TORONTO, April 19, 2023 — COVID-19 took a toll on society far beyond its impact on our physical and mental health. The pandemic disrupted the global economy, widened inequalities, interrupted children’s education and forever changed how Ontarians work, play, live and interact with one another.
The pandemic worsened burnout for health-care workers and others on the front lines. And more people are suffering from substance use, depression and anxiety.
It may have also made us meaner and lonelier, said physicians and researchers who spoke at an Ontario Medical Association media briefing.
“The way that young people communicate with each other changed during lockdown and their empathy has really decreased,” said Dr. Kaitlynn Mendes, the Canada research chair in inequality and gender at Western University in London, Ont.
In 2021, as lockdowns were lifting, Dr. Mendes conducted surveys, focus groups and interviews in England and Ireland with young people ages 13 to 18, parents and teachers. She found that while in-person interactions decreased during the pandemic, screen time increased exponentially. This led to more young people experiencing sexual harassment, misogyny, racism, body shaming and homophobia.
“They told us about things like increased anxiety, depression and even various forms of self-harm and a lot of them noted how these harms were directly linked to their use of digital technologies and screens that increased during COVID,” she said. “Teachers really noted this, and they noted that as young people were coming back into school, the way they were communicating with each other during lockdowns had changed. They found that their empathy had really decreased.
“This is likely due to things like the lack of eye, contact, spatial expression, human touch and even voice intonations. These are really important cues that are missing from online interaction and this makes empathizing hard. But it means that harassment and abusive comments actually become much easier.”
Dr. Mendes plans to extend her study to Canada this year.
Panellists also discussed Ontarians’ increase in substance and opioid use during the pandemic This could have been influenced by new pandemic-related stressors such as food insecurity and rising housing costs, said Dr. Lisa Lefebvre, associate medical director of the OMA’s Physician Health Program.
“I've really noticed a strain on a lot of my patients who are struggling with the basic necessities of life,” said Dr. Lefebvre, a community addiction medicine physician. “The most basic is access to food and housing. I have some patients who are newly homeless. I have patients who are losing significant amounts of weight because they literally aren't able to eat. It's heartbreaking.”
At the same time, she said, waits for community mental health services are three or four times longer than they were before COVID. Dr. Lefebvre, said that because of these wait times, patients often turned to already strained emergency departments.
Physicians, meanwhile, are working to keep up with the demand while facing record levels of burnout.
When the OMA conducted its annual survey of members in 2022, 93 per cent of Ontario physicians said that doctors were feeling burned out, while 64 per cent of Ontario doctors responded that they personally felt burnt out.
The OMA’s Physician Health Program provides confidential support for physicians struggling with mental health concerns. In 2021, the program saw a 20 per cent increase in calls compared to before the pandemic. Approximately one-quarter of those calls were related to stress and burnout.
Dr. Jon Novick, the medical director of the Physician Health Program, remembered physicians regularly calling the program in tears because of their burnout.
“They need a break, but they don't know what to do,” Dr. Novick said, “They're too concerned about their patients not receiving care if they were to take time off or to burden their peers by asking for coverage. They feel quite paralyzed, and they don’t have a lot of support to be able to take care of themselves while they take care of everybody else.”
Panellists noted that, because of burnout, many health-care workers are leaving their professions or taking leaves of absence. If these workers aren’t replaced, their patients could go without a doctor. Between one and two million Ontarians already don’t have a family doctor.
OMA President Dr. Rose Zacharias said one solution would be to reduce barriers to physician licensing.
“We have many internationally trained physicians in Ontario that could be expedited in their licensing,” she said. “There's a standard of care that physicians need to acquire before they are able to set up practice in Ontario. … We know that hundreds of physicians fit this description, and we could address the doctor shortage significantly if we applied this immediate solution.”
Dr. Zacharias, a family physician, said that long-term solutions include building more medical schools and creating more residency training positions.
The administrative burden on physicians is also a factor in burnout. Physicians spend an average of 10.6 hours a week handling administrative tasks.
“Doctors spend so much time at their computers at their desks, looking into a screen as opposed to building that repore, developing that relationship, listening, speaking, hearing, developing a therapeutic plan with a patient,” said Dr. Zacharias, “We want doctors to be doctors.”
To combat burnout, the OMA and Ontario Ministry of Health created a Bilateral Burnout Task Force, which aims to improve the physician experience across the province. The Bilateral Burnout Task Force is working to decrease the number of forms physicians must fill out and to streamline physicians’ computers and technologies so that physicians will have more time to dedicate to patient work.
“There are drivers that contribute to either burn-out or joy in medicine,” agreed Dr. Novick, who is also a psychiatrist, psychoanalyst and addiction medicine specialist. “What we have is this imbalance right now. So, if we can more consistently address those drivers, we can rebalance so that physicians and other health care workers are satisfied and engaged with their work as opposed to feeling exhausted, burnt out and cynical.”