Trust in physicians, hospitals drops from COVID-19 pandemic to early 2024

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Trust in doctors and hospitals plummeted from the start of the COVID-19 pandemic to early 2024, according to a new study.

A repeating survey of thousands of American adults with “a lot of trust for physicians and hospitals” declined from 71.5% in April 2020 to 40.1% in January this year. More trust was associated with greater likelihood of COVID-19 vaccination. But as of summer 2023, features associated with lower trust were being aged 25 and 64 years, female gender, lower educational levels, lower income, Black race, and living in rural settings, according to the findings.

“This study suggests that the COVID-19 pandemic has been associated with a continuing decrease in trust in physicians and hospitals, which may necessitate strategies to rebuild that trust to achieve public health priorities,” the study said. “Trust in Physicians and Hospitals During the COVID-19 Pandemic in a 50-State Survey of U.S. Adults” was published in JAMA Network Open.

Who do you trust?

Beginning in April 2020, the COVID States Project began conducting the online survey every one to two months among adults in all 50 states and Washington, D.C. A total of 443,455 unique respondents generated 582,634 responses to questions including:

• “How much do you trust the following people and organizations to do what is right?”
• “How much do you trust the following people and organizations to do the right thing to handle the current coronavirus (COVID-19) outbreak?”

Participants had four choices: a lot, some, not too much, or not at all.

The survey also asked about “propensity to trust more generally,” with the query: “Generally speaking, would you say that most people can be trusted, or that you cannot be too careful in dealing with people?” Participants answered on a scale from 1 to 10, where 1 is you cannot be too careful and 10 is most people can be trusted, the study said.

Complexity of trust

The results showed all sociodemographic groups had lower trust in physicians and hospitals through the COVID-19 pandemic, and lower trust was associated with less likelihood of vaccination against COVID-19 and influenza. That finding held true with earlier studies about association of physician trust and COVID-19 vaccine uptake.

The results could be unique to the United States. One Chinese study found people trusted physicians more when doctors “were seen in national public health messaging as leading the fight against the pandemic,” the study said.

In the United States, at least two other surveys in 2022 and 2023 found people trusted physicians and nurses more than other institutions. Meanwhile, polls of late 2020 and early 2021, and in 2023, found decreasing trust in the health system, according to the study.

Financial conflicts of interest “remain a major factor associated with mistrust,” the study said. The researchers identified a number of limitations to the study – not least the complexity of which can be depend on multiple factors, for good or bad. Comparing the results to surveys involving only physicians should be interpreted with caution, because other research has found people tend to have greater trust in doctors than in health systems, the study said.

The survey examined associations with trust, but could not determine if the associations between trust and behavior are causal, the study said.

“Despite these caveats, this multiwave nationally representative survey identifies a substantial decrease in trust in physicians and hospitals during the COVID-19 pandemic and demonstrates associations between trust and health-related behavior after accounting for a host of potential confounding variables,” the study said. “Whether interventions to restore trust could increase compliance with vaccination and other positive health behaviors merits further investigation.”