Physician well-being amidst COVID-19: An analysis of online resource provision by the 123 national medical specialty societies in the AMA house of delegates.

Dear editor,

The prioritization of physician well-being amidst the COVID-19 pandemic has garnered acknowledgement and support from many corners of the medical community (Bansal et al., 2020; Dzau et al., 2020). However, this voice must continue to become stronger and more consistent across all medical specialties, regardless of whether they serve in a point-of-care capacity. National medical organizations (i.e. societies, associations, academies), given their expansive and diverse reach, can serve in a unique role in creating and facilitating awareness of physician well-being, especially through digital/online mediums. Accordingly, explicit acknowledgement and provision of online/digital resources regarding physician well-being should be a high-yield tool leveraged by all medical societies amidst the COVID-19 pandemic.

Our study

The objective of our study was to understand the extent and timeliness to which national medical organizations (United States based) have acknowledged and supported physician well-being amidst the COVID-19 pandemic via online/digital content. A systematic review of the official websites for the 123 national medical specialty organizations in the American Medical Association (AMA) House of Delegates was performed (date: May 19th, 2020). A reproducible methodology was employed to screen each respective website to assess for presence of 1) general COVID-19 content, 2) a centralized COVID-19 resource page/information hub, and 3) the presence of physician well-being related content. The date(s) of which these resources were released/added were recorded whenever possible. All dates were normalized to elapsed time (days) since the first confirmed COVID-19 (index) case in the United States (January 20th, 2020) (Holshue et al., 2020). Statistical analysis was performed to determine the prevalence of well-being acknowledgement and resource provision, as well as trends/predictors in the timeliness of this provision.

Findings

Some form of publicly available COVID-19 related content was identified on 85.4% (n = 105) of organizational websites. An internally derived statement regarding COVID-19 was identified for 77.2% (n = 95) of organizations. A dedicated COVID-19 resource/information page was identified for 74.0% (n = 91) of organizations. Eighty organizations (65%) provided both an internally derived statement regarding COVID-19 and a dedicated resource page. A small portion of organizations (3.3%) indicated availability of COVID-19 content accessible for members only. Thirteen organizations (10.6%) provided no content regarding COVID-19. Of those organizations that acknowledged COVID-19 on their website (n = 105), 39% (n = 41) provided some form of content related to physician well-being amidst the COVID-19 pandemic.

Of those organizations providing COVID-19 related content (n = 105), 82 possessed a clearly identifiable date of earliest content. The mean date for earliest COVID-19 content was March 17th, 2020 (SD: 12.7 days), 56.9 days since first confirmed U.S. case (SD: 13.1 days). Of the 41 organizations who provided content related to physician well-being, 19 had a date associated with release of such content. Mean date of earliest well-being related content was March 30, 2020 (SD: 19 days), 70.8 days since first confirmed U.S. case (SD: 17.2 days). Mean time (days) to earliest well-being related content was significantly longer than mean time to earliest COVID-19 content (p<0.01). Neither time to earliest COVID-19 related content or time to earliest well-being content was a significant predictor of use of external well-being resources (p ≥ 0.29).

Of those organizations that possessed a clearly identifiable date of earliest COVID-19 content (n = 82), 35 would eventually provide well-being related content. Mean time to earliest dated COVID-19 content for these organizations was 52.9 days (SD: 15.2), which was significantly shorter than those who did not provide well-being content (59.9 days; SD: 10.3) (p = 0.03). For those organizations that had associated dates for both earliest COVID-19 content and well-being content (n = 18), linear regression demonstrated a significant relationship such that earlier provision of general COVID-19 content was associated with earlier provision of well-being content (p = 0.03).

Collectively, 269 discrete external well-being related resources were referenced across 31 organizations. The Headspace application (Headspace Inc., Santa Monica, CA USA) was most common (n = 11 societies). Other commonly cited external well-being resources (or organizations) included: Centers for Disease Control and Prevention (n = 9), American Medical Association (n = 8), National Academy of Medicine (n = 6), American Psychiatric Association (n = 5), and the Ten Percent Happier (Phone Application; n = 5). Two organizations provided reference to validated physician burnout/well-being screening tools (i.e. The Copenhagen Burnout Inventory). Five organizations provided telephone hotline/helpline contacts (i.e. National Suicide Prevention Lifeline).

Take-aways

Amidst the COVID-19 pandemic, the digital initiative by national medical societies has been strong, as evident by the high prevalence of COVID-19 content on their websites (85.4%). However, provision of content regarding physician well-being appeared markedly less (39.0%). While the tangible provision of content is important, it is the implication of this content that bears greatest value. More succinctly, provision of content not only creates awareness as to the importance of physician well-being, but also facilitates normalization of the subject matter. Doing so helps alleviate the stigma associated with mental health, a known phenomenon within the physician community (Mehta and Edwards, 2018). Furthermore, the acknowledgement and provision of well-being content serves to prompt dialog, either internally and/or externally, regarding individual well-being. It is through these dialogues that physicians can become more aware and present in their current feelings, as well as recognition of that fact that they are not alone. These conversations will also provide a tangible framework through which increased and enhanced well-being and mental health resources may be identified (Cho et al., 2020). As the COVID-19 pandemic continues, it is essential that medical societies prioritize the acknowledgement of physician well-being, as well the dissemination of resources to support their members during this troubling time.