COVID-19: The impact of the pandemic on the medical profession

The second of five BMA reports, each with a particular focus on the pandemic response.

Location: UK
Audience: All doctors Patients and public
Last reviewed: 18 May 2022
COVID virus illustration

About this report

This report looks at the impact of the pandemic on the medical profession. It explores how the pandemic has affected their physical, mental, and emotional wellbeing, and to what extent adequate support was available. It also discusses the financial consequences of COVID-19 for medical professionals and the pandemic's impact on career progression for those in training.

The report will also look at some of the positive changes to the UK's health services brought about by the pandemic, and how these changes might be maintained or restored.

Physical health

The pandemic seriously affected the physical health of medical professionals

The pandemic posed an immediate threat to the physical health of medical professionals. Those working on the frontline were and remain acutely vulnerable to COVID-19 infection. Many caught COVID-19; a significant proportion of those developed long COVID and experienced severe and long-term symptoms.

I caught COVID in March 2020 from a colleague at work. I have been mostly bedbound since. My life as I knew it had ended. These are supposed to be the best years of my life but I'm spending them alone, in bed, feeling like I'm dying almost all the time.
Junior Doctor, Scotland
My second COVID infection (both infections occupationally acquired) has left me with damage to my spinal cord. I now walk with crutches and cannot walk more than about 200m without them. I also have bladder and bowel problems and have to intermittently catheterise. There is not a day that goes by where I don't have some form of pain.
Medical academic (trainee), England

Tragically, some doctors lost their lives while caring for others. Death rates may have been lower, and the impact of illness and seeing death of colleagues mitigated, had doctors been better protected and supported by the UK government and employers.

I had no PPE at first and caught COVID. My Consultant colleague died.
Consultant, England

The physical effects of the pandemic were not felt equally among doctors. Infection and mortality rates were higher amongst ethnic minority doctors, which may in part be due to differential treatment by others.

Key recommendations

  • UK health services need good occupational health systems that can act quickly to protect staff both during and outside of health emergencies.
  • To mitigate inequity in the future, mechanisms must be introduced to make the experience of working in the NHS less variable by background or protected characteristic.

Questions for the inquiries

  • What can be learned from the experiences of ethnic minority doctors, disabled doctors, and other groups during the pandemic? How can we mitigate inequality in the UK’s health services?
  • How well were the UK's health services able to support medical professionals who suffered from the short- or long-term health effects of COVID-19?

 

Mental health and wellbeing

The negative impact on mental health and emotional wellbeing

The pandemic has had a considerable impact on the mental health and emotional wellbeing of the medical profession. Worryingly, this impact on staff mental health worsened as the pandemic progressed.
Many doctors suffered from mental health conditions like anxiety or depression, which were caused or made worse by the pandemic.

Psychologically it was one of the worst periods of my life. I received private therapy throughout the pandemic and that helped tremendously but I have felt suicidal at times.
SAS doctor, England
I found the experience to be most disturbing of my career because of the stress of the unknown, the frustration around slow national response, the overwhelming pressure we were under and the emotional toll on almost everyone I was working with. I didn’t sleep, often felt angry and suffered post-traumatic stress for a period.
Consultant, Scotland

Often, the mental and emotional suffering of doctors was compounded by feelings of isolation.

The psychological impact was huge - not seeing family or friends who were a massive support system for me in my job as a doctor, and not being able to socialise or do anything that usually helped reduce stress and cope with work, was really difficult.
GP trainee, England

The medical profession experienced moral distress and moral injury working under pandemic conditions, contributing to poor mental health outcomes.

Honestly, it was horrific. The patients were incredibly sick, there was a general feeling of being helpless, […] you’d do everything you could, and they’d just suddenly die, and there was nothing you could do. Having to do end of life discussions over the phone, family members being unable to visit. It was bad, very bad.
Locally employed/Trust grade doctor, Wales
I have seen some difficult things in the past few years. I have made some decisions that I would not have had to make in pre-pandemic times. These have all caused me significant moral injury.
Salaried GP, Scotland

In addition, fear of infection resulted in a sense of poor psychological safety among doctors. This was further compounded by the fear of passing the virus onto loved ones.

My partner is clinically vulnerable as are my elderly parents. I have been afraid throughout at the possibility of catching COVID and risking the wellbeing of those I love.
Salaried GP, England

Finally, burnout and overwork have also significantly impacted on the wellbeing of medical professionals. Staffing shortages were often a contributing factor. 

I feel burnt out and everybody I work with seems tired and finding it difficult to deal with the backlog of patients.
GP trainee, Wales

As with physical health, inequalities can be found in medical professionals’ experiences of mental health and burnout: a decline in mental health was more common in female respondents to our call for evidence and in those with a disability or long-term condition.

Key recommendations

  • General wellbeing support must be made available for staff at all levels across all UK health services, along with specific support to recover from the pressure of delivering care during a pandemic.
  • Continuous and transparent assessments of workforce shortages and future staffing requirements must be undertaken, to ensure Governments take accountability for providing safe staffing levels and fully resourcing it.
  • All Governments and system leaders across the UK must have an honest conversation with the public about the need for a realistic approach to restoring non-COVID care, and support for doctors in tackling the backlog of care.

Questions for the inquiries

  • How did the state of the UK’s health services going into the pandemic contribute to the impact of COVID-19 on the medical profession?
  • Poor physical and mental health within the medical profession might be expected in a pandemic. To what extent, though, could the negative impact experienced by doctors have been mitigated?

 

Support for doctors

Doctors did not always receive the support they needed

During the pandemic, medical professionals needed support more than ever. Too often, however, this support was not forthcoming.

A lack of publicly stated government support for doctors has damaged the image of staff working in UK health services and has resulted in medical professionals being subject to unrealistic expectations from patients and, in some cases, abuse.

In our call for evidence, a handful of respondents linked increased abuse by patients to poor government support.

I am now finding demand from patients has risen exponentially and with long delays in referrals to secondary care, we are receiving a lot of verbal abuse from angry and frustrated patients. This has not been helped by the negative impression of primary care perpetuated in the media and by the comments of some politicians.
Salaried GP, England

Primary care staff in particular bore the brunt of the UK government’s failure to explain that the system, not the medical profession, was at fault for difficulties in accessing care.

Whilst doctors generally felt better supported by their employer, too many still did not receive the support they needed – especially those who were shielding or Clinically Extremely Vulnerable (CEV).

As my trust created their own risk table which missed out any question of shielding or immunosuppression I was told I was not able to shield. I had to refuse this risk assessment and fight hard to be allowed to shield even after I had received my shielding letter and sent it in. It was extremely stressful and unfair.
Consultant, England

It is also clear that, due to chronic underfunding, occupational health services were not adequately equipped to look after doctors who needed help during the pandemic.

Didn't feel much protected and there was no timely response and advice received from the Occupational Health department regarding my underlying condition.
Consultant, England

In addition, the pandemic impacted on the career and financial prospects of medical professionals. Medical training was severely disrupted, often leading to delays in career progression, and some doctors lost significant proportions of their income due to factors like long covid or loss of locum work.

Limited access to academic learning, clinical placements, and assessments; disrupted semester dates (an extremely long year); both electives cancelled (we don't have any, putting us at a disadvantage for applying for training posts); interruption to courses such as BSS [Basic Surgical Skills].
Medical student working in NHS, Scotland
I am in bed with long COVID worrying about if I will be able to afford my mortgage. It is very distressing.
Consultant, England

Key recommendations

  • Health education bodies across the UK must fund a model that supports adequate occupational medicine training posts to meet the level of demand in the UK’s health services now and in the future.
  • Junior doctors and medical students must be assured that their efforts to support the delivery of care during the acute waves of the pandemic will not disproportionately affect their future careers. They must be supported to flexibly access training opportunities to make up for those lost.

Questions for the inquiries

  • To what extent was the system able to protect staff from infection?
  • To what extent was the system able to support staff who suffered any short- or long-term health effects from the pandemic?

 

Some initial positives

The pandemic also had some positive effects on the medical profession, at least initially

Despite the severe negative impact, the pandemic had some positive effects on the medical profession, such as a strong sense of team spirit and satisfaction from being able to help in times of crisis.

It was positive - made me appreciate how hard the ITU nurses and doctors worked and it strengthened us as a team.
SAS doctor, Wales

However, initial feelings of positivity and high morale amongst staff tended to wear off after the first wave. As the crisis raged on, the backlog increased, and some doctors perceived that public support was waning.

Initially a very positive mutually supportive atmosphere in the practice, but difficult to maintain this given the duration of the pandemic and the increasing workload. In the first wave all we were dealing with was the pandemic; since then it has been on top of normal workload, so more stressful and tiring.
GP contractor/principal

Key recommendations

  • As far as possible, changes to the health services made since March 2020 that made a positive impact on doctors, such as hybrid working, should be retained or brought back to improve staff health, morale and retention rates.

Questions for the inquiries

  • What were some of the positive changes brought about because of COVID-19, and how might some of them be maintained or restored?