Female Family Medicine Physicians Especially Prone to the Effects of Moral Distress on Burnout During the Initial Wave of the COVID-19 Pandemic in California

Introduction : Primary care clinicians are especially prone to burnout. This study investigated factors contributing to burnout and moral distress and their relationship at the start of the COVID-19 pandemic among practicing family physicians (FPs) in California. Methods: Sample : This cross-sectional study reports the findings of a 22-item multiple-choice survey sent to California family physicians (FPs) between July-August 2020. The final sample included 218 FPs. Data Analysis : Univariate and multivariate logistic regression was used to determine the relationship between demographic and characteristic variables, concerns and coping mechanisms with moral distress and burnout and to evaluate the relationship between moral distress and burnout. Gender was evaluated as an effect modifier of the relationship between moral distress and burnout. Results : Physicians experiencing higher burnout and moral distress were more likely to report concerns regarding personal COVID-19 risk and lack of PPE. Practicing self-care and personal wellness were associated with decreased moral distress. Female physicians were 3.86-fold more likely to report worsening burnout compared to male physicians. Employer support was associated with a 59% reduced burnout risk and 54% reduction of frequent moral distress. Frequent moral distress was associated with a 3.12- fold higher burnout risk. Gender modified the relationship between moral distress and burnout. Moral distress was associated with a 3.55-fold increase in burnout risk among females. Conclusions : Female FPs experienced greater levels of moral distress and burnout than male physicians. Moral distress was differentially associated with increased burnout among female physicians. Employer support was a protective factor against moral distress and burnout.