Mental Health Trends in Physicians

The past few years have wreaked havoc among healthcare professionals. According to a recent survey by Mayo Clinic, there was a dramatic increase in burnout and a decrease in job satisfaction during the first two years of the COVID-19 pandemic. The increase in distress appeared to be primarily work-related since depression scores only increased modestly.

Even before COVID, the rate of depression and mental health issues was rising in medicine. Studies showed an annual increase of about half a percent over three decades. The COVID pandemic has increased the rate of symptoms, with an all-time high of 63% reporting symptoms of burnout.

The statistics for physician burnout and mental health are alarming. Two-thirds of doctors know someone who is going to stop practicing medicine in the next five years due to burnout. A quarter of medical residents would choose not to go into medicine if they were starting their education over. Even medical students face depression at a significantly higher rate than the general public. The statistics for female physicians are even worse. The suicide rate is 250-400% higher than in females in other occupations. Physicians have a higher suicide completion rate due to greater knowledge and better access to lethal means.

Physicians are less likely to seek mental healthcare. Mental health carries a stigma in society, but it is even worse in the healthcare culture. Physicians may fear mental health diagnoses will affect their licensing and ability to practice. Physicians are concerned about medical boards having discriminatory practices regarding mental health. Physicians are less likely to talk to their coworkers about their concerns because of the myth of invulnerability, the need for self-sufficiency, and the concerns about a colleague facing punitive actions for having mental health problems.

Why are physicians so prone to burnout and mental health struggles? Long hours and heavy workloads are some of the things that provide an obvious setup for burnout. Feeling that they can't reach out because of the stigma further exacerbates this. Like everyone else, physicians also have life stressors. These life stressors further exacerbate mental health.

Suicide risk increases when mental health concerns are not addressed. Physicians are more likely to self-medicate as a way to alleviate symptoms. Studies show that suicide rates are lower among physicians who receive mental health treatment.

The challenge is that untreated mental health issues can affect patient care in addition to other aspects of life. A recent Medscape study showed that 47% of depressed physicians were more irritable with staff, 35% were more exasperated with patients, and 26% were less careful while taking patient notes. Substance abuse is frequently a problem in people with depression; physicians are no exception. 15.3% of American surgeons and 18.9% of Danish doctors had Alcohol Use Disorders Identification Test scores indicative of alcohol abuse or dependence.

Does the physician's specialty make a difference? In short, yes. Suicidal ideation is highest in specialties with more shortages. The rate is highest in otolaryngology at 13%, followed by psychiatry, family medicine, anesthesiology, obstetrics and gynecology, and emergency medicine at 12%. Physical medicine and rehabilitation, internal medicine, pediatrics, plastic surgery, public health and preventative medicine, allergy and immunology, general surgery, and neurology all came in at 10% or higher. Pulmonology came in lowest at 4%.

These alarming statistics have led to multiple medical organizations calling for a greater focus on physician mental health. Programs are being instituted in medical schools and residency programs where depression incidence is highest to help raise awareness. Studies show that individually focused interventions can help improve symptoms. Trials are in place to try to develop mental health apps for trainees.

Ultimately, to address physician mental health, the problem must be tackled at a systemic level. This means working conditions such as administrative and bureaucratic burdens, training program cultures, and discriminatory practices of medical licensing boards must be addressed as part of the greater solution.

One potential solution to the increasing rate of physician burnout may be the value-based healthcare model. The value-based care model aims to improve health outcomes in patient enrollees. This is accomplished by pooling resources to provide more patient-centered care. One of the ways that this is accomplished is by limiting patient panels to provide physicians more time to interact with their patients and build a doctor-patient relationship. More resources, such as social workers, are also available to help offload some of the administrative burdens. This addresses one of the aspects of our current healthcare system, which is causing burnout and leading to better work-life balance for physicians.

Did you know that burnout has famously been defined as “an erosion of the soul”? Among physician specialties, primary care doctors are particularly hit hard by burnout. Value-based healthcare is the Rx for physician burnout. Learn more when you download our eBook.