GPs Left Depressed, Anxious, and Burned Out by Pandemic

Dr Rob Hicks

March 22, 2022

Primary care doctors around the world are facing increasing chronic stress and burnout that is detrimentally affecting their mental health and wellbeing.

According to the first systematic review to explore the psychological wellbeing of GPs during the COVID-19 pandemic, it has left GPs depressed, anxious and burned out, with women and older doctors most affected.

For the systematic review, published in the British Journal of General Practice , researchers from the University of York searched six bibliographic databases, Google Scholar, and MedRxiv and conducted reference checking to identify studies of GP psychological wellbeing during the pandemic. They identified 31 studies that evaluated the impact of COVID-19 on the wellbeing and mental health of primary care doctors, three of which were studies of GPs working in the UK.

Study author, Dr Laura Jefferson from the Department of Health Sciences, University of York, said: "While there has been a tendency for research like this to focus on hospital roles, there was a need to synthesise evidence and explore factors associated with GPs’ mental health and wellbeing during the pandemic."

Women and Older Doctors Faring Worse

The new review found that the pandemic had left many GPs around the world feeling depressed, anxious and in some cases burned out. The researchers also found that women doctors in primary care reported more psychological problems, including higher stress levels, burnout and anxiety. The authors suggested that one reason for this could be that "women may be more open in discussing difficulties and seeking support due to socialised gender norms". However, they also suggested that their findings might be because "women may also have experienced greater pressures during the pandemic due to wider caring responsibilities".

In addition, the researchers said that older primary care doctors reported greater stress and burnout, adding that “increasing stress with age may result from seniority and additional roles including practice management”.

The authors highlighted that "doctor burnout has been described as a 'global crisis', affecting the quality of patient care and sustainability of health care systems". They said that there were common themes when it came to difficulties faced by doctors in primary care settings, with sources of stress including "changed working practices, exposure to COVID-19 and inadequate PPE, information overload, lack of preparedness for the pandemic, and poor communication across health sectors".

Dr Jefferson said: "The COVID-19 pandemic has presented additional challenges for GPs, including rapid change, risks of infection, remote working, pent-up demand, and reductions in face-to-face patient care."

Physical Symptoms Also Heightened

The researchers explained that the studies demonstrated an impact on primary care doctors' psychological wellbeing, "with some also experiencing a fear of COVID-19 and lower job satisfaction".

Physical symptoms were also reported in a third of the studies, as a consequence of the impact of the pandemic. Some of the problems reported by GPs included migraines and headaches, tiredness and exhaustion, sleep disorders, and increased eating, drinking, and smoking. GPs with symptoms of long COVID felt 'let down' and expressed frustration at the lack of support and recognition for the condition, the authors said.

"Many GPs have reported stress and burnout over recent years," said Dr Jefferson, "which is potentially damaging not just to doctors themselves, but also to patients and healthcare systems".

In the opening session of the House of Commons health select committee’s inquiry into the future of general practice last week, GPs highlighted that pressures of workload and poor job satisfaction were resulting in many GPs retiring early.

In fact, even before the COVID-19 pandemic hit, a survey in 2019 by the General Medical Council (GMC) found that around 1 in 6 (18%) GPs said they were considering leaving medicine entirely within the next year, around a third of whom were considering retirement. Excluding those who were considering retirement, 1 in 10 (11%) GPs said they may be considering a career outside medicine. Professor Martin Marshall, Chair of RCGP Council, told the health select committee: "Our own work in the college showed that 34% of GPs said that they planned to retire in the next 5 years."

GPs also told the health select committee’s inquiry that the "unsafe workload of general practitioners needs to be reduced to prevent an exodus of struggling doctors from the profession".

The researchers commented that their review highlighted the need for policy and infrastructure to support GPs and further research is needed to explore gender and age differences, identifying interventions targeted to these groups. They added that the identified gender and age differences should be taken into account by policy makers and researchers when designing "tailored interventions".

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