Fearful of professional consequences, some physicians may delay or decide against seeking the help they need to maintain optimal mental health – and the consequences can be devastating.
The death of Dr. Lorna Breen, an ER doctor at a Manhattan hospital, made headlines in April of 2020. “She was a casualty [of COVID-19] just as much as anyone else who has died,” her father said in the days following her tragic suicide. Though Breen had no history of mental illness, the endless days of treating, and often losing, COVID patients took a toll.
Dr. Breen’s death brings to light an undeniable truth. Physicians and other healthcare workers are suffering as a result of the pandemic. Those treating COVID patients on the frontlines have been overworked and are emotionally exhausted, leading to dangerous levels of physician burnout and, in some cases, even depression.
While burnout and depression are often discussed together, the two are not inherently connected – a topic recently addressed by the AMA VP of Professional Satisfaction, Christine Sinksy, MD. In an interview with AMA News, she noted that burnout is a syndrome caused by external work circumstances, while depression is a medical condition that is caused by a variety of factors, both biological and external. She also notes that while a significant percentage of depressed physicians are also suffering from burnout, only a small percentage of those who are experiencing burnout are clinically depressed.
Regardless of the correlation between burnout and depression, both take a toll on the overall well-being of physicians. Healthcare administrators increasingly recognize the need to offer various forms of emotional support, and yet, data suggests physicians are hesitant to get professional help. Healthcare must overhaul the stigma associated with physicians seeking professional mental healthcare. Dr. Breen’s death reminds us that the consequences of physicians coping alone can be deadly.
A Stigma That Leads to Silence
Despite increasing concerns about physician well-being, a survey by Jackson Physician Search, documented in the White Paper: On the Verge of a Physician Turnover Epidemic, found just 21% of physicians report access to mental health programs through their employers. Another 13% said their employer provides a physician hotline to address feelings of burnout. While a hotline is useful, this should be just one part of a multi-faceted mental health program that encourages participation by physicians. These numbers suggest the current offering is not enough to address the massive need.
Even if mental health programs become more of a standard, simply establishing a program will do very little if the culture of an organization diminishes the need for care. All too often, physicians fear they will be seen as weak if others knew they were seeking care. For programs to be effective, physicians must feel encouraged to seek help.
In an October 2020 survey of emergency physicians, fewer than half of respondents said they would feel comfortable seeking professional help for feelings of burnout (let alone depression), and 73% reported a stigma in their workplace associated with seeking professional help. In the same survey, 57% of emergency physicians said they would be concerned for their job if they were to seek professional mental healthcare. Other studies reflect similar professional concerns.
Are these concerns just an extension of the aforementioned “stigma”? Or are physicians truly at risk of losing their licenses – or facing other professional consequences – if they seek help for mental health issues?
The “Cost” of Seeking Mental Health Care
A recent article written for the American Association of Medical Colleges notes that, for decades, state licensing boards have asked invasive questions about a physician’s mental health history. Physicians are all too aware that answering “yes” might set off a process that could put one’s ability to practice medicine at risk. While the American Disabilities Act protects physicians with a history of mental illness to some degree, the question alone stands as a deterrent to professionals in a high-pressure job who would benefit from the emotional support of a professional.
While licensing boards vary by state, most ask physicians, upon applying for or renewing a license, to disclose psychiatric treatment. A 2016 study published in Mayo Clinic Proceedings reviewed licensure application and renewal forms in all 50 states to understand how medical licensure application questions impacted physicians’ willingness to seek mental healthcare. The study found 40% of physicians were reluctant to seek mental healthcare for fear of repercussions to their medical licensure. Only one-third of the states either did not ask about mental health issues or asked only about current impairment from mental health issues. The study found physicians living in states with questions related to mental health history were more likely to feel reluctant to seek treatment.
Of course, licensing concerns aren’t the only thing keeping physicians from seeking treatment. Many hospitals ask similar questions when physicians apply for credentialing. Psychiatric treatment may come up on applications for disability and malpractice insurance.
Evolving Views on Physician Mental Health
Fortunately, attitudes about physicians seeking treatment for mental health issues are evolving, albeit slowly. In 2018, the Federation of State Medical Boards issued updated recommendations regarding the scope of mental health questions on licensing applications and renewals. The recommendations extend to hospitals and healthcare organizations, suggesting they too revise, where necessary, the mental health questions asked in their credentialing processes.
As noted, however, the concerns felt by physicians run deep. Adjusting the questions on licensing and credentialing applications is just one part of the solution. For true change, there must be an overhaul of attitudes about physicians and mental healthcare. One organization fighting for such change is the Dr. Lorna Breen Heroes’ Foundation.
After Dr. Breen’s suicide in April of 2020, her family founded the organization to reduce burnout and safeguard the well-being and job satisfaction of healthcare professionals. One way they are doing this is through proposed bi-partisan legislation addressing the mental health challenges of those working in healthcare. The Dr. Lorna Breen Healthcare Provider Protection Act establishes grants for training, education, and awareness of mental health issues in healthcare professionals. It would also establish studies to identify evidence-based methods for reducing suicide and promoting mental health. The legislation is endorsed by a long list of healthcare associations including the American Medical Association and the American Psychiatric Association.
Establishing an Effective Physician Mental Health Program
Organizations can work to overturn negative attitudes about physician mental healthcare by implementing robust mental health programs that encourage participation by all physicians. These programs should provide multiple channels and pathways for physicians to seek help.
The American Medical Association has published a comprehensive guide to caring for caregivers during Covid-19. The guide is continually updated and many of the suggestions and resources are applicable for supporting physician mental health beyond the pandemic as well.
Among other things, the guide suggests providing self-assessment tools, setting up a free, anonymous hotline, providing access to a meditation and sleep app, creating an online toolkit with links to available resources, and educating providers on their right to get help without persecution.
Perhaps most importantly, supervisors and leadership must consistently convey positive attitudes about the organization’s mental health program, continually reminding and encouraging physicians to make use of on-site resources available to them.
The AMA guide suggests managers conduct 5-minute debriefing sessions at the end of every shift to check in on mental health status. Counselors and therapists should be readily accessible for in-the-moment support, providing a direct pathway for more intensive support as needed.
Through STEPS Forward, the American Medical Association Online Education hub, practice managers and healthcare administrators can earn CME for modules focused on strategies to prevent physician burnout and build a culture that supports physician well-being.
A Standard Act of Physician Self Care
Legislation and programs addressing physician mental health are just part of the solution. These programs are part of a larger endeavor to create an environment where professional mental healthcare is a standard act of physician self-care. Physicians face extraordinary levels of stress, and they should know that it’s not only okay to seek help, it is anticipated.
Certainly, the increased attention to the matter of physician mental health is working to shift attitudes, and hopefully, the next generation of physicians will not hesitate to utilize mental health programs offered by their employers or seek outside professional help when needed.
If your organization is seeking physicians who value a culture of well-being, Jackson Physician Search specializes in recruiting physicians who are both a clinical and cultural match. Contact us today to learn more.
Hospital administrators know all too well the importance of physician engagement. Study after study confirms its significance, and yet, a troubling disconnect undoubtedly exists between physicians and the organizations that employ them…