PROJECT ABSTRACT US physicians are at high risk for depression, substance abuse, suicide, overwork, exhaustion, and burnout. New working conditions imposed by the COVID-19 pandemic have exacerbated these occupational health burdens for physicians at a time when baseline levels of stress, burnout, and poor mental health were already overwhelmingly high. Research on physician burnout has expanded, yet much of it focuses on individual-level causes and solutions that do little to identify and respond to the broader structural factors shaping physicians' wellbeing. This study will apply an occupational health lens to examine the experiences of hospital physicians in New York City (NYC) and Seattle, the two epicenters of the US COVID-19 outbreak. Our socio- ecological model acknowledges the synergistic relationships between health systems, work environments, and individual wellbeing, and accounts for the complex interplay between the multi-level factors shaping physicians' occupational health. We will conduct qualitative interviews with physicians in NYC (n=40) and Seattle (n=40) who work at the front lines of COVID-19 care (i.e. hospital-based attending physicians or fellows practicing in internal medicine, family medicine, emergency medicine, infectious diseases, and pulmonary/critical care). By sampling physicians from diverse hospitals in each city, we will assess how differences in state and local public health responses and institutional factors mediate the way physicians respond to the crisis. Our specific aims are to: Aim 1: Describe the relationships among the systems-, professional-, and institutional-level factors shaping workplace conditions during the COVID-19 pandemic and physicians' perceptions of occupational health and wellbeing; Aim 2: Identify systems-, professional-, institutional-, and individual-level characteristics that protect physicians' occupational health and wellbeing during the COVID-19 pandemic; Aim 3. Develop and disseminate evidence-based recommendations to protect physicians' occupational health and wellbeing during normal and crisis conditions, with expert panel input. The study addresses a well-documented occupational health problem that has taken on new urgency due to the pandemic, and does so through novel attention to structural factors that shape occupational wellbeing during a unique historical moment. The outputs of this study include evidence-based recommendation to improve physicians' occupational health and wellbeing and organizational responses to pandemic conditions. Therefore, the study responds to NIOSH's Total Worker Health™ Initiative and meets NIOSH Research to Practice standards.

PROJECT NARRATIVE US physicians are at risk for poor mental health and wellbeing, and the COVID-19 pandemic is exacerbating these preexisting work-related health burdens. In this qualitative interview study, we will examine the individual, institutional, professional, and systems-level factors shaping the occupational health and wellbeing of physicians working at the front line of COVID-19 care in two epicenter cities: Seattle and New York City. We will then use findings from qualitative interviews to develop and disseminate evidence-based recommendations to improve physicians' occupational health and wellbeing during normal and crisis conditions.