The sudden onset and profound severity of the COVID-19 pandemic found our healthcare system and society woefully underprepared. Hospitals struggled financially and were unable to procure supplies. At the society level these challenges were further complicated by the significant political divisions in the response to the pandemic. The divide was worsened by fragmented and conflicting messaging, with political figures more likely than healthcare leaders to communicate with the public. Partisan differences in the COVID-19 response were shown to be associated with higher COVID-19 infection and mortality rates.1

Because healthcare leadership during crises is understudied, our study examined the perspectives of physician surgeons on improving crisis preparedness based on their COVID-19 experience.


After approval by the institutional review board of the Veterans Affairs Boston Healthcare System, a survey was emailed nationwide in November 2022 to surgeons from various specialties regarding their COVID-19 experience.


In 3 months, 671 of 2360 surveys were completed (28.4% response rate). Both female [38.6% (259)] and male [52.1% (349)] surgeons participated in our survey. Other characteristics of our survey respondents are displayed in Table 1.

Table 1.Demographic characteristics of respondents
Variable (n) (%)
Age (years) 30-39 182 (27.1)
40-49 280 (41.7)
50-59 84 (12.5)
60-65 56 (8.3)
Older than 65 42 (6.3)
Not specified 28 (4.2)
Race/Ethnicity White 419 (62.4)
Asian/Pacific Islander 126 (18.8)
Hispanic/Latino 58 (8.6)
Black/African American 25 (3.7)
Native American/American Indian 2 (0.3)
Not specified 42 (6.2)
Practice location Northeast 264 (39.3)
Mid-Atlantic 44 (6.6)
Southeast 83 (12.4)
Midwest 141 (21.0)
Northwest 35 (5.2)
Southwest 24 (3.6)
West 66 (10.0)
Alaska 1 (0.1)
Hawaii 1 (0.1)
Not specified 11 (1.6)
Practice environment Academic or University 490 (73.0)
Community hospital / health system 120 (17.8)
Community private or group practice 30 (4.4)
Veteran Affairs hospital 22 (3.3)
Not specified 10 (1.4)
Surgical specialty Trauma and/or Acute Care 168 (25.0)
General 151 (22.5)
Vascular 84 (12.5)
Cardiac and/or Thoracic 64 (9.5)
Breast 42 (6.3)
Plastic 28 (4.1)
Colon and Rectal 27 (4.0)
Surgical Oncology 20 (3.1)
Bariatric 20 (3.1)
Endocrine 19 (2.9)
ENT 14 (2.1)
Neurosurgery 7 (1.0)
Transplant 5 (0.8)
Pediatric 5 (0.8)
Prefer not to say 17 (2.5)

Nearly half (48.6%) of respondents were not asked to provide any input, and more than half (55.2%) of them were not asked to give any feedback, on the workplace measures instituted during the COVID-19 pandemic. 60% of surgeons reported that no review has been conducted in their workplace to analyze the COVID-19 response.

To improve societal preparedness for future major crises respondents recommended the creation of a national unity government (4.8/5 on a 1-5 Likert scale) and the temporary nationalization of hospitals and healthcare providers (4.3/5) for the duration of the crisis (Figure 1).

Figure 1
Figure 1.Proposed interventions for improving preparedness for major crises

Demographic characteristics were not associated with significant differences in our study results.


Successfully managing major health crises requires a coordinated response between individual healthcare institutions, the public health system as a whole, and the government and legislative institutions.

At a healthcare institution level, developing crisis leadership requires trust and productivity, both of which are improved by ongoing evaluation and feedback. Despite this, we found that these processes are not standardized in the leadership structure at respondents’ institutions. These findings suggest that formalized leadership training and feedback should be included at all levels of the healthcare system.

To adequately prepare for future crises, it is also crucial that healthcare leaders emerge to provide guidance and public communication in concert with political leaders, to rise above partisan divides and prioritize public health.2

From a public health system standpoint, there is precedent in other countries for temporarily nationalized healthcare. Thus, in Ireland3 and Spain4 all private hospitals were temporarily placed under public control as part of a comprehensive response to the COVID-19 pandemic. Our respondents strongly agreed with the utility of this type of systemic response to healthcare crises. A temporarily nationalization would unify the healthcare systems and could avert some of the delayed actions and poor outcomes related to an unprepared and fragmented healthcare system in times of crisis.

At a society level, our respondents would like to see a unifying national leadership that would rise above political divisions in our response to major crises to a magnitude similar to COVID-19. Calls for unity national governments were indeed made throughout the world during the pandemic5,6


Physicians believe that temporary healthcare nationalization and unity governments are important to bring our society together and consolidate our response to major crises. Importantly, as frontline defenders during healthcare crises, our physicians should receive specific crisis leadership training and should be actively involved in instituting, communicating, and evaluating crisis interventions.