Introduction Positive work engagement can increase in times of hard pressures, and especially when organisational resources are at place. Nevertheless, such hard pressure as the COVID-19 pandemic on care processes is not seen in modern times in Sweden. Inherent unpredictability of a pandemic together with the initial lack of reliable scientific data have posed major challenges to healthcare professional.

Objective The aim of this study is to describe hospital-based physicians experiences of work, support and leadership in the health organisation they worked in during the first wave of the COVID-19 pandemic.

Methods A total of 25 physicians from different clinical units, and different hospitals in Sweden were interviewed between July and October of 2020. Interviews were transcribed verbatim and analysed using a qualitative content analysis as described by Graneheim, Lindgren and Lundman (2017). Analysis was inspired by a system approach sorting experiences on micro, meso and macro levels.

Results Preliminary results show that physicians experienced on micro level physicians struggled to keep their health and control over their work situation. On meso level, physicians described trust in and support from first line managers. However, organisational and health service leadership were lacking. Physicians led the transition from regular to pandemic care, which was perceived as positive.

Conclusions Health service organisation can learn from the physicians’ experience both in preparation for the next crisis and the importance of including medical professions in the organisation of care.