Table 4.

Themes and exemplary quotations

Subtheme	Exemplary quotation
Individual
Age, experience, and life stage	“These are all lessons that I learned in my first eight years through H1N1, through losing young lung transplant patients with cystic fibrosis. You know, total tragedies, the patients you never forget. The … mom who’s exactly your age with a 2-year-old who dies 28 days post-transplant…You’ve kind of been through this on a smaller scale with other diseases and you apply that experience and that toughness to COVID. So I think I managed pretty well.” (0102, male, pulmonary critical care, academic hospital, NYC)
Institutional
Resource disparities	“The grapevine word was that there’s another hospital organization in town that had a lot more money than we did, and they scooped up a lot of the resources pretty quickly, and so then it took us longer to find the resources that we needed in terms of the equipment” (0225, female hospitalist, academic hospital, NOLA)
	“There was a dichotomy between private institutions and public institutions. For example, my institution worked with a lot of private institutions to give them ventilators that they weren’t using and all of that. They didn’t do the same thing for the public hospitals. And I think it created that ‘the tale of two cities’ that often is the reference to the way that this crisis was managed, and other crises as well. That if you’re poor, you live in certain neighborhood and all of that, you’re going to receive poor care.” (0106, male, pulmonary critical care, academic hospital, NYC)
Institutional size	“During the peak, when it wasn’t just hanging out, and we did feel threatened, that lack of leadership just destroyed everybody. Yeah, I think, full-on anger looking at [how] they used shower curtains to separate the patients at one point. It was this running joke, we’re a, you know, multi-hundred-million-dollar company, a billion-dollar [company] and we got shower curtains? … It’s a very corporate institution, so I don’t think anyone felt comfortable, even you know, [saying] ‘This isn’t right.’” (0120, male, emergency medicine, academic hospital, NYC)
	“The hospital administration was still a little removed from what was truly happening on the floors. And we could notice that in their delayed response in allocating resources and adjusting to the acute needs. Whereas I feel like the divisions within the hospital that are truly taking care of patients just rapidly came up with redesigning in how we have to manage patients and how to manage our workflows.” (0107, female, hospitalist, academic hospital, NYC)
Institutional policies	“Our visitation policy right now is two people per day. And then if it’s truly end of life, four can come in, which we’ve…been negotiating against because we’ve been holding this four-person thing as, ‘Well, if you say the word comfort care, we will let more people in.’ It’s like this dangling carrot which we kind of felt like we were holding them hostage.” (0205, female, pulmonary critical care, academic hospital, NOLA
Professional
Informal rationing	“I think that was pretty distressing, certainly for me, and probably for other clinicians, where they felt like either they were implicitly rationing care, or they weren’t providing the usual level of care that they’re accustomed to providing.” (0115, male, hospitalist, public hospital, NYC)
Medical uncertainty	“There is a real struggle because I wanted to provide that reassurance and because I couldn’t, I felt like I was not being a good doctor. If I provided inaccurate reassurance or concern or whatever, I think it was magnified because of the sheer amount of fear I saw on my patients’ faces and the voices or faces of their families when we called or FaceTimed them. And there was this definite erosion in my sense that…I knew what I was doing.” (0129, male, hospitalist, academic hospital, NYC)
Concern for colleagues	“We had some nurses who were terrified to take care of the patients and it was palpable. And so, to what degree do I force them to adhere to the standards that they would normally do, and to get in the patient’s room and really take care of the patient?” (0219, male, pulmonary critical care, community hospital, NOLA)
Specialty differences	“Most ERs throughout the country had decreased volume. And any non-academic ones are run like corporate groups, like businesses. So if you’re extra staff, they just furloughed, so the ER doctors are getting furloughed across the country. So now suddenly, everyone’s morale’s down, you’re a beaten dog, you’re at your employer’s mercy, but then you’re also were like, ‘But I have a job. So I’m just gonna, now, shut up and be happy at least I’m employed.’” (0120, male, emergency medicine, academic hospital, NYC)
Societal
Federal response	“I feel like when we’re kids, we’re told that America is special, right? American exceptionalism. We may not have the fastest trains, but we are the greatest country. And I feel like I woke up from a dream about that.” (0116, male, emergency medicine, community hospital, NYC)
COVID politics	“I think social media really created a lot of stress for all of us because...say you just had the worst day of your life. And then you come home and you’re reading someone’s Facebook post about how COVID isn’t real and doctors are getting paid for COVID. … I think it was that kind of stuff that would cause stress.” (0214, female, pulmonary critical care, academic hospital, NOLA)
Societal inequalities	“We also have a lot of undocumented people … So I think that kind of feels sad and upsetting that my patients can’t get the same care as other people. … I think I have more feelings during the beginning when I’m worried about whether someone is gonna get really sick or not than when I’m like, oh, they’re probably not gonna make it.” (0133, female, hospitalist, public hospital, NYC)