By Benjamin Chesluk PhD, ABIM Senior Researcher for Ethnographic Research | Assessment and Research and Bradley Gray PhD, ABIM Senior Health Services Researcher
Previous blog posts have already described some of ABIM’s significant efforts to document physicians’ experiences in the COVID-19 pandemic – namely, the major national surveys of critical care physicians developed in collaboration with physician researchers from Harvard Medical School and the Harvard T.H. Chan School of Public Health. But there’s another effort to talk about: a recent round of phone interviews with a broad sample of ABIM diplomates from a wide range of specialties with an MOC assessment due in 2021, and aimed at understanding what impacts from the pandemic physicians are continuing to experience in 2021, and how these could affect their ability to take an MOC assessment this year.
What we heard: Physicians told us that they were still experiencing significant personal and professional impacts from the COVID-19 pandemic; that they felt cautiously optimistic about the future, though with lots of uncertainty, especially in the short term; and that this combination of ongoing stress and uncertainty about the near future made it challenging to envision preparing for their 2021 MOC assessment or learn from the study process as they normally do.
Our first data about how physicians were feeling actually came before the interviews themselves, during the scheduling process. We reached out to the approximately 400 members of ABIM’s Community Insights Network who have an MOC assessment due in 2021. (The Community Insights Network are physicians who have asked to be contacted about surveys, interviews and other opportunities to give ABIM feedback; if this sounds interesting, please sign up at www.abim.org/jointhenetwork.) Within a few short hours of our initial email, the entire schedule of available timeslots was filled almost immediately. We’re not used to ABIM research interviews being treated like coveted concert tickets – this gave us a signal that physicians had lots they were eager to share. In the end we did a total of 52 interviews over the space of 4 days in mid-February 2021. Our interviewees were a diverse group in terms of gender, age, geography and medical specialty. 23 (44%) had already deferred at least one MOC assessment from 2020. 22 (42%) said they would definitely defer in 2021 if given the option, and another 14 (27%) said they would strongly consider deferring.
Significant ongoing stress
“COVID-19 has turned everything upside down for the past year; it never really let up at all for us. Initially, there was a lot of fear, and as ID specialists, we have to help our patients make sense of things that don’t make sense, even when we are trying to figure everything else ourselves. I’ve been working nonstop, no days off. I don’t take time off. I just can’t. It’s really challenging, and the burnout is very real.” (Infectious disease specialist)*
*Note, all quotes in italics are close paraphrases of interviewees’ own words, edited and condensed for clarity and length
We heard that the impacts of COVID have been many and profound. Physicians told us about juggling responsibility for caring for COVID patients and keeping up with rapidly changing new knowledge and protocols, alongside a host of work changes (such as loss of practice revenue or pivoting to phone or video visits with patients), and personal pressures as well – keeping a practice running while also helping kids manage distance learning, or caring for newly live-in elderly parents.
And for some, all this was alongside seeing family or peers get sick with COVID, or becoming sick themselves:
“I was infected and battled COVID-19 myself in late March-April. Everything in [my area] was shut down from March 17 to April. My small office was taking a pay cut with seeing no patients, and when we re-opened, there was a cost to clean everything after every patient. Rent still needed to be paid by medical offices, so we got no break. There’s costs to so many more things just to keep afloat, and at times, I feel like I’m barely hanging on by strings. I would be sending scripts for my patients to go to the hospital, and if patients were too young, they were sent away. It really all breaks my heart. I still feel a bit of PTSD. I would want to go to a therapist to help myself cope if I had time, but there’s just no time.” (General internist)
“Life at home was crazy with helping the kids with schooling at home to make sure they’re not losing ground. It’s a very difficult time for everybody. We also lost two close colleagues which has had a very depressive effect. It takes a long time to get past that. It’s been hard and psychologically very burdensome. You don’t feel like yourself.” (Rheumatologist)
Optimistic, but uncertain
Our interviewees told us they felt cautiously optimistic about the future, many commenting on having been vaccinated and seeing things improve around them. At the same time, much was still uncertain: What would national vaccine rollouts look like? What about new variant strains? How would state and local governments respond to any changes – would we see new lockdowns or school closures? All this uncertainty was just one more impact from the pandemic for physicians to manage.
“It feels like I’m struggling with new updates every week, where to get people tested, what are the new rules. And now we’re trying to get patients vaccinated—it changes every week. Honestly, to me, it feels like it did at the beginning of pandemic.” (General internist, CMO of large IPA; already had to defer once in 2020)
Hard to contemplate taking an MOC exam
These impacts and uncertainty carried into what physicians told us they were thinking about their 2021 MOC exam – most said they were unable to find time and concentration to study, and weren’t sure their exams would be held as planned. Some interviewees had already registered for a 2021 exam and were prepared to take it as scheduled if possible, even despite the multiple pandemic-related challenges. More told us they had been thinking about their exam but didn’t know how they would make time to prepare – and for this group, the fact that in-person board review courses (which by their nature would help with focus and concentration) were cancelled in 2020 and might not be held in 2021 posed a significant challenge. And some said they had not even begun to think about their MOC exam this year and did not envision being able to anytime soon, for all the reasons described above.
“It’s going to be really hard to concentrate on studying for an MOC exam. So many physicians have been exposed, and you know COVID can cause memory deficits. I feel like my brain was foggy for a month—I couldn’t remember how to get home from work at night. I know a lot of my colleagues felt like this as well. Now it feels like my memory is coming back, so it’s not permanent, but it meant I couldn’t study for two or three months. Ordinarily I would go to at least one live board prep course—but there are no live courses, and I can’t even get together with my friends in a study group.” (Gastroenterologist)
The prospect of being able to defer 2021 MOC assessments for a year, as had been offered in 2020, struck all our interviewees as a welcome relief from having to think about board certification in addition to the exhaustion, stress and uncertainty they and their peers continued to face.
“I have to see how things go—how the safety standards are for physicians, how easy it is to start recruiting faculty again, if less time focusing on COVID means I’d be able to get away from my family responsibilities to study. So a lot will really depend on the state of things. Ultimately I just want to get it done! At some point you still have to do the exam, life isn’t going to stop getting complex, preparation will always be hard. But if COVID ramps back up and my level of activity and engagement stays high, I might have to take the option to defer. And I know many of my colleagues would appreciate having that option as well.” (Rheumatologist, program director)
Ten interviewees (19% of our sample) said they still want to take their MOC exam this year as planned, regardless of the difficulties posed by the continuing pandemic – simply because they’ve already found a way to prepare sufficiently and don’t want to defer until 2022. But most said they would defer if possible – and even those who want to test this year thought ABIM should give everyone the deferral option. And that is the decision that the ABIM Board of Directors made, in part thanks to the words of our interviewees.
“I would jump up and down with joy if I could defer. Right now I’m facing the blitzkrieg of trying to prepare for the full-day exam, and I’m not doing it very well. I like the study material – when I get time to read, I’m like, ‘This is interesting!’ But knowing that the pressure was off would go a long way right now.” (Pulmonologist / sleep medicine specialist)
ABIM as an organization has the deepest respect and gratitude for the work our diplomates have done, and continue to do, during the pandemic. This extension is first and foremost meant to help recognize the heroism shown by so many in what we hope is a once-in-a-century event. Fortuitously, it also opens the possibility for many more physicians to be able to use the new Longitudinal Knowledge Assessment MOC option in 2022, should they choose to do so.