Study reveals hundreds of excess deaths among US physicians during COVID-19 pandemic

In the United States, there were more than 600 excess deaths among physicians from March 2020 to December 2021, according to a research letter published in JAMA Internal Medicine.

However, researchers said this trend receded after April 2021, “coinciding with the widespread availability of COVID-19 vaccines.”

Mathew V. Kiang, ScD, MPH, an assistant professor in the department of epidemiology and population health at Stanford University, and colleagues noted that the COVID-19 pandemic has resulted in more than 1 million excess deaths among the general U.S. population, “defined as the difference between the number of observed and expected deaths over a specified period.”

“Despite their essential role in the pandemic response, little is known about excess deaths among physicians,” they wrote.

The researchers compiled data from the AMA’s Deceased Physician File to estimate monthly physician mortality from January 2016 to February 2020. They then used a counterfactual model to identify expected deaths during the pandemic and calculate excess deaths.

Physicians were categorized by age and type of practice, which included:

• active physicians providing direct patient care;
• active physicians not providing direct patient care; and
• nonactive physicians.

Kiang and colleagues identified 4,511 deaths among a monthly mean of 785,631 physicians from March 2020 to December 2021, with 622 more deaths than expected during this period. These physicians were aged 45 to 84 years and 65.3% were men.

Overall, Kiang and colleagues estimated there were 43 excess deaths per 100,000 person-years (95% CI, 33-53). Excess mortality peaked at 70 deaths in December 2020 before declining in 2021. There were no excess deaths after April 2021.

The researchers highlighted a “strong age gradient” within active physicians providing direct patient care, with 10 excess deaths per 100,000 person-years in the youngest age group (95% CI, 3-17) and 182 excess deaths per 100,000 person-years in the oldest age group (95% CI, 98-267). Regardless of age, physicians had lower excess mortality rates than the general population, according to Kiang and colleagues.

The results further showed that nonactive physicians had the highest excess mortality, with 140 deaths per 100,000 person-years (95% CI, 100-181) compared with 27 deaths per 100,000 person-years among active physicians providing direct patient care (95% CI, 18-35) and 22 deaths per 100,000 person-years among active physicians not providing direct patient care (95% CI, -8 to 51).

“The findings suggest that personal protective equipment use, vaccine requirements, infection prevention protocols, adequate staffing and other workplace-based protective measures were effective in preventing excess mortality,” the researchers wrote.

They added that increased excess deaths among older physicians providing direct patient care “suggest that workplace policies should prioritize mitigating risk in this group.”

The researchers listed several limitations to the study, which include unidentified physician deaths and pandemic-related workforce changes that potentially resulted in an underestimation of deaths.

Kiang and colleagues concluded that because excess physician mortality can put a strain on hospitals and thus negatively affect patient care, “preventing excess deaths among physicians is an important component of mitigating excess deaths in the general population.”