Introduction
The COVID-19 pandemic prompted a crisis in the health care sector, which struggled to maintain the accessibility of services to patients; ensure patient satisfaction; promote the work satisfaction and well-being of physicians; and develop and apply new tools in remote patient care (Dominguez-Salas et al., Reference Dominguez-Salas, Gomez-Salgado, Guillen-Gestoso, Romero-Martin, Ortega-Moreno and Ruiz-Frutos2021). Scientists recommend mitigating these challenges through effective communication and special training for medical professionals (Abideen et al., Reference Abideen, Mohamad and Hassan2020). During the pandemic, physicians feared staff shortages; difficulties in the work environment, leadership, and management of their health care institution; and increased workload (Abd-Ellatif et al., Reference Abd-Ellatif, Anwar, Aljifri and El Dalatony2021). Health care workers were under a staggering amount of stress and perceived COVID-19 as a threat to their lives and safety, which impacted their work satisfaction and could result in professional burnout (Dymecka et al., Reference Dymecka, Filipkowski and Machnik-Czerwik2021). A survey of health care workers in Italy during the COVID-19 pandemic presented the following findings: 7.5% experienced symptoms of depression; 37.9% experienced psychological distress; 30.5% felt discriminated against; and 5.7% reported having experienced violence (Moro et al., Reference Moro, Calamandrei, Poli, DiMattei, Perra, Kurotschka, Restrepo, Romano, La Torre, Preti, Mascayano, Picardi, Chiarotti, Rapisarda, Urban, Alvarado, Susser and Carta2022). Elsewhere, an estimated 16.5% of physicians experienced a sense of fear, which negatively impacted their work satisfaction (42%) (Abd-Ellatif et al., Reference Abd-Ellatif, Anwar, Aljifri and El Dalatony2021). Another study found that elements of psychological stress – stress vulnerability, anxiety symptoms, loneliness, and irritability – had a negative impact on work satisfaction among health care workers, and loneliness was observed as having a significantly greater effect than other elements (Caponnetto et al., Reference Caponnetto, Platania, Maglia, Morando, Gruttadauria, Auditore, Ledda, Rapisarda and Santisi2022). The following measures were implemented to manage the challenges posed by the COVID-19 pandemic: the establishment of a mentally safe work environment; the implementation of leadership programs; the introduction of measures increasing employee well-being and communication; and assistance provided to the health care team (Dominguez-Salas et al., Reference Dominguez-Salas, Gomez-Salgado, Guillen-Gestoso, Romero-Martin, Ortega-Moreno and Ruiz-Frutos2021). One study established a link between family physicians’ work satisfaction and burnout syndrome, anxiety, and depression, which can potentially have negative consequences on work efficiency (Yilmaz, Reference Yilmaz2018). It was determined that during the pandemic physicians experienced increased levels of exhaustion and burnout, whereas nursing staff noted a drop in work satisfaction (Ruiz-Fernandez et al., Reference Ruiz-Fernandez, Ramos-Pichardo, Ibanez-Masero, Cabrera-Troya, Carmona-Rega and Ortega-Galan2020). Diabetes and hypertension remained the key reasons for visiting a family physician during the pandemic (Stephenson et al., Reference Stephenson, Butt, Gronsbell, Ji, O‘Neill, Crampton and Tu2021). Patient anxiety and depression were reportedly the main reasons for remote consultations with a family physician (90.6% of consultations), and disease prevention measures shrunk compared to pre-pandemic times (Stephenson et al., Reference Stephenson, Butt, Gronsbell, Ji, O‘Neill, Crampton and Tu2021). Patients faced reduced access to health care services during the pandemic, with the elderly, those with fewer technological resources, and those with lower health literacy being among the worst affected (Albert et al., Reference Albert, Paul, Nguyen, Shelley and Berry2021). Among primary health care specialists, 58% expressed concern over their patients’ limited ability to use certain technologies, and 55% were concerned with their patients’ overall technological knowledge (Mohammed et al., Reference Mohammed, Hyseni, Bui, Gerritsen, Fuller, Sung and Alarakhia2021). However, these findings also indicate that 74.5% of patients were satisfied with remote services provided by physicians (Mohammed et al., Reference Mohammed, Hyseni, Bui, Gerritsen, Fuller, Sung and Alarakhia2021). Novelty services (such as remote consultations) introduced over the course of the pandemic could certainly remain in use in the post-pandemic world (Albert et al., Reference Albert, Paul, Nguyen, Shelley and Berry2021). The key questions posed in this study are:
1. Does the perception of pandemic-related threats depend on respondents’ sociodemographic characteristics?
2. Did work satisfaction among physicians decrease during the COVID-19 pandemic?
3. How do physicians view the satisfaction of their patients with the provision of family health care services?
4. How did the pandemic affect the accessibility of services for patients?
5. Does the need for new tools for remote consultations depend on the locale of the respondent’s current workplace (urban/rural setting)?
Methods
Study design
Based on other studies, the researchers developed an instrument for a quantitative study (a questionnaire) and conducted a pilot study to test its validity. Upon implementing the necessary corrections, the main survey was conducted among physicians working in family physician teams. Permission to conduct the study was issued in advance by the Kaunas Regional Committee of Biomedical Research Ethics. The following hypotheses were postulated for interrogation via the study results:
H1: The perceptions of physicians regarding threats to their life and safety during the COVID-19 pandemic are statistically significantly dependent on the sociodemographic characteristics of the respondents.
H2: Work satisfaction among physicians decreased during the COVID-19 pandemic.
H3: Patient satisfaction with the services provided by the family medical institution decreased during the pandemic.
H4: Physicians perceived a decrease in their patients’ level of access to services during the pandemic.
H5: The opinions of respondents regarding the need for new tools for remote consultations during the COVID-19 pandemic depend on the location of their workplace (urban/rural setting).
Source of data
A pilot study was conducted on 21–30 June 2021 involving 13 physicians: 3 from public PHCIs, 9 from private PCHIs, and 1 physician who worked in both public and private PHCIs. An anonymous survey of physicians (N = 191) working in family physician teams was carried out from 21 June 2021 to 17 September 2021. The respondents signed an informed consent form prior to participation. Of the 398 questionnaires distributed, 191 were used in the final analysis, and 4 were invalid, resulting in a response rate of 48% – that is, 9% of the sample population. A total of 39 PHCIs were randomly selected for the study; of these, 11 were public and 28 were private. The respondents were distributed as follows: 31% were employed by a private PHCI; 63% were employed by a public PHCI; and 6% worked for both. In terms of location, 88% of the respondents were city-based and 12% resided in rural areas. Females comprised 84% of respondents and males 16%. The regional distribution of the respondents was as follows: Vilnius county – 33%, Kaunas county – 18%, Klaipėda county – 8%, Šiauliai county – 15%, Panevėžys county – 13%, Tauragė county – 7%, and Telšiai county – 6%.
Sample
The sample size was representative of the age, gender, and distribution of physicians in different counties in Lithuania. The 50/50 principle was applied when selecting respondents to ensure the participation of physicians from both public and private PHCIs. According to the data provided by the Institute of Hygiene, 1,903 family physicians and 238 internal medicine physicians were employed by primary health care institutions (PHCIs) and care homes at the end of 2020.
Statistical analysis
IBM SPSS Statistics 27 was used for data analysis. The quantitative variables did not meet the conditions of normal distribution and were therefore compared in three groups using the nonparametric Kruskal–Wallis test and pairwise comparisons with the Bonferroni correction. The results were described in medians and quartiles (Q1–Q3). The relationship between qualitative variables was analyzed using the χ2 test of independence, pairwise comparisons, and Cramér’s coefficient. The results were described in terms of frequency and relative frequency (percentage). The observed differences and dependency were considered statistically significant if the calculated P-value was below 0.05.
Results
The threat posed by the COVID-19 pandemic
Responses to the statement “The COVID-19 pandemic posed a threat to the life and safety of my colleagues and I” were distributed as follows: 33 (17.27%) physicians disagreed or neither agreed nor disagreed; 83 (43.5%) physicians agreed; and 75 (39.3%) physicians strongly agreed. Statistically significant differences among the three groups were noted in the age (P = 0.046) and work experience (P = 0.039) variables. Pairwise comparisons of the Kruskal–Wallis criterion revealed that both characteristics were only statistically significantly different between two groups: those who disagree or neither agree nor disagree and those who strongly agree (Table 1).
The assessment of the threats posed by the COVID-19 pandemic as perceived by physicians
Note. Data presented as a median (Q1–Q3). *The Kruskal–Wallis criterion; a–b pairwise comparisons with Bonferroni correction.
As a result, H1 is confirmed: physicians’ perceptions of the threat posed by the COVID-19 pandemic depend on their sociodemographic characteristics – namely, age and work experience.
Overall work satisfaction among physicians
Based on responses to the statement “My work satisfaction decreased during the COVID-19 pandemic”, physicians working in family physician teams were divided into three groups: disagree or neither agree nor disagree (n = 52, 27.23%); agree (n = 76, 39.8%); and strongly agree (n = 63, 33%). These groups demonstrated a statistically significant difference in age (P = 0.001), work experience (P < 0.001), and duration of employment (P = 0.012) (Table 2). Pairwise comparisons of the Kruskal–Wallis criterion revealed statistically significant differences in age, work experience, and duration of employment between all three groups. Sample characteristics showed a higher proportion of younger, less experienced respondents and those who had been employed for a shorter time clustered in the strongly agree or neither agree nor disagree categories. Conversely, no difference between the same characteristics was observed among physicians who agreed or strongly agreed with the statement.
Work satisfaction among physicians during the COVID-19 pandemic
Note. Data were presented as a median (Q1–Q3). *The Kruskal–Wallis criterion; a–f pairwise comparisons with Bonferroni correction.
The study outcome confirmed H2, which postulated that the overall work satisfaction of physicians working in family physician teams decreased during the COVID-19 pandemic.
Patient satisfaction with service provision
The statement “The satisfaction of my patients with the services provided by their family medical institution decreased during the COVID-19 pandemic” yielded the following responses: 64 (33.51%) physicians disagreed or neither agreed nor disagreed; 83 (43.5%) agreed; and 44 (23%) strongly agreed. The only statistically significant difference between these groups was observed in the work experience characteristic (quartiles of 24.5 (7.25–36.75), 35 (14–42), and 21 (7.5–40), respectively; P = 0.037). Pairwise comparison of the Kruskal–Wallis criterion yielded a statistically significant difference in work experience between the agree and disagree or neither agree nor disagree groups (P = 0.018). H3 was thus confirmed, suggesting that patient satisfaction with the family medicine services provided decreased during the pandemic.
Access to services
The statement “My patients experienced reduced access to family medicine services during the COVID-19 pandemic” was met with the following responses: 57 (29.84%) physicians disagreed or neither agreed nor disagreed; 91 (47.6%) physicians agreed; and 43 (22.5%) strongly agreed. Statistically significant differences in age (P = 0.004), work experience (P = 0.003), and duration of employment (P = 0.012) were observed among these groups (Table 3). Pairwise comparison of the Kruskal–Wallis criteria demonstrated a statistically significant difference in terms of these characteristics among two groups: those who agreed and those who disagreed or neither agreed nor disagreed with the statement.
Patient access to services during the COVID-19 pandemic
*The Kruskal–Wallis criterion; a–c pairwise comparisons with Bonferroni correction.
These findings showed that patients experienced reduced access to services during the pandemic, and H4 was thus confirmed: physicians perceived a decrease in their patients’ level of access to services during the pandemic.
The need for new tools in the provision of consultations
The majority of respondents from both urban- and rural-based PHCIs indicated that new tools are needed to facilitate the provision of standard consultation services during the COVID-19 pandemic (Table 4). However, agreement was not homogenous: statistically significantly more urban-based respondents agreed rather than strongly agreed with this statement (97.3% and 80.2%, respectively).
The need for new tools for patient consultations during the COVID-19 pandemic
Note. χ 2 = 11.406; r cr = 0.244; P = 0.003; a, b pairwise comparisons P < 0.05.
These results confirmed H5, which stated that the perceived need for new tools during the pandemic was dependent on the location of the respondent’s workplace (urban/rural setting).
Discussion
The majority of health care institutions failed to meet the challenges posed by the COVID-19 pandemic with quick and decisive action (Alketbi et al., Reference Alketbi, del Rio and Fernandez2022). Generally, crisis management utilizes the following tools: information technologies, strategic planning, communication, media, information management, leadership, and effective governance at the national level (Hazaa et al., Reference Hazaa, Almaqtari and Al-Swidi2021). Some researchers found that crisis management in the uncertainty of the COVID-19 pandemic could be positively impacted by employee training, leadership, an effective organizational strategy, organizational structure, and organizational culture (Alketbi et al., Reference Alketbi, del Rio and Fernandez2022). A link has been established between competencies in crisis management and team-level activities pertaining to information sharing, teamwork, and the identification of crises (Jankelová et al., Reference Jankelová, Joniaková, Blštáková, Skorková and Procházková2021). In a crisis, institutional values and employee satisfaction facilitate effective service provision and employee well-being (Alketbi et al., Reference Alketbi, del Rio and Fernandez2022). Over the course of this study, it has been determined that physicians’ age and work experience affect their perception of the threat posed by the COVID-19 pandemic to their life and safety. Leadership, communication, public image, innovation, and a strong team led by a good manager are critical to the successful management of a crisis situation (Dwiedienawati et al., Reference Dwiedienawati, Tjahjana, Faisal, Gandasari and Abdinagoro2021). This study found that the majority of respondents supported the use of innovative technologies to augment standard consultation experience. Elsewhere, family physician teams expressed a greater level of overall work satisfaction than their single-practice colleagues (Werdecker and Esch, Reference Werdecker and Esch2021). Although female physicians demonstrate a higher level of work satisfaction than males (Werdecker and Esch, Reference Werdecker and Esch2021), this study found that satisfaction was dependent on the physician’s age, work experience, and duration of employment in their current institution. Furthermore, patient satisfaction is conditional on positive patient–physician interactions and plays a key role in building long-term relationships (Rajić et al., Reference Rajić, Rakić and Milošević2021). This study found that work experience determined how respondents perceived patient satisfaction with the services provided by family medical institutions during the COVID-19 pandemic. Similarly, physicians’ age, work experience, and duration of employment in their current institution impacted their perception of patients’ access to services during the pandemic.
Limitations
This study yielded a mass of scientific data regarding physicians’: perception of their individual satisfaction and that of their patients; perceived level of threat posed by the COVID-19 pandemic; perception of patient access to services; and views pertaining to the use of innovative technologies for consultation management. The key limitation of this study concerns the sample population, which encompassed exclusively primary-level health care workers (physicians working in family physician teams). More insight could be gained from hospital-based physicians and those involved in emergency services. Furthermore, the anonymous survey was conducted within a single country, and a comparison with equivalent data from other countries could provide an interesting perspective.
Implications for practice
In an effort to cope with the challenges of crisis management during the COVID-19 pandemic, physicians working in family physician teams must be afforded access to proper mental health care services. The pandemic prompted a fall in overall work satisfaction among physicians; therefore, additional training for physicians regarding patient interactions would be beneficial. Patients were less satisfied with services provided during the pandemic; this could be mitigated by ensuring effective patient–physician communication. New tools to aid with patient consultations (e.g., telemedicine, psychological support, small-group workshops, training, etc.) must be introduced and effectively applied in practice during crisis situations in the health care sector.
Conclusions
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Physicians should be afforded professional mental health care services and support, beyond the simple provision of PPE to protect against infection.
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Crisis management necessitates new tools for providing consultations to patients.
Acknowledgments
The authors are grateful to the managers and physicians of family medical institutions for participating in this scientific study and completing their questionnaires. The authors are also grateful to the institutions (The Institute of Hygiene, the Lithuanian Department of Statistics, and the State Health Care Accreditation Agency under the Ministry of Health) that provided the data required to determine the sample size.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or nonprofit sectors.
Conflict of interest
The authors declare no conflict of interest.
Ethical approval
Permission (No. BE-2-63) to conduct this research was issued on 15 June 2021 by the Kaunas Regional Committee of Biomedical Research Ethics.
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