How You Can Make a Difference for Physician Mental Health

Please Note: This article discusses data surrounding physician suicide and may be triggering for some. If you need mental or emotional health support, please call 988 or text “HELP” to 741-741.

Physician Burnout is at a Historic High

It’s no secret that becoming a doctor is an incredibly difficult feat. After completing a four-year undergraduate program, potential doctors must navigate taking the MCAT and applying to extremely selective medical schools. Only 41% of applicants to medical school programs will be accepted to one out of 18 medical schools they apply to on average, where they spend the next four years in medical school, followed by three to seven years in a residency program to study a specialty. And if they manage to complete all of this, they have to pass a licensing exam and potentially get a board certification—which means becoming a licensed physician takes no less than 10-15 years.

Most physicians clock in 40 to 60 hours a week, but about 25% regularly work between 61 and 80 hours—which is about as much as resident physicians work. Before the Accreditation Council for Graduate Medical Education limited residents to work no more than 80 hours a week and 30 hours per shift in 2003, some residents were working up to 100 hours a week. This leaves very little time for self-care, time with friends and family, hobbies, and work-life balance.

All this considered, it’s no wonder that 78% of physicians report “sometimes” or “always” experiencing work-related burnout, and 80% report being at “full capacity” or “overextended”. Burnout is an occupational syndrome, which means it’s usually linked to chronic work-related stress.

Physician Burnout Symptoms

The three main symptoms of burnout are:

• Emotional exhaustion: extremely low physical, mental, and emotional energy levels.
• Depersonalization: demonstrated by cynicism, sarcasm, or resentment around your work.
• Lack of efficacy: doubting the importance and purpose of your work.

Different medical specialties are affected by burnout at different rates, though they are all impacted by it at some level. The highest rates of burnout are being seen right now in emergency medicine, internist, and pediatric specialties. Additionally, female physicians experience burnout at higher rates than their male counterparts, at 63% versus 46%.

The Effects of Physician Burnout

Those core symptoms of burnout can cause great harm in every area of a physician’s life. Here are some of the consequences that have been recorded by researchers.

Burnout vs. Depression: What’s the Difference?

A career in medicine is associated with a much higher risk of suicide than in the general population. While it was previously believed that burnout was the reason behind this phenomenon, recent research has discovered that this may not be the case. This is because there is a distinction between burnout, an occupational syndrome, and depression, a mental health condition.

Anywhere between 25-50% of physicians experience burnout, and this percentage can be as high as 78% depending on the evaluation method used.  Of those, 28.8% qualify for a diagnosis of depression, in contrast to the much lower depression rate of 3.8% in the general American population. Depression is linked to an increase of suicidal ideation, and one study found that burnout seemed to be as well, until researchers adjusted for depression. After doing so, they noted that burnout was no longer linked to suicidal ideation—but to an increase in medical errors.

It’s entirely possible for burnout to fuel the symptoms of depression in physicians, but depression is still a separate mental health condition. This means physicians can experience burnout without depression, depression without burnout, or both at the same time. Regardless of what exactly someone is struggling with, it’s important to do what you can to support yourself, which often means seeking some form of mental health treatment. And as many physicians can attest, stigma is a massive barrier that can prevent them from getting the help they need.

How Stigma Prevents Physicians Seeking Mental Health Treatment

As much progress as there has been in reducing mental health stigma across America, this barrier is still prevalent among the healthcare workforce. In one study, 62% of medical students agreed they would keep it secret if they received treatment for their mental health. Half of them agreed that if a residency director knew a student applying had a mental health issue, they wouldn’t accept that student into the program. In another study, 57% of medical interns said that concerns about confidentiality stopped them from getting treatment for their depressive symptoms. Of the 43% of interns who had screened positive for depression in this study, only 23% had begun treatment.

These findings are reflected in graduated physicians as well. They are less likely to seek mental healthcare, also citing concerns that a mental health diagnosis will affect their licensure, their ability to practice medicine, and cause discrimination from medical boards, coworkers, and employers. One survey asked physicians why they weren’t sharing their depression diagnosis with anyone. 42% responded that they were concerned about their employer or medical boards hearing about it, and 44% said they worried that their skills as a physician would be doubted.

Physician Mental Health: 3 Ways to Make a Difference

For clinicians struggling with burnout or depressive symptoms, support is crucial. Here are some ways, big and small, to end the stigma and make a difference.

1.  Recognize Warning Signs of Suicide in Fellow Clinicians

Warning signs are not necessarily an indication that a physician is considering suicide or has a mental health issue. However, if a sign persists for a long time and is causing someone significant distress, it may mean that they need additional support. Don’t hesitate to share what you’ve noticed with this person, ask if they need help, and pass along mental health resources. Here are some of the warning signs you might notice in a fellow physician or yourself:

• Increasing the use of medications and/or alcohol or illicit drugs
• Talking about wanting to hurt themselves or die
• Experiencing extreme mood swings
• Feeling hopeless or having no purpose
• Being negative about professional and personal life
• Having inappropriate outbursts of anger or sadness
• Withdrawing or isolating themselves from family, friends and coworkers
• Talking about being a burden to others
• Acting anxious or agitated; behaving recklessly
• Being constantly uncomfortable, tired, or in pain

2. Utilize “Psychological Personal Protective Equipment (PPE)”

Just like you wear physical PPE in situations that call for it, sometimes we need psychological PPE to get us through tough moments. Many organizations have created toolkits and resources for this purpose; here are some you can use for yourself or share with others at your practice!

• CAPC25: Emotional PPE Toolkit
• The Emotional PPE Project
• IHI: The Psychological PPE Tool
• Psychiatry Research: Mental Health PPE Model

3. Get Involved in Advocacy Work

We’ve already talked about how prevalent stigma is in the healthcare field, along with how it prevents physicians from seeking mental health treatment. This stigma is perpetuated by many things, including the very real possibility that their mental health records could be shared publicly if the physician becomes involved with a malpractice lawsuit. Even if they never go through that process, physicians routinely fill out forms to maintain their licensure and credentials, and these forms often include unnecessarily broad questions about mental health. For many physicians, this can feel like an invasion of privacy. The Dr. Lorna Breen Heroes’ Foundation is working with states across America to remove intrusive questions from these forms, but many have yet to adopt these recommendations.

One great way to advocate for yourself and fellow physicians is to join forces with the Medical Society of Virginia (MSV). MSV was pivotal in developing SafeHaven, a space for physicians to access well-being resources that can be used without risk to their medical license. MSV has also helped pass legislation in Virginia which protects mental health records in SafeHaven and keeps them confidential. The hope is that other states will begin adopting this legislation and the SafeHaven program. Michigan, Georgia, Illinois, and Arizona are already following suit!

MSV advocates for physician mental health on a variety of issues, including on lobby days at the General Assembly, with their advocacy summit, and by training physicians like you on how to be powerful advocates for yourself and your patients. They are a fundamental part of the positive systemic change for physicians happening in Virginia, and you can be a part of it too.

We hope this article has helped you learn more about the current situation surrounding physician mental health, along with what you can do to make a difference. If you are a healthcare provider who needs confidential mental health support, you can either enroll independently in SafeHaven, or speak to your practice about bringing it in for the whole team.