ABSTRACT
Background: Physician burnout is associated with reduced quality of care and patient satisfaction and increased costs. We sought to quantify professional fulfillment levels and burnout rates and identify drivers of burnout among physicians within Vancouver Coastal Health during the COVID-19 pandemic. Methods: Members of the Vancouver Physician Staff Association were surveyed in the fall of 2020. The Stanford Professional Fulfillment Index was used to assess physician professional fulfillment and burnout. Physicians were also asked to assess the effect of the COVID-19 pandemic on their physical and mental health, determine psychological safety within their department, and identify interventions to improve their well-being. Results: Of the 1949 physicians contacted, 566 (29%) responded to the survey. Results were analyzed for 84% of the responses (475/566);the completion rate was 24% (475/1949). The overall professional fulfillment level was 25.3%, and the overall burnout rate was 51.4%. Interventions that physicians felt would improve their well-being included providing higher financial remuneration, improving patient access to resources, enhancing staff support, and providing coaching sessions and better support for work-life balance. Conclusions: Further work is needed at every level—individual, departmental, and system-ic—to address physician burnout. It is our hope that these survey results will help drive systemic, cultural, and organizational changes to improve physician well-being. Results: Of the 1949 physicians contacted, 566 (29%) responded to the survey. Results were analyzed for 84% of the responses (475/566);the completion rate was 24% (475/1949). The overall professional fulfillment level was 25.3%, and the overall burnout rate was 51.4%. Interventions that physicians felt would improve their well-being included providing higher financial remuneration, improving patient access to resources, enhancing staff support, and providing coaching sessions and better support for work-life balance. © 2023, British Columbia Medical Association. All rights reserved.
ABSTRACT
Background The COVID-19 pandemic has brought significant challenges to clinicians caring for liver transplant (LT) recipients. Researchers have sought to better understand the risk and clinical outcomes of LT recipients infected with COVID-19 globally, however, there is a paucity of data from within Canada. Aims Our multi-center study aims to examine the characteristics and clinical outcomes of LT patients with COVID-19 in Canada. Methods We identified a retrospective cohort of adult LT recipients with RT-PCR confirmed COVID-19 from 7 Canadian tertiary care centers between March 2020 and June 2021. Demographic and clinical data were compiled by clinicians within those centers. We identified liver enzyme profile at the time of COVID-19 infection, immunosuppression type and post-infection adjustments, rate of hospitalization, ICU admission, mechanical ventilation, and death. Results A total of 49 patients with a history of LT and COVID-19 infection were identified. Twenty nine patients (59%) were male, the median time from LT was 66 months (1, 128) and the median age at COVID-19 infection was 59 years (52, 65). At COVID-19 diagnosis, the median ALT was 37 U/L (21, 41), AST U/L was 34 (20, 37), ALP U/L was 156 (88, 156), Total Bilirubin was 11 umol/L (7, 14), and INR was 1.1 (1.0, 1.1). The majority of patients (92%) were on tacrolimus monotherapy or a combination of tacrolimus and mycophenolate mofetil (MMF);median tacrolimus level at COVID-19 diagnosis was 5.3 ug/L (4.0, 8.1). Immunosuppression was modified in 8 (16%) patients post-infection;either the tacrolimus dose was reduced or MMF was held. One patient developed acute cellular rejection which recovered after re-initiation of the prior regimen. Eighteen patients (37%) required hospitalization, 6 (12%) were treated with dexamethasone, and 3 (6%) required ICU admission and mechanical ventilation. Four patients (8%) died due to complications of COVID-19. On univariate analysis, neither age, sex, co-morbidities nor duration post-transplant were associated with risk of hospitalization. Conclusions In our national retrospective study, approximately 40% of patients required hospitalization with a mortality rate of < 10%. Previous studies have shown proximity to LT as an independent factor for mortality with COVID-19;the median time from LT for our patients was 5 years, which may explain the lower mortality rate. Of note, the median tacrolimus levels were much lower in comparison to the target of 8–10 ug/L used in the first year post-transplant. As the landscape of COVID-19 changes with vaccination, evolving treatments, and increasing rates of variant transmission, additional studies are required to continue identifying trends in clinical outcomes. Funding Agencies None