Mental health impact of COVID-19 on family doctors in Canada: one year after.

Context: A year after the pandemic outbreak, primary care providers continue to face extreme psychological pressure. This study gauges the mental health and burnout levels of family physicians during the third wave of the COVID-19 pandemic in Canada. Objective: Assess the levels of personal, professional and patient-related burnout of family physicians (FPs) in the response to the pandemic and explore demographic and work-related factors that may influence burnout levels. Study Design: Online, self-report survey administered between April 7 and May 10, 2021. Setting or Dataset: The College of Family Physicians of Canada's (CFPC) list of all active members was used to reach family physicians in diverse practice settings in all Canadian provinces and territories. Population studied: All active CFPC family physician (FP) members were included. Family medicine trainees and members with primary addresses outside Canada were excluded. Most FPs in Canada are CFPC members; 39,991 FPs received survey invitations; 3,409 replied, for an overall response rate of 9%. Outcome Measures: The study used the Copenhagen Burnout Inventory (CBI) which measures the level of personal, work-related and patient-related burnout. As well, question asking about FP's overall sense of well being and personal wellness which were asked in a previous survey, a year prior, were incorporated to allow for longitudinal comparison. Results: 15% of FPs reported feeling burned out and thinking of, or have taken, a break from work, three times more than last year. More than one-fifth of FPs currently experience high or severe personal (22%) and work-related (21%) burnout, while 13% report the same levels of patient-related burnout. Female FPs report higher levels of personal burnout (26%, 17%) and work-related burnout (23%, 16%) than male FPs. Generations Y (30%) and X (25%) are experiencing higher levels of personal burnout than Baby Boomers (14%) and Traditionalists (2%). Conclusions: Roughly 1-in-4 FPs in Canada are currently experiencing high or severe personal and work-related burnout. Compared with the survey results a year prior, the numbers are climbing rapidly, reflecting the serious challenges FPs facing during the pandemic. This study was designed to contribute to a better understanding of the extent of the problem, contributing factors and to assist in considering approaches to build effective support systems to improve the mental health of FPs.

The role of Canadian family physicians in the response to the COVID-19 pandemic.

Context: In Canada, most medical care is delivered through front line, first contact primary care. As nations traverse the most significant health event in a century, it is important to understand how primary care has been engaged in the challenge. Objective: Assess the patterns of direct clinical patient care involvement of Canadian family physicians (FPs) in the response to the COVID-19 pandemic by province, age, remuneration model, and practice setting. Study Design: Online, self-report survey administered between April 7 and May 10, 2021. Survey invitations sent via email, with three reminders following initial contact. Setting or Dataset: The College of Family Physicians of Canada (CFPC) membership list was used to reach family physicians in diverse practice settings in all Canadian provinces and territories. Population studied: All active CFPC family physician (FP) members were included. Family medicine trainees and members with primary addresses outside Canada were excluded. Most FPs in Canada are CFPC members; 39,991 FPs received survey invitations; 3,409 replied, for an overall response rate of 9%. Outcome Measures: Percent of FPs engaged in the pandemic response, including performing COVID-19 testing, administering COVID-19 vaccines, and caring for COVID-19 patients. Results: Almost all FPs (99%) were in some way involved in the COVID-19 response. Most FPs (77%) were involved in direct clinical patient care (eg vaccination, testing, and/or caring for COVID-19 patients). In particular, 54% cared for COVID-19 patients and 15% vaccinated patients at their practice. Older FPs, FPs receiving remuneration only via fee-for-service, and FPs practicing in family medicine clinics only were less likely to be involved in the COVID-19 response. The findings also vary across jurisdiction. Conclusions: While most family physicians have been involved in the COVID-19 response, discrepancies exist across jurisdiction, ages, remuneration types, and practice models. These results suggest that there were obstacles to the full involvement of Canada's primary care system in the response to the pandemic. Evidence generated by this study points to factors that could enable a more responsive future primary health care system.

Pandemic reflection: Significant change is needed to tap into the power of primary care during times of crisis.

Context: As a front-line resource, primary care could function as an indispensable health system resource during pandemic crises. However, throughout COVID-19, Canada's primary care providers expressed concern over their ability to respond. This study investigates factors related to these concerns, suggesting key areas for future primary care system development. Objective: Assess specific areas where robust, well-supported primary care could contribute significantly to the health system's pandemic response, & factors that may have prevented it from doing so. Study Design: Online, self-report survey administered over 3 weeks, April-May, 2021. Survey invitations sent via email, with three reminders following initial contact. Setting or Dataset: The College of Family Physicians of Canada (CFPC) membership list was used to reach family physicians in diverse practice settings in all Canadian provinces and territories. Population studied: All active CFPC family physician (FP) members were included. Most FPs in Canada are CFPC members; 39,991 FPs received survey invitations; 3,409 replied, for an overall response rate of 9%. Outcome Measures: Percent of FP engaged in systems level, pandemic response measures, including: 1) reporting COVID-19 cases to public health authorities, 2) identifying priority patients for vaccination, 3) participating in COVID-19 task forces, & 4) contributing to COVID-19 research/clinical studies. Results: Overall, one-third (34%) of FPs say that family practices in their region report COVID-19 cases to public health authorities. Most FPs (55%) say that their practices have not been asked to identify priority cases for COVID-19 vaccination. Less than 1-in-5 (19%) FPs have been involved in COVID-19 advisory/planning committees, task forces or groups. Very few FPs (6%) contribute to COVID-19 research/clinical studies. Half of FPs (50%) are highly concerned about the lack of clarity from government regarding FP response to the pandemic. These findings vary across jurisdictions and practice/remuneration models. Conclusions: Canada's primary care system has not been adequately engaged in important COVID-19 response measures, including monitoring viral spread in the population, pandemic planning, vaccination roll out, and therapeutic research. Practice models and remuneration arrangements are related to primary care's responsiveness to the COVID-19 pandemic,& should be considered in future primary care health system development.