System-Based Interventions to Address Physician Burnout: A Qualitative Study of Canadian Family Physicians’ Experiences During the COVID-19 Pandemic

Document Type : Original Article

Authors

1 Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada

2 Faculty of Nursing, Memorial University, St. John’s, NL, Canada

3 Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada

4 Department of Family Medicine Primary Care Research Unit, Dalhousie University, Halifax, NS, Canada

5 Doctors Nova Scotia, Dartmouth, NS, Canada

Abstract

Background 
Medical professionals experienced high rates of burnout and moral distress during the COVID-19 pandemic. In Canada, burnout has been linked to a growing number of family physicians (FPs) leaving the workforce, increasing the number of patients without access to a regular doctor. This study explores the different factors that impacted FPs’ experience with burnout and moral distress during the pandemic, with the goal of identifying systembased interventions aimed at supporting FP well-being and improving retention.
 
Methods 
We conducted semi-structured qualitative interviews with FPs across four health regions in Canada. Participants were asked about the roles they assumed during different stages of the pandemic, and they were also encouraged to describe their well-being, including relevant supports and barriers. We used thematic analysis to examine themes relating to FP mental health and well-being.
 
Results 
We interviewed 68 FPs across the four health regions. We identified two overarching themes related to moral distress and burnout: (1) inability to provide appropriate care, and (2) system-related stressors and buffers of burnout. FPs expressed concern about the quality of care their patients were able to receive during the pandemic, citing instances where pandemic restrictions limited their ability to access critical preventative and diagnostic services. Participants also described four factors that alleviated or exacerbated feelings of burnout, including: (1) workload, (2) payment model, (3) locum coverage, and (4) team and peer support.
 
Conclusion 
The COVID-19 pandemic limited FPs’ ability to provide quality care to patients, and contributed to increased moral distress and burnout. These findings highlight the importance of implementing system-wide interventions to improve FP well-being during public health emergencies. These could include the expansion of interprofessional team-based models of care, alternate remuneration models for primary care (ie, non-fee-for-service), organized locum programs, and the availability of short-term insurance programs to cover fixed practice operating costs.

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Articles in Press, Corrected Proof
Available Online from 01 June 2024
  • Receive Date: 14 June 2023
  • Revise Date: 01 March 2024
  • Accept Date: 29 May 2024
  • First Publish Date: 01 June 2024