Although physicians were at a much higher risk of contracting COVID-19 than the general population, they had significantly lower excess mortality rates, according to a new study published in JAMA Internal Medicine.

Study details and key findings

For the study, researchers used the American Medical Association Masterfile, along with the corresponding Deceased Physician File, to estimate monthly mortality rates for physicians ages 45 to 84. Physicians younger than 45 were excluded since they had fewer than five deaths per month.

Mortality rates were determined for two time periods: January 2016 to February 2020 and March 2020 to December 2021. The difference between observed and expected deaths was used to determine the total number of excess deaths.

Overall, the researchers found that there were 4,511 deaths among a monthly mean of 785,631 physicians between March 2020 and December 2021 — representing 622 more deaths than expected. Among physicians, there were 43 excess deaths per 100,000 person-years. In comparison, there were 294 excess deaths per 100,000 person-years in the general population.

Active physicians, whether they were directly involved in patient care or not, also had fewer excess deaths per 100,000 person-years than nonactive physicians. However, the researchers noted there was a "strong age gradient" among active physicians who provided direct patient care, with those in the youngest group having significantly lower excess death rates than those in the oldest group (10 vs. 182, respectively).

"Increased excess deaths among older active physicians providing direct patient care suggest that workplace policies should prioritize mitigating risk in this group," the researchers wrote.

In general, the excess death rate among all active physicians peaked at over 70 in December 2020, and then "had a rapid monotonic decrease in 2021." After April 2021, when COVID-19 vaccines became widely available, there was no longer statistically significant excess mortality among physicians.

According to the researchers, some limitations of the study included unidentified physician deaths and pandemic-related workforce changes, such as early retirement among older physicians, which could have led to an underestimate of mortality.

Commentary

According to Mathew Kiang, the study's lead author from the Stanford University School of Medicine, "[d]espite physicians being at much higher risk of contracting COVID-19, they experienced much lower excess mortality than the general population."

"Obviously, some of this is due to higher income, access to care, and other socioeconomic factors, but it's also likely much of this protection came from workplace policies," such as personal protective equipment, vaccination requirements, infection prevention protocols, and more, Kiang said.

"Understanding how this workforce was impacted will hopefully better prepare us for future epidemics," he added. "COVID-19 won't be the last epidemic, and a better understanding of how we can protect healthcare professionals is pivotal to also protecting the general population," since COVID-19 surges can strain hospital resources, which then lead to more excess deaths overall.  (Henderson, MedPage Today, 2/6; Kiang et al., JAMA Internal Medicine, 2/6)