Table 2.
Summary of 10 Primary Themes with Frequency Across All Three Questions (Total Responses n = 4,465) and Exemplary Quotes
| Theme and definition | Responses, n (%) | Exemplary quotes |
|---|---|---|
| 1. Personal health and safety: Challenges or suggestions related to personal health, safety, and/or well-being, including both physical and mental/emotional health | 1,324 (30.2) | • We only have 1 surgical mask per person per week. In mid-March we had 2 physicians (myself included) and 5 [medical assistants] contract COVID-19. Then many of our family members became ill. One of our [medical assistant's] mothers ended up in the [intensive care unit] on the ventilator. (FL 414) • My employer needs to be able to provide universal testing for patients and health care care workers so that appropriate quarantining and treatment can occur and minimize the rate of spread in a health care setting. My employer also needs to provide optimum levels of [personal protective equipment] in all settings, not just the high-risk inpatient settings. (NFL 292) • I don't know. I'm having trouble helping myself most days and I feel like I'm just going through the motions. I feel guilty to use up resources for mental health that are available for front line workers since I'm at home. I had baseline depression/anxiety that is much worse and untreated. I am afraid for my life and what will happen to my child when I am forced to return to work if I get sick and die. (NFL 1,536) |
| 2. Patient care and safety: Challenges or suggestions related to caring for patients during the pandemic, including both COVID and other patients | 982 (22.4) | • Stress of trying to figure out what is safest, delaying care vs. sending someone for imaging or bringing them to clinic for exam or labs, delaying consults/referrals—every straightforward medical decision is now a complex analysis of risk vs. benefit without any textbook answer. (FL 116) • I'm a psychiatrist—My patients are starting to decompensate. Psychotic patients are becoming more psychotic, anxious patients are becoming more anxious, depressed patients are becoming more depressed. (NFL 1,477) • The deep sadness over elderly COVID patients being unable to have the comfort of family nearby and the loss of physical interaction with patients. (FL 399) • I am a pediatric intensivist taking care of older adults COVID patients. I last took care of [intensive care unit] adult patients in medical school in 2000. (FL 171) |
| 3. Financial/job security: Challenges or suggestions related to professional, personal or home finances, including loans or cost of living, salary, productivity loss, or job security | 910 (20.8) | • Salary decrease by 20% and voluntary days off without pay, or to keep full salary, need to volunteer to be part of the intubation team, [intensive care unit] team, or be deployed to high COVID-19 centers in [New York City] or New Jersey. (FL 30) • Simultaneously being in some situations where I treat persons under investigation with or who have COVID as a consultant but also at risk for pay cut due to loss of other clinical revenue. (FL 253) • I want to work and help patients, but there isn't a need right now… I have student loans (not all federal and forbearance-able), children, and a husband in fellowship in an incredibly high cost of living area. I (we) are crumbling. (NFL 19) • Rather than cutting lowest earners first, top earners including [Chief Executive Officer, Chief Operations Officer] need to take cuts first. (FL 60) |
| 4. Parenting/homeschooling: Challenges or suggestions related to caring for children and/or the home during the pandemic, including physical, psychological or educational needs | 676 (15.4) | • …trying to keep my teenagers safe and sane while running full time distance learning through their schools… (FL 30) • The biggest challenges at home are about our kids. Their school has transitioned to online classes, but the reality is that they are looking at a screen for class, watching YouTube or playing video games for the majority of the day. I worry about their mental and emotional health. And I worry about their physical health both from less activity but also if I were to bring the virus home to them. (NFL 1,552) • Provide grocery hours for providers in person and for online orders also, this could ease at least one stress…(NFL 468) • Supporting my children mentally—my husband and I are both physicians. I worry we are not supporting them as best we could. I know they are scared. (FL 289) • The fear in my kids eyes when I leave for work, I am keeping myself away from them as much as I can but it is impossible to achieve completely. Home schooling while working full time. (FL 28) |
| 5. Community and government support: Challenges or suggestions related to the government and/or the broader community's support for public health measures and health care workers | 564 (12.9) | • General public can stay home, respect the gravity of the situation and support those trying to work to care for patients in this challenging time. Also, this underscores that the business and politics of medicine does not work for the people we care for or the health care providers who provide the care. (NFL 165) • The general public should stop treating this like a joke and stay inside. The recent protests make it seem like they don't care about Health care workers let alone themselves. (FL 114) • General public needs to do their part and stay home and social distance. I don't need “free coffee or car washes.” I need them to stay home. (NFL 129) • Listen to scientific experts and stay home and stay clean. Put pressure on government to implement adequate testing, case tracking, appropriate quarantining, and adequate financial support for small businesses, unemployed individuals and their families during this time. (NFL 292) |
| 6. Organizational communication and relationships: Challenges or suggestions related to communication or relationship with their health care organization leadership | 537 (12.3) | • I would feel so much better if I knew there was enough PPE and that policies were not being dictated by supply. I feel that I can't trust my institution to do the right thing because I know their decisions are influenced by the lack of supply. They tried to say giving nebs did not require N95 and continue to say this. I can't help but wonder if they are saying that because they want to save masks. (NFL 1,529) • Too many administrators having too many meetings about the best way to practice medicine—these administrators don't know what it is like on the front lines. (NFL 74) • Administrators: Come into the [emergency room], Gown up and shadow a doctor for a complete shift at least once a week. See every patient with them, even if they are doing a high-risk procedure. Wear the same PPE they are wearing. (FL 324) • [Do] not require PTO/vacation for work related exposure, COVID symptoms, etc. It's terrible to know we are being forced to use all our paid time off for this year and next year (in advance) if we get COVID. (FL 60) |
| 7. Family health and safety: Challenges or suggestions related to the potential for family members to contract COVID, including strategies used to mitigate risk of transmission | 374 (8.5) | • Fear of bringing COVID home…I worry about my diabetic smoker husband catching it from me. I can't check on my depressed mother who lives alone. I call daily but it isn't the same… (FL 89) • Death of father-in-law during the lockdown—not COVID related—but died alone in hospital with very small funeral and inability to have friends and family around for comfort of my spouse, [mother-in-law] now alone and needing support but difficult given stay at home orders in our state…(NFL 1,021) • Fear of passing COVID to my family. I have a disabled child and a father who is elderly with many comorbidities. I have a husband with many comorbidities. (NFL 1,042) |
| 8. Work/life balance: Challenges or suggestions related to the tension, intersection and/or conflict between work and home roles and responsibilities during the pandemic | 363 (8.3) | • Parents call every day to make sure I'm okay, and ask if I can quit my job to be safe. (FL 1,774) • Allowing work from home in days with only virtual visits to help kids with schoolwork during the day… (FL 1,288) • Trying to complete telemedicine with my patients with the company of my 2 and 5 years [olds]. (NFL 1,074) • Not letting my work stress interfere with being present at home…(FL 1,269) • Work is home and home is work. Very little separating the two now. (NFL 571) |
| 9. Access to childcare: Challenges or suggestions related to finding, utilizing, or paying for outside childcare providers during the pandemic | 318 (7.2) | • Need someone to watch my child!!! School is out. After school program is closed and critical infrastructure workers can't have had contact with someone with COVID [for] their kids to be in daycare??? (NFL 75) • A daycare in the hospital or subsidized childcare would be great. (FL 110) • We are trying to avoid having our nanny come. My husband is still working 4/7 days per week, and I am working 3 late shifts in the [emergency department]. We are trying to juggle our schedules to avoid needing help, because while we know our own risk, we have no idea whether those we ask to help us are actually practicing safe social distancing. (FL 705) |
| 10. Spouse/partner relationship: Challenges or suggestions related to managing the relationship with a spouse or partner, including roles and responsibilities | 222 (5.1) | • My partner is not in health care plus his source of information is not very reputable. We argue quite a bit because our area has not been hit very hard yet and he thinks I'm blowing this out of proportion…(FL 244) • Tired of social distancing from my spouse. (FL 1,047) • Husband is not happy about having to take the kids almost solo. (FL 740) • …Spouse furloughed but not picking up the fair share of homeschooling or house work (FL 356) |
COVID-19, coronavirus disease 2019; PPE, personal protective equipment; PTO, paid time off.