and Perceived Stress Scale-4 (stress) screening as well as questions exploring self-reported perceptions of change in their mental health, followed by a semi-structured virtual interview. Quantitative data showed an overall increase in self-reported depression, anxiety, and stress levels. Thematic analysis revealed seven qualitative themes including the positive and negative psychological impacts on rural physicians, as well as the effects of increased workload, infection risk, limited resources, and strained personal relationships on the mental health of rural physicians. Coping techniques and experiences with physician wellness resources were also discussed. Recommendations include establishing a rapid locum supply system, ensuring rural representation at decision-making tables, and taking an organizational approach to support the mental health of rural physicians.
Highlights
The Coronavirus Disease 2019 (COVID-19) pandemic has introduced additional burdens on the publicly funded Canadian healthcare system, alongside great uncertainty and personal health risk for people working within the healthcare system
16% screened positive for depression in Patient Health Questionnaire (PHQ)-2 and 44% screened positive for anxiety in Generalized Anxiety Disorder (GAD)-2 at the time of the study, the majority of the participants self-reported increased levels of perceived depression (48%), anxiety (72%), and stress (92%), as well as a decreased sense of overall mental wellbeing (80%) compared to before the pandemic
The COVID-19 pandemic has introduced immense stresses on the Canadian healthcare system and the mental health of frontline physicians [1]. This is especially significant for physicians living in under-resourced rural and remote areas, who were already experiencing high pre-pandemic burnout rates [3,4]
Summary
The Coronavirus Disease 2019 (COVID-19) pandemic has introduced additional burdens on the publicly funded Canadian healthcare system, alongside great uncertainty and personal health risk for people working within the healthcare system This has resulted in significant psychological impacts on frontline healthcare workers (HCW), who experience high levels of work-related stress even under normal circumstances [1]. While one in four Canadian physicians and residents reported high levels of burnout before the pandemic, the available pre-pandemic literature shows profoundly reduced wellness, increased burnout, decreased job satisfaction, and lower retention rates of rural physicians as compared to their urban counterparts [3–5]. Supporting the mental health of physicians is, vital for sustaining an effective response from the medical workforce during the pandemic, in underserviced rural areas
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