10.14639/0392-100X-N1229
Objective: The changing trend in medical practice, uncertainties and monetary apprehensions due to COVID-19 pandemic may influence the sense of well-being among otorhinolaryngologists. The present study was conducted to evaluate quality of life (QOL) and perceived financial implications in otorhinolaryngologists during the COVID-19 pandemic across India.
Methods: A cross-sectional study was carried out among otorhinolaryngology specialists across India using WHOQOL-BREF and Consumer Financial Protection Bureau (CFPB) Financial Well-Being Scale questionnaires on Google Forms, which was kept open for the latter half of July 2020.
Results: A total of 358 responses were obtained; the response rate was 26.64%. Twenty-four percent of respondents worked exclusively in academic settings; 40.22% of specialists had over ten years of work experience. Average monthly income in 2019 was between 1-3 lakhs Indian Rupees (INR) in 43.85%, while in 2020, 62.57% of the specialists had an average monthly income of below one lakh INR; this difference was highly statistically significant (p&lt;0.001). Mean WHOQOL-BREF scores for physical, psychological, social, and environmental domains were 68.8±1, 62.3±0.75, 68.9±1.17, and 65.8±1.01 respectively; mean CFPB financial well-being scale score was 55.5±0.66. QOL and financial well-being were better in otolaryngologists older than 60 years, male specialists, and private consultants.
Conclusion: There has been a tremendous bearing on quality of life and financial well-being among otorhinolaryngologists in India during the COVID-19 pandemic. The study outcome may help otolaryngologists comprehend and perceive the extent to which it has affected their professional and personal lives and explore ways and means to face and overcome the situation.
text/xml
1827-675X
1229
en
Prasanna P. Mithra
https://creativecommons.org/licenses/by-nc-nd/4.0
ACTA Otorhinolaryngologica Italica
WHOQOL-BREF
Quality of life and perceived financial implications among otorhinolaryngologists during the COVID-19 pandemic across India
Text.Serial.Journal
https://www.actaitalica.it/
41
COVID-19
2021-05-06
2020-11-05
2021-09-15
2021-09-15
289-295
1
Prasanna P. Mithra
2021/05/06
10.14639/0392-100X-N1229
289
Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India - 576104
1827-675X
WHOQOL-BREF
295
Quality of life and perceived financial implications among otorhinolaryngologists during the COVID-19 pandemic across India
https://www.actaitalica.it/article/download/1229/551
41
ACTA OTORHINOLARYNGOLOGICA ITALICA 2021;41:289-295; doi: 10.14639/0392-100X-N1229




COVID-19


Quality of life and perceived financial implications
among otorhinolaryngologists during the COVID-19
pandemic across India
Qualità di vita e impatto economico percepito dalla comunità otolaringoiatrica indiana
durante la pandemia da COVID-19
Deviprasad Dosemane1, Meera Niranjan Khadilkar1, Jayashree Kanthila2, Prasanna P. Mithra3
1
 Department of Otorhinolaryngology and Head & Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of
Higher Education, Manipal, Karnataka, India - 576104; 2 Department of Paediatrics, Kasturba Medical College, Mangalore, Manipal
Academy of Higher Education, Manipal, Karnataka, India - 576104; 3 Department of Community Medicine, Kasturba Medical
College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India - 576104


SUMMARY
Objective. The changing trends in medical practice, uncertainties and monetary apprehen-
sions due to the COVID-19 pandemic may influence the sense of well-being among otorhi-
nolaryngologists. The present study was conducted to evaluate quality of life (QOL) and
perceived financial implications in otorhinolaryngologists during the COVID-19 pandemic
across India.                                                                                      Received: November 5, 2020
Methods. A cross-sectional study was carried out among otorhinolaryngology specialists             Accepted: December 1, 2020
across India using WHOQOL-BREF and Consumer Financial Protection Bureau (CFPB)                     Published online: May 6, 2021
Financial Well-Being Scale questionnaires on Google Forms, which was kept open for the
latter half of July 2020.                                                                          Correspondence
Results. A total of 358 responses were obtained; the response rate was 26.64%. Twenty-             Meera Niranjan Khadilkar
four percent of respondents worked exclusively in academic settings; 40.22% of specialists         Department of Otorhinolaryngology and Head &
had over 10 years of work experience. Average monthly income in 2019 was between 1-3               Neck Surgery, Kasturba Medical College, Man-
                                                                                                   galore, Manipal Academy of Higher Education,
lakhs Indian Rupees (INR) in 43.85%, while in 2020, 62.57% of the specialists had an av-
                                                                                                   Manipal, Karnataka, India – 576104
erage monthly income of below one lakh INR; this difference was statistically significant          Tel. +91 8150042608
(p < 0.001). Mean WHOQOL-BREF scores for physical, psychological, social and environ-              E-mail: meera.khadilkar@manipal.edu
mental domains were 68.8 ± 1, 62.3 ± 0.75, 68.9 ± 1.17 and 65.8 ± 1.01, respectively; mean
CFPB financial well-being scale score was 55.5 ± 0.66. QOL and financial well-being were           Funding
better in otolaryngologists older than 60 years, male specialists and private consultants.         None.
Conclusions. There has been a tremendous impact on quality of life and financial well-
being among otorhinolaryngologists in India during the COVID-19 pandemic. The study                Conflict of interest
outcome may help otolaryngologists comprehend and perceive the extent to which it has              The Authors declare no conflict of interest.
affected their professional and personal lives, and explore ways to face and overcome the
situation.
                                                                                                     How to cite this article: Dosemane D, Khadilkar
KEY WORDS: CFPB financial well-being scale, financial management, India,                             MN, Kanthila J, et al. Quality of life and perceived
otolaryngologists, quality of life, WHOQOL-BREF                                                      financial implications among otorhinolaryngolo-
                                                                                                     gists during the COVID-19 pandemic across In-
                                                                                                     dia. Acta Otorhinolaryngol Ital 2021;41:289-295.
RIASSUNTO                                                                                            https://doi.org/10.14639/0392-100X-N1229
Obiettivo. I cambiamenti della pratica medica, le incertezze e le preoccupazioni inerenti
l’impatto economico dovuto alla pandemia COVID-19 possono influenzare negativamente                © Società Italiana di Otorinolaringoiatria
il senso di benessere degli specialisti otorinolaringoiatri. Il presente studio è stato condotto   e Chirurgia Cervico-Facciale
per valutare la qualità della vita (QOL) e le implicazioni finanziarie percepite dagli otori-
nolaringoiatri durante la pandemia COVID-19 in tutta l’India.                                                     OPEN ACCESS
Metodi. È stato condotto uno studio trasversale tra specialisti di otorinolaringoiatria in         This is an open access article distributed in accordance with
tutta l’India utilizzando i questionari WHOQOL-BREF e Consumer Financial Protection                the CC-BY-NC-ND (Creative Commons Attribution-Non-
Bureau (CFPB) Financial Well-Being Scale su Google Forms, durante la seconda metà di               Commercial-NoDerivatives 4.0 International) license. The
                                                                                                   article can be used by giving appropriate credit and mentio-
luglio 2020.                                                                                       ning the license, but only for non-commercial purposes and
Risultati. Abbiamo ricevuto 358 risposte; il tasso di risposta è stato del 26,64%. Il 24%          only in the original version. For further information: https://
degli intervistati ha lavorato esclusivamente in contesti accademici; Il 40,22% degli spe-         creativecommons.org/licenses/by-nc-nd/4.0/deed.en




                                                                                                                                                           289
D. Dosemane et al.




cialisti aveva più di dieci anni di esperienza lavorativa. Il reddito mensile medio nel 2019 era compreso tra 100 mila e 300 mila rupie indiane
(INR) nel 43,85%, mentre nel 2020, il 62,57% degli specialisti aveva un reddito mensile medio inferiore a 100 mila INR; questa differenza era
statisticamente significativa (p < 0,001). I punteggi WHOQOL-BREF medi per i domini fisico, psicologico, sociale e ambientale erano rispet-
tivamente 68,8 ± 1, 62,3 ± 0,75, 68,9 ± 1,17 e 65,8 ± 1,01; Il punteggio medio della scala del benessere finanziario CFPB era 55,5 ± 0,66.
La qualità della vita e il benessere finanziario erano migliori negli otorinolaringoiatri di età superiore ai 60 anni, negli specialisti maschi e
nei consulenti privati.
Conclusione. Durante la pandemia COVID-19 c’è stato un impatto enorme sulla qualità della vita e sulal stabilità economica tra gli otorino-
laringoiatri in India. Il risultato dello studio può aiutare gli otorinolaringoiatri a comprendere e percepire fino a che punto il COVID-19 ha
influito sulla loro vita professionale e personale ed esplorare modi e mezzi per affrontare e superare la situazione.
PAROLE CHIAVE: scala del benessere finanziario CFPB, gestione finanziaria, India, otorinolaringoiatri, qualità della vita, WHOQOL-BREF



Introduction                                                              Materials and methods
The novel coronavirus disease (COVID-19) pandemic has                     This cross-sectional study was carried out among otorhi-
destabilised every facet of medical care in a short period 1.             nolaryngology specialists in institutions and/or private set-
Though every healthcare worker has some risk of exposure,                 tings across India between June and July 2020. After ob-
it is predominantly marked in those treating patients un-                 taining Institutional Ethics Committee (IEC) approval from
dergoing aerosol-generating or mucosal procedures 2, such                 Kasturba Medical College, Mangalore (Reference number
as otolaryngology specialists and maxillofacial and head                  IEC KMC MLR 07/2020/211), participants were contacted
and neck surgeons. Although all protective precautions are                and enlightened about the study objectives using Google
                                                                          Forms through WhatsApp groups, social media (Facebook)
to be adhered to, there can be chances of altered comfort
                                                                          and e-mails. They were assured of anonymity and confi-
level, fear, etc. Therefore, sustaining a balance between
                                                                          dentiality of the information collected from them. Digital
physical health and mental health is of utmost importance
                                                                          consent was obtained from each participant with Google
to perform with optimal lucidity 3.                                       Forms. The data were collected using WHOQOL-BREF 6
It now requires healthcare workers to find newer methods of               and Consumer Financial Protection Bureau (CFPB) Finan-
providing safe healthcare while keeping patient outcomes                  cial Well-Being Scale questionnaires 7 on Google Forms,
and valuable resources in mind 4. This changing trend in                  which were distributed via the same platforms. Junior resi-
medical practice and the uncertainties can influence the                  dents undergoing training in otorhinolaryngology were ex-
quality of life of healthcare professionals. Also, the bearing            cluded from the study. The survey was kept open from 15
of monetary apprehensions on the performance and well-                    July 2020 for 2 weeks to reduce the bias of the outcome at
being of healthcare providers must not be undervalued 5.                  a particular point. Basic demographic details such as age,
Patients with upper respiratory infections who were earlier               gender, state/union territory, faculty position, practice set-
attending otorhinolaryngology clinics are now triaged to                  ting, number of years of work experience in otorhinolaryn-
COVID-19/ fever screening portals. The American Acade-                    gology and average monthly income for the years 2019 and
my of Otolaryngology-Head & Neck Surgery has endorsed                     2020 were also obtained.
otolaryngologists to postpone elective cases to permit bet-               WHOQOL-BREF questionnaire contains 26 items and 4
ter safety of healthcare workers and patients, conserve es-               domains. The physical domain comprises daily activities,
sential personal protective equipment (PPE) and magnify                   the necessity of medications, fatigue and energy, mobil-
the capacity of hospitals and treatment centres during the                ity, discomfort and pain, the capacity to work and sleep.
                                                                          The psychological domain takes into account bodily ap-
pandemic 4. Because of these circumstances, the income of
                                                                          pearance and image, positive plus negative feelings, self-
otolaryngologists is likely to be affected significantly.
                                                                          esteem, belief and spirituality, thinking ability, concentra-
There are limited studies on health care professionals in
                                                                          tion, recollection and learning. The social domain includes
the literature, and otolaryngologists in specific, regarding              interpersonal relationships, support from friends and sexual
the effect of this pandemic on mental health and clinical                 activity. Sense of security and safety, accessibility, mon-
practice. Similarly, in India, none of the studies have fo-               etary resources, quality of healthcare, home and physical
cused on the financial consequences in otolaryngologists.                 environment, leisure activities, transport and prospects for
The present study was performed to evaluate the quality of                obtaining additional information and skills, make up the en-
life (QOL) and perceived financial implications in otorhi-                vironmental domain. The domain scores provide an insight
nolaryngologists during the COVID-19 pandemic across                      into the quality of life of an individual in each domain. The
India.                                                                    scores are represented positively, meaning greater scores



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                                                                 Quality of life and perceived financial implications among otorhinolaryngologists




signify a better quality of life. Scores of items within each        Table I. Geographical distribution of respondents.
domain are added up to compute the raw domain score,                  State/Union Territory in India               Count           Proportion
which is then transformed to a 0-100 scale 6.                         South India
CFPB Financial well-being scale questionnaire comprises                 Karnataka                                    140             39.1 %
10 questions. The total response value is obtained by add-              Kerala                                        27              7.5 %
ing up individual responses. This is converted to a CFPB                Andhra Pradesh                                23              6.4 %
Financial Well-Being Scale score depending on the re-                   Tamil Nadu                                    20              5.6 %
spondent’s age group, and whether the questionnaire was                 Telangana                                     12              3.4 %
self-administered. The final score is a standardised number             Pondicherry                                    2              0.6 %
between 0 and 100, which depicts an individual’s essential              TOTAL                                        224             62.6 %
measure of financial well-being. A higher score represents
                                                                      Central India
a better degree of estimated financial well-being 7.
                                                                        Maharashtra                                   35             9.8 %
The confidentiality of information was strictly maintained.
                                                                        Gujarat                                       13             3.6 %
The collected data were coded and entered into Microsoft
                                                                        Madhya Pradesh                                 4             1.1 %
Excel for Windows and analysed using Jamovi 1.1.9.0 soft-
                                                                        Chhattisgarh                                   4             1.1 %
ware, Sydney, Australia. Results were expressed as propor-
tion and summary measures using appropriate tables. Indi-               Odisha                                         3             0.8 %
vidual WHOQOL-BREF domain scores and CFPB Financial                     West Bengal                                    3             0.8 %
well-being scale score were compared with the demographic               Goa                                            2             0.6 %
variables using linear regression study. WHOQOL-BREF                    TOTAL                                         64             17.8%
domain scores were compared with the CFPB Financial                   North India & North-East India
well-being scale score using Pearson’s correlation coeffi-              Rajasthan                                     17             4.7 %
cient test. A comparison of average monthly income for the              Delhi                                         16             4.5 %
years 2019 and 2020 was done with Chi-square test. A p-                 Uttar Pradesh                                 14             3.9 %
value of below 0.05 was regarded as statistically significant.          Assam                                          5             1.4 %
                                                                        Haryana                                        5              1.4 %
Results                                                                 Sikkim                                         3              0.8 %
                                                                        Punjab                                         3              0.8 %
Three hundred and fifty-eight responses from 24 states and              Uttarakhand                                    2              0.6 %
2 union territories of India were obtained from 1344 otorhi-
                                                                        Manipur                                        1              0.3 %
nolaryngologists contacted with a response rate of 26.64%.
                                                                        Bihar                                          1              0.3 %
Age ranged from 26 years to 70 years, with a mean and me-
                                                                        Jharkhand                                      1              0.3 %
dian age of 40 and 37 years, respectively. There were 239
                                                                        Nagaland                                       1              0.3 %
males (66.8%) and 119 females (33.2%), with a male/fe-
                                                                        Meghalaya                                      1              0.3 %
male ratio of 2.01. The majority of the respondents worked
in Karnataka (39.1%) state, followed by Maharashtra                     TOTAL                                         70             19.6 %
(9.8%) and Kerala (7.5%) (Tab. I). Most of the specialists
worked as private consultants (45.8%). Twenty-four per-
                                                                     (Tab. II). WHOQOL-BREF domain scores were compared
cent of respondents worked exclusively in academic set-
                                                                     with the CFPB financial well-being scale score and were sig-
tings. Over 10 years of work experience was reported by
40.22% of specialists. In the majority (43.85%), average             nificant (p < 0.001) (Tab. III). WHOQOL-BREF scores for
monthly income in 2019 was between one to three lakhs                all four domains, as well as CFPB financial well-being scale
Indian Rupees (INR), while in 2020, 62.57% of the special-           score, were higher in otorhinolaryngologists above 60 years
ists had an average monthly income of below one lakh INR             of age; WHOQOL-BREF score for the social domain was
(Fig. 1). Chi-square test used to compare average monthly            highest in the age group of 41-50 years. Males were found
income for the years 2019 and 2020 was highly statistically          to have a better quality of life and CFPB financial well-be-
significant (X2 = 165, p < 0.001).                                   ing scores, and this difference was statistically significant.
Mean WHOQOL-BREF scores for the physical, psycho-                    Associate professors were found to have the best quality of
logical, social and environmental domains were 68.8 ± 1,             life and CFPB financial well-being scale scores among all
62.3 ± 0.75, 68.9 ± 1.17 and 65.8 ± 1.01, respectively. The          faculty positions. Physical, psychological and environmental
mean CFPB financial well-being scale score was 55.5 ± 0.66           domain scores, as well as financial well-being, were highest



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D. Dosemane et al.




                                                                                droplets. Therefore, healthcare providers such as otorhi-
                                                                                nolaryngologists managing patients with aerodigestive
                                                                                tract related diseases are the most susceptible to infection.
                                                                                The first physician to succumb to COVID-19 was an otolar-
                                                                                yngologist from Wuhan, China on 25 January 2020 5.
                                                                                The number of COVID-19 cases and fatalities is rapidly
                                                                                escalating in India; physicians have also succumbed to the
                                                                                virus, making the situation grim. The Medical Group Man-
                                                                                agement Association reported that the pandemic has ad-
                                                                                versely affected finances in 97% of 724 medical practices
                                                                                that were surveyed 8.
                                                                                The WHOQOL-BREF questionnaire was developed to
                                                                                generate a tool that would assess the quality of life and ap-
                                                                                ply across all ethnic groups. The initiative comes from a
                                                                                requirement of a genuine measure pertinent internationally
Figure 1. Graphical representation of average monthly income in the years       and an assurance to the sustained promotion of a univer-
2019 and 2020 in otorhinolaryngologists in India.
                                                                                sal approach to healthcare. The questionnaire comprises 26
                                                                                questions to enable assessment of physical, psychological,
in otorhinolaryngologists working in private settings, while                    social, environmental domains 6.
social domain score was the highest in government hospital                      The Consumer Financial Protection Bureau steered a la-
specialists. No statistical significance was found between do-                  borious research attempt to develop a consumer-driven
main scores, scores of CFPB financial well-being scale and                      description of financial well-being, thus enabling research-
practice setting. Quality of life domain scores and financial                   ers worldwide with a consistent, accurate and accessible
well-being scores were highest in specialists with experience                   technique of determining financial well-being and perceive
of over 10 years post-specialisation and those with an aver-                    the point to which one’s financial status and capacity of-
age monthly income above three lakh INR (Tab. IV).                              fer them a sense of security and liberty of choice. Thus, a
                                                                                10-item scale was developed 7. No investigations assessing
                                                                                the financial welfare of healthcare providers using CFPB
Discussion                                                                      financial well-being scale score have been conducted to the
COVID-19 is affecting people from all walks of life world-                      best of our understanding.
wide, including healthcare workers. The disease is highly                       In the present study, otorhinolaryngology specialists above
contagious, predominantly acquired through respiratory                          the age of 60 years were found to be the most financial-


Table II. WHOQOL-BREF domain scores and CFPB financial well-being scale score.
 Parameters                                     Mean            Median                  Standard deviation         Minimum           Maximum
    WHOQOL-BREF domain score
      Physical                                       68.80                69                  18.9                    6                 100
      Psychological                                  62.30                63                  14.1                    6                  94
      Social                                         68.90                69                  22.1                    0                 100
      Environmental                                  65.80                69                  19.1                    6                 100
    CFPB financial well-being scale score            55.50                55                  12.6                    14                 95



Table III. Comparison of WHOQOL-BREF domain scores with CFPB financial well-being scale score.
                                                                                                     WHOQOL- BREF domain score
                                                                               Physical         Psychological       Social       Environmental
    CFPB financial well-being scale     Pearson’s correlation coefficient r     0.535                0.494          0.453           0.657
    score
                                                     p-value                   < 0.001  *
                                                                                                  < 0.001    *
                                                                                                                   < 0.001   *
                                                                                                                                   < 0.001*
*
    Highly statistically significant.




292
                                                                                         Quality of life and perceived financial implications among otorhinolaryngologists




Table IV. Comparison of various parameters with mean WHOQOL-BREF domain scores and mean CFPB financial well-being scale score.
                              N (%)            Mean physical        Mean          Mean social score           Mean                Mean CFPB
                                                   score        psychological                            environmental        financial well-being
                                                                    score                                     score               scale score
    Age
      Up to 30 years          48 (13.41%)                            63.58 ± 19.16   58.65 ± 21.05       62.33 ± 21.68          61.06 ± 22             51.04 ± 12.2
      31-40                  177 (49.44%)                            68.18 ±18.38    63.43 ± 17.08       68.28 ± 22.51         63.64 ± 18.5           54.03 ± 12.67
      41-50                   82 (22.91%)                             69 ± 19.72     66.63 ± 19.19       72.84 ± 21.66         67.3 ± 17.82           56.85 ± 10.92
      51-60                    34 (9.49%)                            75.41 ± 17.77   72.12 ± 16.70       71.18 ± 20.75         72.91 ± 18.86          58.85 ± 11.52
      61 and above             17 (4.75%)                            76.59 ± 18.01   72.12 ± 13.69        70.18 ± 20.2         81.06 ± 12.63           70.12 ± 9.83
      p-value                                                            0.027#          0.109               0.114               < 0.001*                < 0.001*
    Gender
      Male                   239 (66.80%)                            70.03 ± 18.29   67.86 ± 17.15       68.92 ± 20.96         66.64 ± 18.89          56.08 ± 12.96
      Female                 113 (33.20%)                            66.45 ± 19.98   58.54 ± 18.98       68.84 ± 24.18         64.24 ± 19.60          54.34 ± 11.69
      p-value                                                          < 0.001*        < 0.001*              0.014#              < 0.001*               < 0.001*
    Current designation
      Private consultant     164 (45.80%)                            70.99 ± 19.23   65.96 ± 18.84       69.95 ± 22.37         67.18 ± 19.97          56.05 ± 13.54
      Professor               46 (12.80%)                            67.07 ± 18.78     68 ± 16.81        70.93 ± 20.55         69.85 ± 17.45           58.7 ± 10.45
      Associate Professor      20 (5.60%)                             73.7 ± 18.66    71.1 ± 18.73       76.55 ± 18.96          70.1 ± 14.14          59.05 ± 11.61
      Assistant Professor     51 (14.20%)                            68.39 ± 20.54   62.25 ± 20.36        67.76 ± 26.4         62.84 ± 18.84          53.67 ± 11.23
      Senior Resident         77 (21.50%)                            64.32 ± 16.59   60.27 ± 15.42       64.17 ± 19.22         61.48 ± 18.89           52.7 ± 12.08
      p-value                                                            0.081            0.31               0.144                 0.059                  0.043#
    Practice setting
      Academic setting        85 (23.74%)                            66.35 ± 17.67   63.06 ± 16.59       66.28 ± 20.97         64.88 ± 17.22          54.66 ± 12.12
      Private setting        239 (66.76%)                            69.83 ± 19.32   65.4 ± 18.75        69.34 ± 22.71         66.32 ± 19.43          55.79 ± 13.02
      Government               34 (9.50%)                             68.03 ± 19     64.53 ± 19.27       72.24 ± 19.81         64.88 ± 21.87          55.59 ± 10.46
      hospital
      p-value                                                           0.335           0.290                 0.356                 0.799                  0.791
    Years of experience post-specialisation
      Less than 5 years        129 (36%)                             65.53 ± 20.17   61.44 ± 18.29       65.11 ± 22.73         62.81 ± 20.78          52.85 ± 12.76
      5 to 10 years           85 (23.70%)                             68.76 ± 16.9   62.95 ± 18.53       68.35 ± 22.21         62.87 ± 17.75          54.61 ± 12.51
      More than 10 years     144 (40.20%)                            71.83 ± 18.51   68.8 ± 17.48        72.6 ± 20.86          70.31 ± 17.58           58.4 ± 11.88
      p-value                                                            0.023#          0.207               0.019#                0.001#                < 0.001*
#
    Statistically significant; * Highly statistically significant.



ly stable (CFPB financial well-being scale mean score                                        there is greater monetary stability, contentment, satisfac-
of 70.12 ± 9.83) and had the highest scores among three                                      tion and also an enhanced ability in managing profession-
of the 4 domains of WHOQOL-BREF (76.59 ± 18.01,                                              al and financial commitments. The frontline COVID-19
72.12 ± 13.69, 81.06 ± 12.63 in physical, psychological                                      healthcare providers typically belong to the younger strata,
and environmental domains respectively), with statistical                                    who are burdened by prolonged working hours, stressful
significance for physical and environmental domains and                                      lifestyle, fear of contracting the disease and lesser income.
financial well-being. Quality of life and financial well-be-                                 Moreover, unsettled duty schedules, unconventional work
ing was also the highest in respondents with over 10 years                                   patterns and unfamiliar patient care units have taken a toll
of work experience post-specialisation (mean WHOQOL-                                         on the physical, emotional and social well-being. This also
BREF score of 71.83 ± 18.51 for physical, 68.8 ± 17.48 for                                   explains the findings of the lowest quality of life (mean
psychological, 72.6 ± 20.86 for social, 70.31 ± 17.58 for                                    scores of 64.32 ± 16.59, 60.27 ± 15.42, 64.17 ± 19.22,
environmental domains, and mean CFPB financial well-                                         61.48 ± 18.89 in the 4 domains of WHOQOL-BREF, re-
being scale score of 58.4 ± 11.88), with statistical signifi-                                spectively) and financial well-being (52.7 ± 12.08) in the
cance. This emphasises the fact that with advancing age,                                     younger respondents mainly comprising senior residents,



                                                                                                                                                                    293
D. Dosemane et al.




compared with other faculty positions and private practi-        (mean WHOQOL-BREF score of 68.9 ± 1.17 and 68.8 ± 1,
tioners. Statistical significance was noted between the CF-      respectively) compared to psychological and environmen-
PB financial well-being score and all cadres of otolaryngol-     tal domains (62.3 ± 0.75 and 65.8 ± 1.01, respectively).
ogists. Liang and co-authors studied mental well-being in        An improved sense of health consciousness, enhanced
medical staff during COVID-19 pandemic and found that            tools of audio and video communication and social media
depression and anxiety were more prevalent in the younger        have helped otolaryngologists maintain a balance between
frontline healthcare workers 9. Another study by Lai et al.      physical and social domains. However, mental well-being
in healthcare workers treating COVID-19 patients showed          remains a matter of concern. The emotional toll upon clini-
that mental health was most affected in junior and interme-      cians is demanding; unexpected circumstances inexorably
diate level staff 10. However, it is presumed that healthcare    bring about extreme moral strain. Self-care and well-being
professionals were relatively comfortable and tuned in to        of practitioners and observing for indicators of burnout are
their regular working conditions prior to the pandemic.          critical to stay adequately irrepressible and endure chal-
Quality of life was superior in men when compared to             lenges in these tough times 1. Fitness activities and yoga
women respondents (mean WHOQOL-BREF scores of                    should be promoted to enhance the physical and emotional
70.03 ± 18.29, 67.86 ± 17.15, 68.92 ± 20.96, 66.64 ± 18.89       wellness of otolaryngologists to combat stress.
for the 4 domains respectively); so was the CFPB financial       The present study showed that the average monthly income
well-being scale score (mean score of 56.08 ± 12.96). Ex-        of otorhinolaryngologists drastically dropped during the
tremely high statistical significance for 3 of the 4 WHO-        COVID-19 pandemic compared to 2019. The number of
QOL-BREF domains and financial well-being (p-value               respondents earning over 3 lakh INR and between 1 and 3
< 0.001) was found between male and female respondents.          lakh INR halved over one year, thus increasing the number
This can be attributed to the fact that women have more do-      of specialists in the less than 1 lakh INR bracket. This was
mestic responsibilities, and are constantly subjected to so-     also found to be statistically significant. The average CFPB
cietal, family and moral pressures. A study by Civantos et       financial well-being scale score was 55.5 ± 0.66. Doctors
al. to assess mental healthiness in otolaryngologists in the     working in academic institutions have faced a reduction in
course of the COVID-19 pandemic revealed women suf-              their remuneration; elective otorhinolaryngology proce-
fered from a greater amount of distress and burnout 2. Dew-      dures and surgeries have been postponed or cancelled with
ey and co-authors provided practical suggestions to boost        the onset of the pandemic owing to the risk of exposure to
the clinical workforce during the COVID-19 pandemic.             infection.
These include recognising concerns, fixed work hours,            The greatest number of respondents were from the southern
providing ample resources and adequate PPE, engaging in          states of Karnataka, Kerala and central state of Maharash-
wellness activities, promoting spiritual resilience 11.          tra. Incidentally, the number of COVID-19 infected cases
Specialists working exclusively in academic settings             was also greater (112,504 in Karnataka and 400,651 in Ma-
were found to have a lower quality of life (mean scores of       harashtra, respectively) 12. Also, a paradigm shift was noted
66.35 ± 17.67, 63.06 ± 16.59, 66.28 ± 20.97, 63.71 ± 19.55)      in Gross State domestic product (GSDP) in these states
and financial well-being (63.71 ± 19.55) compared with           with the onset of the pandemic 13.
doctors working in private sectors. Besides patient care, fac-   Many otorhinolaryngologists are keenly waiting to restart
ulty working in educational institutions are weighed down        their pre-pandemic daily routine 1. With resurgent India gal-
by undergraduate, postgraduate teaching, research work           loping towards universal digitisation in all fields, telemedi-
and other academic activities. Financial well-being was          cine should be encouraged and implemented effectively for
greatest in the private sector specialists (57.78 ± 13.75),      efficient healthcare delivery to the public and financial re-
which is expected since private sectors generate more            covery of the healthcare setup.
revenue. It was noticed that the quality of life in doctors      To the best of our knowledge, there are no studies in medi-
with private practice had only slightly higher WHOQOL-           cal literature determining the quality of life in otorhinolar-
BREF domain scores. The plausible explanation could be           yngology specialists, nor has the financial well-being been
that practitioners running private establishments are under      analysed. The response rate (26.64%) was lower than ex-
continual stress concerning the smooth functioning of the        pected, which may be attributed to the short time frame of
setup, dealing with medico-legal aspects and independent         two weeks that the survey was kept open. The changing
decision-making, in contrast to specialists working in aca-      trends in COVID-19 infected cases, and the fluctuation in
demic institutions, who could seek guidance and support          individual response to the questionnaire prompted us to lim-
from their peers and colleagues.                                 it data collection for two weeks only. The figure may not be
Quality of life was higher in social and physical domains        representative of the entire population of otolaryngologists



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                                                                   Quality of life and perceived financial implications among otorhinolaryngologists




in India, although as the majority of the respondents belong                ogy. Otolaryngol Head Neck Surg 2020;162:811-812. https://doi.
to the states of Karnataka and Maharashtra, where a lot of                  org/10.1177/0194599820920850
otolaryngologists are based, the data may be considered ar-
                                                                       2
                                                                            Civantos AM, Byrnes Y, Chang C, et al. Mental health among oto-
                                                                            laryngology resident and attending physicians during the COVID-19
chetypal. The findings of the study may be generalised to                   pandemic: national study. Head Neck 2020;42:1597-1609. https://doi.
some extent, assuming that the pre-pandemic situation was                   org/10.1002/hed.26292
stable with regard to social and economic aspects. Limita-             3
                                                                            Balasubramanian A, Paleri V, Bennett R, et al. Impact of COVID-19
tions of the study include a comparison with the quality                    on the mental health of surgeons and coping strategies. Head Neck
of life before the COVID-19 pandemic which was not as-                      2020;42:1638-1644. https://doi.org/10.1002/hed.26291
sessed, and parameters attributable to COVID-19 disease                4
                                                                            Brody RM, Nicolli E, Bur AM, et al. Changes in head and neck
such as working hours before and during the pandemic,                       oncologic practice during the COVID-19 pandemic. Head Neck
                                                                            2020;42:1448-1453. https://doi.org/10.1002/hed.26233
availability of personal protective equipment and training,            5
                                                                            Kowalski LP, Sanabria A, Ridge JA, et al. COVID-19 pandemic: ef-
magnitude of the pandemic were not studied. State-wise                      fects and evidence-based recommendations for otolaryngology and
comparison of quality of life and financial welfare is rec-                 head and neck surgery practice. Head Neck 2020;42:1259-1267. htt-
ommended, as disease burden varies in the different regions                 ps://doi.org/10.1002/hed.26164
of the country.                                                        6
                                                                            World Health Organization. WHOQOL-BREF Introduction, Admin-
                                                                            istration, Scoring and Generic Version of the Assessment Field Trial.
                                                                            Geneva: World Health Organization; December 1996. https://www.
Conclusions                                                                 who.int/mental_health/media/en/76.pdf. Accessed August 2020.
COVID-19 has had a tremendous impact on the quality
                                                                       7
                                                                            Consumer Financial Protection Bureau. Measuring financial well-
                                                                            being - A guide to using the CFPB Financial Well-Being Scale. Wash-
of life and financial well-being of otorhinolaryngologists                  ington: Consumer Financial Protection Bureau; December 2015. htt-
in India. The treating specialists may be fatigued, but the                 ps://files.consumerfinance.gov/f/201512_cfpb_financial-well-being-
pandemic is most likely here to stay. Since the profession                  userguide-scale.pdf. Accessed August 2020
demands that patient service cannot be compromised, a                  8
                                                                            Rubin R. COVID-19’s crushing effects on medical practices, some
watchful balance is required between risk of exposure and                   of which might not survive. JAMA 2020;324:321-323. https://doi.
patient care. The outcome of the study may help otolar-                     org/10.1001/jama.2020.11254
yngologists comprehend and perceive the extent to which
                                                                       9
                                                                            Liang Y, Chen M, Zheng X, et al. Screening for Chinese medical staff
                                                                            mental health by SDS and SAS during the outbreak of COVID-19.
the pandemic has affected their professional and personal                   J Psychosom Res 2020;133:110102. https://doi.org/10.1016/j.jpsy-
lives, and explore ways and means to face and overcome                      chores.2020.110102
the situation.                                                         10
                                                                            Lai J, Ma S, Wang Y, et al. Factors associated with mental health out-
                                                                            comes among health care workers exposed to Coronavirus disease
                                                                            2019. JAMA Netw Open 2020;3:e203976. https://doi.org/10.1001/
Acknowledgements                                                            jamanetworkopen.2020.3976
The authors are grateful to all the otorhinolaryngologists             11
                                                                            Dewey C, Hingle S, Goelz E, et al. Supporting clinicians during the
from India for participating in the study. We acknowledge                   COVID-19 pandemic. Ann Intern Med 2020;172:752-753. https://doi.
                                                                            org/10.7326/M20-1033
Dr. Pooja D. Nayak, Dr. Bhavya B.M., Dr. Prishni Dutta                 12
                                                                            PRS Legislative Research. COVID-19 - Compare States. New Delhi:
for helping with data collection. We are thankful to Dr. Ur-
                                                                            PRS Legislative Research; June 2020. https://prsindia.org/covid-19/
mila Khadilkar and Dr. N.P. Khadilkar for proofreading the                  cases/statewisecomparison. Accessed August 2020.
manuscript.                                                            13
                                                                            Deccan Herald. Covid-19: GDP of states to contract 1.4-14.3%
                                                                            in FY21, says report. Mumbai: Deccan Herald; June 2020. https://
                                                                            www.deccanherald.com/business/economy-business/covid-19-gdp-
References                                                                  of-states-to-contract-14-143-in-fy21-says-report-855042.html. Ac-
1
    Shuman AG. Navigating the ethics of COVID-19 in otolaryngol-            cessed August 2020.




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