The Impact of COVID-19 on Physician–Scientist Trainees and Faculty in the United States: A National Survey : Academic Medicine

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The Impact of COVID-19 on Physician–Scientist Trainees and Faculty in the United States: A National Survey

Kwan, Jennifer M. MD, PhD1; Noch, Evan MD, PhD2; Qiu, Yuqing MS3; Toubat, Omar PhD4; Christophers, Briana5; Azzopardi, Stephanie6; Gilmer, Gabrielle7; Wiedmeier, Julia Erin MD, MPH8; Daye, Dania MD, PhD9

Author Information
doi: 10.1097/ACM.0000000000004802

Abstract

COVID-19 has infected more than 80 million people and killed more than 900,000 people in the United States as of April 2022. 1 To combat this virus, physician–scientists—physicians who spend the majority of their time conducting research—have been redeployed to provide care for the large influx of infected patients. Many have pivoted their research to address the pathophysiology of the virus to aid in the development of viable treatments and vaccines. While physician–scientists are well positioned to address these aspects of the COVID-19 pandemic and the long-term health consequences of COVID-19, 2 they are also vulnerable to disruptions in their training paths and careers. Before the pandemic, they were already considered an endangered species whose ranks have been declining over the past several decades. 3,4 Disruptions start at the beginning of the physician–scientist pathway, at the medical student level, and continue all the way to the faculty level, with residents/fellows and early-career faculty being particularly vulnerable.

For medical students, COVID-19 restrictions led to reduced hands-on learning experiences during the initial peak of the pandemic and deferral of standardized exams. 5 For physician–scientist trainees entering their graduate school research phase, COVID-19 restrictions posed challenges for transitioning out of the preclerkship phase of medical school and into the laboratory (lab) and for gaining exposure to different lab environments when in-person lab rotations were significantly limited. 5 Graduate students who were finishing up their research faced interruptions to their research progress, particularly for wet lab work and animal experiments. 6

For residents, fellows, and faculty, the pandemic has posed additional challenges, including not being able to find a desired research position, compromised training opportunities, and reduced productivity as research stalled. 7–9 The rise of COVID-19 has disrupted the entire biomedical research enterprise, from halted clinical trials to reduced research capacity in labs and redirection of resources to combat COVID-19. 10–13 In addition to these disruptions, COVID-19 has led to increased levels of stress, social isolation, depression, burnout, and suicide among health care providers, 14–19 and it has affected the well-being, health, productivity, and training of residents, fellows, and physician–scientist faculty. 20–22

Before the COVID-19 pandemic, several factors emerged as key contributors to decreased productivity and increased attrition of physician–scientists at the resident, fellow, and early-career faculty level, including work–life balance, grant acquisition, institutional pressures for clinical productivity, and financial stressors. 23,24 During the pandemic, women have been disproportionately affected by increased caregiving demands and home-related duties that have subsequently reduced their career productivity. 25–29 Identifying the ways and extent to which the COVID-19 pandemic has affected physician–scientists and trainees is critical if we are to retain them to address biomedical research problems, including tackling long COVID. 30 Therefore, in this study, we investigated the impact of COVID-19 on the personal lives, career activities, stress levels, and research productivity of physician–scientist trainees and faculty.

Method

We designed a survey tool with feedback from mental health researchers and academic faculty with expertise in training physician–scientists. The 3 versions of the survey included different numbers of questions, according to training level: 13 for medical students, 17 for graduate students, and 18 for residents/fellows and faculty. Medical students doing their graduate research training in a combined or separate science degree-conferring program were defined as graduate students in this study. The survey instrument (with the questions for the 3 versions) is available as Supplemental Digital Appendix 1 at https://links.lww.com/ACADMED/B297.

From April 14 to June 26, 2020, the survey was distributed to 120 U.S. institutions with MD–PhD programs by the chairs of the Association of American Medical Colleges’ Group on Graduate Research, Education and Training and by institutional representatives of the American Physician Scientists Association. The survey was administered via SurveyMonkey (Momentive, San Mateo, California). This study was approved as exempt by the Weill Cornell Medicine Institutional Review Board.

There were 2,100 responses, but after filtering for responses with significant missing data, 1,929 total respondents were included in the analyses. Standard biostatistical analyses were performed, including chi-square and Fisher’s exact tests, to compare differences between groups. An elastic net machine learning method was used to select variables for multivariate logistic regression analyses to determine significant differences between independent variables for the outcomes of stress and impaired productivity. The stress outcome was defined by answering “agree” or “strongly agree” to one or more of the following questions in the survey: “The COVID-19 pandemic has caused me a significant amount of stress, anxiety, hopelessness, and/or depression”; “The COVID-19 pandemic has caused sleep problems, decreased energy, changes in appetite, difficulty concentrating, and/or restlessness”; “Uncertainty of not being able to finish my research or to graduate is a great source of stress”; and “Worrying about my own health is a great source of stress.” The impaired productivity outcome was defined as answering “agree” or “strongly agree” to at least one of the following questions: “My research productivity/medical training will be negatively impacted in the short term (< 2 months)” and “My research productivity/medical training will be negatively impacted in the long term (> 2 months).”

For the demographic variables, respondents self-defined their gender as female, male, or other and self-described their racial/ethnic identity as White, Black or African American, Asian, Hispanic/Latino(a), or other. When specialty data were analyzed, respondents’ specialties were grouped according to the categories shown in Supplemental Digital Table 1 at https://links.lww.com/ACADMED/B298. Multivariate regression results were presented using forest plots. Results were deemed significant if P < .05. All analyses were performed in R, using R programming language version 4.1.2 (2021-11-01; R Core Team, Vienna, Austria) and RStudio (Integrated Development for R) by RStudio Team (2020; Boston, Massachusetts).

Results

Demographic and professional characteristics of the 1,929 respondents from 120 U.S. institutions with MD–PhD programs are summarized in Table 1. There were 679 (35%) medical student (MS), 676 (35%) graduate student (GS), 274 (14%) resident/fellow (R/F), and 300 (16%) faculty (F) respondents. Dual-degree status was indicated by 73% (n = 495) of MS, 96% (n = 648) of GS, 64% (n = 175) of R/F, and 36% (n = 109) of F respondents. Female respondents represented 55% (n = 370) of MS, 52% (n = 349) of GS, 45% (n = 121) of R/F, and 52% (n = 156) of F respondents. The majority of respondents were White, followed by Asian. Black/African American and Hispanic respondents were represented at lower proportions across all groups. Regionally across the United States, most MS (34%, n = 229), GS (30%, n = 204), and R/F (43%, n = 119) respondents were from institutions in the Northeast. Most faculty respondents were from institutions in the South/Southeast (48%, n = 143). Faculty respondents spanned career stages, as stratified by age: Junior or early-career faculty (< 40 years old) made up 58% (n = 173), intermediate faculty (40–50 years old) made up 28% (n = 84), and senior faculty (≥ 51 years old) made up 14% (n = 43) of F respondents. R/F and F respondents differed in terms of specialties (Supplemental Digital Table 2 at https://links.lww.com/ACADMED/B298).

T1
Table 1:
Demographic Characteristics of Respondents by Cohort, Survey of Physician–Scientist Trainees and Faculty at 120 U.S. Institutions, April–June 2020

All 4 cohorts reported academic and training disruptions caused by COVID-19, including effects on their training/education and their ability to conduct research/scholarly activity (Table 1). All cohorts also reported effects of the pandemic on their personal lives and well-being, with high levels of social isolation (MS: n = 300, 44%; GS: n = 456, 67%; R/F: n = 163, 59%; F: n = 181, 60%) and stress (MS: n = 552, 81%; GS: n = 583, 86%; R/F: n = 222, 81%; F: n = 253, 84%). R/F and F respondents were significantly more likely than MS and GS respondents to report financial difficulties (MS: n = 193, 28%; GS: n = 225, 33%; R/F: n = 99, 36%; F: n = 133, 44% [P < .001]) and a history of being infected by or having symptoms of COVID-19 (MS: n = 48, 7%; GS: n = 55, 8%; R/F: n = 44, 16%; F: n = 41, 14% [P < .001]). Given the high rates of stress and of negative impacts on research productivity (MS: n = 487, 72%; GS: n = 572, 85%; R/F: n = 183, 67%; F: n = 191, 64%), we performed a subgroup analysis of respondents by these categories (Tables 2 and 3; also Supplemental Digital Tables 3 and 4 at https://links.lww.com/ACADMED/B298).

T2
Table 2:
Factors Associated With Stressa by Respondent Cohort, Survey of Physician–Scientist Trainees and Faculty at 120 U.S. Institutions, April–June 2020b
T3
Table 3:
Factors Associated With Impaired Productivitya by Respondent Cohort, Survey of Physician-Scientist Trainees and Faculty at 120 U.S. Institutions, April–June 2020b

Impact on stress

In both the MS and GS cohorts, respondents who identified as having stress were more likely than their peers to perceive their careers as being affected (P < .001 for both). They were also more likely to describe COVID-19 as impacting their ability to conduct research/scholarly activities (P < .001 for both) and their research productivity as being affected by COVID-19 (P < .001 for both). Among MS respondents, those who were infected or had symptoms of COVID-19 and those who identified as females reported more stress (COVID-19: P = .002; female gender: P = .013). For GS respondents, research characteristics, such as research field (biological sciences vs computer and information science and engineering vs mixed/none, P < .001) and lab type (only dry vs only wet vs mixed/none, P < .001), were also associated with stress (Table 2; Supplemental Digital Table 3 at https://links.lww.com/ACADMED/B298).

Dual-degree R/F respondents were more likely than single-degree R/F respondents to report stress (P = .001) (Table 2; Supplemental Digital Table 3). All R/F and F respondents who changed their research or specialty, had financial difficulties, or became infected/had symptoms of COVID-19 reported stress (R/F: P < .001; F: P < .01). Among all R/F and F respondents who reported stress, patient care, personal life, research/scholarly activity, research productivity, social isolation, and training/education were all negatively affected (Table 2; Supplemental Digital Table 3).

We performed a multivariate regression analysis to identify common and unique factors associated with stress among respondents (Supplemental Digital Figures 2 and 3 at https://links.lww.com/ACADMED/B299). For both the MS and GS cohorts, impacted research/scholarly activity (MS: OR 5.32, 95% CI 3.14–9.34, P < .001; GS: OR 9.03, 95% CI 4.59–18.11, P < .001), financial difficulties (MS: OR 6.87, 95% CI 3.15–17.37, P < .001; GS: OR 2.69, 95% CI 1.31–5.99, P = .01), and social isolation (MS: OR 23.25, 95% CI 10.01–67.98, P < .001; GS: OR 4.57, 95% CI 2.54–8.4, P < .001) were associated with stress. For both R/F and F cohorts, effects on personal life (RF: OR 7.24, 95% CI 1.67–35.9, P = .009; F: OR 115.9, 95% CI 21.23–1,231.69, P < .0001) and research productivity (RF: OR 7.88, 95% CI 1.79–41.95, P = .008; F: OR 24.71, 95% CI 3.24–596.19, P = .009) were associated with stress. Effects on patient care (OR 20.97, 95% CI 5.02–102.1, P < .001) and social isolation (OR 6.55, 95% CI 1.45–33.46, P = .016) were predictive of stress among R/F respondents, whereas effects on training/education activities (OR 100.65, 95% CI 11.55–2,910.1, P < .001) were a significant predictor of stress among F respondents (Supplemental Digital Figure 3).

Impact on productivity

We next evaluated characteristics of respondents who reported their productivity as being negatively affected by COVID-19 (Table 3; Supplemental Digital Table 4 at https://links.lww.com/ACADMED/B298). For MS respondents, more of those who perceived their training/education (P < .001) and career (P = .006) as being affected reported impaired productivity compared with those who did not. For GS respondents, region (P = .082), dual-degree status (P < .027), lab type (P < .001), and research field (P < .001) were associated with impaired productivity. In both MS and GS cohorts, we found that conducting research/scholarly activity, financial difficulties, personal life impact, social isolation, and stress were all associated with impaired productivity (P < .001 for all variables).

For R/F and F respondents, there was a statistically significant difference in the mean age of R/Fs (Table 1). More females (n = 26/273, 10%) than males (n = 8/295, 3%) reported that they had increased home demands, including homeschooling, being primary caretakers for children, and spending more time taking care of home-related tasks (Supplemental Digital Figure 1 at https://links.lww.com/ACADMED/B299). R/F and F respondents with a dual degree expressed more impaired productivity compared with those without a dual degree (P < .001 for both). Those R/F and F respondents with impaired productivity also indicated that the pandemic affected their patient care and their personal lives and caused stress (P < .001 for all variables).

In multivariate regression analyses, financial difficulties (MS: OR 2.01, 95% CI 1.27–3.26, P = .004; GS: OR 3.14, 95% CI 1.67–6.3, P < .001) and social isolation (MS: OR 4.1, 95% CI 2.69–6.37, P < .001; GS: OR 3.96, 95% CI 2.36–6.74, P < .001) were the only variables that were associated with outcome of impaired productivity in both MS and GS respondents (Supplemental Digital Figure 2 at https://links.lww.com/ACADMED/B299). An effect on research/scholarly activities (MS: OR 3.0, 95% CI 2.04–4.47, P < .001) was associated with impaired productivity in the MS cohort, whereas wet lab research (GS: OR 2.91, 95% CI 1.23–6.78, P = .013) was predictive among GS respondents. Compared with wet lab research/biological sciences research, research in computer and information science and engineering (GS: OR 0.11, 95% CI 0.03–0.4, P < .001) was associated with lower odds of impaired productivity in GS respondents. For R/F and F respondents, dual-degree status (R/F: OR 2.61, 95% CI 1.17–5.98, P = .02; F: OR 2.45, 95% CI 1.03–6.06, P = .046), an impact on research/scholarly activities (R/F: OR 2.82, 95% CI 1.14–7.57, P = .03; F: OR 26.22, 95% CI 10.31–77.35, P < .001), and an impact on personal life (R/F: OR 2.46, 95% CI 1.14–5.36, P = .022; F: OR 2.84, 95% CI 1.33–6.15, P = .007) were predictors of impaired productivity.

Regional differences

Given the regional differences in the burden of COVID-19 at the time of survey completion in April–June 2020, we performed an additional subgroup analysis comparing the impact of the pandemic on respondents by region. For MS respondents, there were regional differences in the option for early medical school graduation (P = .008), changing research efforts to focus on COVID-19-related topics (P < .001), and changing intended career path/specialty as a result of COVID-19 (P < .001). For GS respondents, there were regional differences in the personal and educational effects of the pandemic, including labs being shut down (P = .008) and experiments being delayed or impaired (P = .004). All regional response variables for MS and GS respondents are presented in Supplemental Digital Tables 5 and 6, respectively, at https://links.lww.com/ACADMED/B298.

Among F respondents on a tenure track, 26% (n = 48) in the South/Southeast and 17% (n = 33) in the Northeast reported their institutions reset the tenure clock due to the pandemic. However, only 6% of respondents at institutions in the Midwest (n = 4) and on the West Coast (n = 5) reported this change to the tenure clock. Regarding clinical duties, R/F and F respondents from the Midwest (R/F: n = 18, 28%, P < .001; F: n = 12, 60%, P < .001) and Northeast (R/F: n = 62, 53%, P < .001; F: n = 70, 63%, P < .001) were more likely than those from other regions to report that their institutions redeployed clinicians from other specialties to assist with COVID-19-related care. While there was a higher proportion of R/F respondents who reported receiving hazard pay from their institutions in the Northeast (n = 14, 12%, P = .001), the total number of R/F respondents receiving hazard pay was low among all respondents (n = 15, 6%, P = .001). All regional response variables for R/F and F respondents are presented in Supplemental Digital Table 7 at https://links.lww.com/ACADMED/B298.

Additional variables

Additional data regarding the impact of COVID-19 on personal lives, scholarly activities, child care, transportation challenges, and other variables among R/F and F respondents are summarized in Supplemental Digital Tables 8–12 at https://links.lww.com/ACADMED/B298.

Discussion

This national study provides data on the personal, educational, and professional consequences of the COVID-19 pandemic for physician–scientist trainees and faculty in the United States, with strong representation of dual-degree trainees from the medical school to fellowship stages. The data presented here demonstrate that the pandemic had significant and comprehensive effects on stress and research productivity in this cohort. While many of the factors associated with stress and impaired productivity during the pandemic were similar among physician–scientist trainees and physician–scientists, some varied slightly by geographic region and according to training or career stage. Key findings are summarized in Supplemental Digital Figures 2 and 3 (available at https://links.lww.com/ACADMED/B298).

Medical students

We identified differences in COVID-19 experiences between subgroups of medical students that warrant further attention. A significantly higher percentage of female students than male students reported experiencing stress in this study, which is consistent with prior studies describing increased stress in female versus male medical students. 31–33 Understanding this disparity is important considering that stress is a known risk factor for depression, burnout, and poorer overall mental health. 34 Moreover, a previous study evaluating risk factors for depressive symptoms in more than 6,000 U.S. adults, using the Patient Health Questionnaire-9 instrument, showed sex and gender differences in depression pre-pandemic and during COVID-19, with depression rates increasing from 10.1% to 33.3% in women and from 6.9% to 21.9% in men. 35 Interestingly, in our study, while more female students reported stress compared with their male counterparts, they did not perceive changes in productivity compared with males. Our data were collected early in the pandemic, however. Follow-up studies are warranted to help explain the reduction in female-authored publications identified more recently in the pandemic. 25

Social isolation was reported by nearly half of medical student respondents and, importantly, served as an independent predictor of stress and impaired productivity in this cohort. This finding may reflect broader issues surrounding mental health among medical students, such as an estimated 27% prevalence of depression and 11% prevalence of suicidal ideation. 36 Especially during the COVID-19 pandemic, it is essential for medical schools to provide adequate health and wellness resources to address mental health issues while overcoming medical students’ fear of stigmatization and concerns about confidentiality. 37 Returning to in-person events, such as lectures and graduations, may also help reduce social isolation.

The majority of medical students reported that their productivity would be affected. Financial difficulty and social isolation were 2 factors that predicted impaired productivity. While the National Institutes of Health maintained stipends for medical scientist training programs during the pandemic, 38 not all physician–scientist trainees receive this funding. Institutions should make funds available on an as-needed basis as a grant/scholarship option to help those who are experiencing financial difficulty.

Graduate students

We found that career and research pursuits, financial challenges, and social isolation were all associated with stress among graduate students. In terms of productivity, graduate students reported impaired productivity if they experienced financial difficulties and social isolation. This finding, coupled with our stress outcome findings, suggests that the COVID-19 pandemic may have increased burnout in this population. 39 Institutional support may be one mechanism to address burnout, as it has been shown to improve students’ mental health. 40 The use of validated modules to assess student health and wellness may also be helpful for programs to consider as we transition out of the pandemic. 41,42 To help address trainees’ concerns about the impact of the pandemic on their careers and research, programs should consider flexibility in their requirements and transparency about these flexible options. 43–45 Additionally, because we found that graduate students performing only wet lab and/or biological sciences research reported that their research was affected (likely driven by the difficulty in transitioning this type of work to the virtual setting), funders offering award extensions should consider longer extensions for wet lab- and/or biological sciences-related research.

Residents/fellows and faculty

Residents/fellows and faculty reported high levels of stress and impaired productivity as a result of the COVID-19 pandemic. Factors independently associated with stress included social isolation, impact on personal life, and impact on research productivity. Having a dual degree was associated with impaired productivity. While being female was not independently predictive of stress or negative impacts on productivity, a subanalysis evaluating the impact of the pandemic on personal life found that more female than male respondents reported increased home demands on their time due to taking care of and/or homeschooling children. The disproportionate impact of child care duties on female scientists’ careers has been described elsewhere; for example, Viglione found that female scientists published fewer papers and preprints in 2020 compared with 2019, in part due to the burden of child care duties during pandemic-related school closures. 25

The results outlined here provide important insights into the adverse effects of the pandemic on physician–scientists at the resident/fellow and faculty levels and emphasize the need for tailored initiatives to protect this vulnerable population. If policies are not implemented to address these challenges, a generation of physician–scientists may be lost, which would have long-lasting effects that outlast the public health effects of the COVID-19 pandemic. Institutional initiatives, such as providing additional intramural funding to support research efforts or to assist with the costs of child care/caregiving as well as flexible work hours to accommodate child care, may help offset challenges associated with maintaining research productivity as we transition out of the pandemic. 46–48 Targeting these grants specifically at the most at-risk physician–scientists—including junior or early-career faculty, women, and individuals whose research efforts were most disrupted by the pandemic—may help ensure success of these vulnerable groups. Federal agency, specialty society, and foundation grants that offer additional support (with budget flexibility to support and/or accommodate child care needs) to early-career and female investigators during this time could improve retention. Resetting the tenure clock may help offset the impact of COVID-19 on the career trajectory of individuals applying for tenure promotion and grant extensions due to impaired productivity as a result of COVID restrictions. In addition, formal mentors and mentoring programs specifically designed for residents/fellows, early-career faculty, and underrepresented in medicine and female physician–scientists may improve postpandemic productivity. Previous studies have shown that targeted mentorship efforts for women in medicine, for example, have been associated with improved career satisfaction, faculty retention, and productivity. 49,50

Limitations

This study has several limitations inherent in its cross-sectional design. The results reported here reflect a one-time assessment of the impact of COVID-19 on respondents’ personal, educational, and professional experiences. A follow-up study is needed to evaluate changes over time. To improve the efficacy of supportive measures aimed at helping the physician–scientist workforce, future studies should examine the extent of stress and productivity changes and the percentage of time allocated to various professional and personal responsibilities during the pandemic. Finally, our survey was not designed to evaluate opinions on institutional or government policies or efforts to mitigate the stress and impaired productivity caused by the pandemic. Exploring diverse perspectives on how best to address physician–scientists’ concerns and support their work are critical for the ultimate success of such policies and efforts. The strengths of this study include its multicenter design, the large and diverse cohort of respondents spanning the continuum from medical and graduate students to residents/fellows and faculty, and the timing of the survey data collection, which coincided with the initial peak of the COVID-19 pandemic.

Conclusions

This national survey of physician–scientist trainees and faculty found that COVID-19 led to high levels of stress, aggravating factors that fueled physician–scientist attrition before the pandemic. Financial stressors were heightened for some respondents. More female than male respondents reported spending more time taking care of children and on home-related duties, which may reduce future grant and career success for women. There also appeared to be some regional differences in the direct impact of COVID-19 and in institutional policies responding to the pandemic. Disruptions to early-career physician–scientists’ research puts society at risk of losing an entire generation of physician–scientists, at a time when we need them the most. Understanding the challenges faced and their associated factors may improve efforts to support the physician–scientist workforce in the postpandemic period.

Acknowledgments:

This initiative and its results were produced and disseminated as an initiative of the American Physician Scientists Association (APSA). The authors would like to acknowledge the chairs of the Association of American Medical Colleges’ Group on Graduate Research, Education and Training (GREAT), Barbara Kazmierczak and Jose Cavazos, for their invaluable help in distributing the survey among GREAT members; Weill Cornell Medicine mental health researchers Corinne Catarozoli, Stephanie Rohrig, Andrea Temkin, and Payal Desai for their assistance in the mental wellness survey question design; and David Markovitz, Christopher Williams, Skip Brass, and Robin Lorenz from the American Physician Scientists Association for their support and guidance on this project and for their advocacy efforts to improve training and educational opportunities for the next generation of physician–scientists. The authors would also like to acknowledge APSA’s support for this study. The authors would also like to acknowledge the Noun Project for the creation of icons used in the supplemental digital figures (available at https://links.lww.com/ACADMED/B299), including Coronavirus created by Sarote Impheng, Medical student by Gan Khoon Lay, Scientist by Parkjisun, Students by Wilson Joseph, Doctor by Arafat Uddin, Lab by Eucalyp, Breastfeeding by Deemak Daksina, and Hospital by Pelin Kahraman.

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