Note: This transcript has been created with a combination of machine ears and human eyes. There may be small differences between this document and the audio version, which is one of many reasons we encourage you to listen to the episode!

Dan Gorenstein: This week we’ve been looking at how research from China, Italy and now the U.S. suggests doctors and nurses are likelier than other professionals to experience depression, anxiety and PTSD related to the pandemic.

Tuesday we met Dr. Mara Windsor, a burned out and anxious ER doc working near Phoenix. 

Mara Windsor: Because I’m a physician, I’m not going to go see a psychiatrist and get a diagnosis. That’s the problem. I mean, a lot of us, unfortunately, don’t reach out for help and care. 

DG: Today, from the Annenberg Studio at the University of Pennsylvania, in part two of our series — what makes it hard for doctors to reach out for help, and the risks that carries for them and their patients. 

I’m Dan Gorenstein and this is Tradeoffs. 

DG: Dr. Mona Masood saw a crisis brewing alongside coronavirus. 

Mona Masood: I started seeing posts come up to about how people were not coping so well. 

DG: Just by scrolling through Facebook, Mona could see doctors overwhelmed by the unprecedented suffering they were watching up close.  

MM: People were saying things like, I know I have to go in. But I want to leave and I want to escape and I want to forget about everything.

DG: In mid-March, on a whim, the Philadelphia-area psychiatrist posted a message to a COVID physician group.

MM: Calling all psychiatrists — who’s with me in putting together a hotline for physician colleagues navigating the COVID-19 crisis? 

DG: She had no idea what to expect.

But within hours dozens of licensed psychiatrists volunteered to help. 

One week later — Mona launched the Physician Support Line — a grassroots organization offering free support to doctors in crisis. 

Today, 700 volunteer psychiatrists field 8,000 minutes of calls from physicians each month. That’s 4.5 hours of calls every day. 

An outlet, says Mona, to purge the day’s stress.

MM: Someone who was seeing 20 deaths a day somebody who is going through marriage problems, someone who has not slept in a week because they keep thinking, well, I didn’t get it today, but I could very well get it tomorrow.

DG: Mona credits the popularity of the hotline to its confidentiality — no names, no organizations, just peer-to-peer conversations. 

She says that anonymity is critical. 

MM: There is something inherent in the culture of medicine that I think prevents physicians from seeking help. There is always this idea, whether it is founded or not, that there is a repercussion for using physician wellness tools, especially if there’s a way to trace that. 

DG: Mona believes the crisis line has legitimately helped doctors over the last several months.

But she knows she’s just chipping away at the surface of a systemic problem — too few doctors are seeking out mental health care — one exacerbated but not created by the pandemic.

DG: We know — even before the pandemic began lots of docs were in a difficult spot.

Almost half of all physicians reported feeling burnt out, unhappy with their jobs. 

To be clear, ‘burn out’ is not an official disease like depression or anxiety. It’s a syndrome driven by stress at work.

Symptoms include being cold towards patients, struggling to find meaning in work, and feeling emotionally exhausted.

But doctors don’t begin their training feeling this way.

Lotte Dyrbye: When people start medical school, they have better mental health than other U.S. college graduates. They have less depression, less burnout, better quality of life. Once they’re in the house of medicine and we’re teaching them to doctor, some of them break. 

DG: Lotte Dyrbye is a physician at the Mayo Clinic in Rochester, Minnesota and leading expert on the issue. 

Over the last 20 years, researchers like Lotte have learned about the toll burnout takes on clinicians and the care they provide. 

LD: If you burn out, you’re more likely to have alcohol and substance abuse problems, relationship difficulties, have thoughts of suicide, twice as likely to commit a major medical error.

DG: One final consequence to note — researchers have found burnout leads to attrition. And when docs leave their jobs, it costs their employers a bunch to replace them.

$4.6 billion a year, Lotte estimates. 

DG: The pandemic has pushed physician mental health more into the spotlight than ever before. 

News tape on Lorna Breen: 

There is a heartbreaking loss on the frontlines of this fight.

Dr. Lorna Breen, frontline worker at New York Presbyterian-Allen hospital

Dr. Lorna Breen took her own life 

DG: While the fixes for burnout require major structural changes — like making clunky electronic health records easier to use, reducing paperwork and increasing time spent with patients  

Most experts agree that once doctors are in distress, many aren’t getting the help they need.

University of Michigan’s Dr. Katherine Gold wanted to know why — so she asked 2100 female physicians for a survey she published in 2016. 

KG: The number one answer had to do with stigma. 

Fear that doctors would not be seen as competent in their jobs, fear of having to ever report to the state board or the hospital credentialing systems.

DG: Another prominent study confirmed this trend in both male and female physicians — 40% said they would avoid seeking care for a mental health issue because they fear professional blowback.

Through her research, Katherine heard horror story after horror story.

KG: People talked about being pulled out of surgery randomly for drug testing, because they had reported depression. 

People have have had episodes where they’re restricted from practice, where they’re forced into drug treatment again, even without any kind of history of drug issues. 

People have talked about coercion in which they’re told, well, unless you submit to our psychiatric analysis and go through this long treatment program which maybe is $30,000 or $40,000, you can’t get your license back. 

DG: There’s no public record of how often state medical boards or hospitals penalize physicians for coping with a mental health condition. 

But anecdotes like the ones Katherine heard through her survey have a chilling effect on physicians, and contribute to the stigma.

KG: Have you ever in your lifetime been diagnosed with any of these mental health problems — depression, anxiety, pyromania, seasonal affective disorder? And have you ever been treated?

DG: This is tricky territory. 

On the one hand, state medical boards exist to protect patients — to recertify physicians, field complaints from patients or peers, investigate problems, and discipline docs who step out of line. 

KG: That’s important because if you have a physician who’s impaired, for example, if you have a physician who’s drinking every day and comes in to do a surgery, that’s not going to be a safe physician to practice.

DG: But Katherine says the questions — like are you still getting treatment for depression — implies that a doctor with depression is somehow unfit.

KG: We have no evidence that having a diagnosis of a mental health problem indicates that you’re not safe to provide clinical care for patients. But the state boards continue to kind of hover over everybody as a threat. 

DG: Even before the pandemic, reforms to encourage doctors to seek mental health were underway.

In 2018, the organization that represents state medical boards recommended either removing mental health questions altogether or, at least, focusing on current impairment that may affect a doctor’s ability to practice.

In response, more than three dozen professional medical and advocacy groups —including the American College of Emergency Physicians, American Medical Association — have joined the bandwagon.

The effort has led several state boards, including Ohio and North Carolina, to revise questions. 

And now, thanks to COVID, Congress has even introduced two bills to expand access to provider mental health. 

Katherine calls this a modest, but important start, and credits a new generation of doctors for helping change the tide. 

KG: It feels different to me when I go and talk to folks now, compared to when I went and talked to folks 10 years ago in terms of the questions I get, in terms of the willingness of the audience to talk about their own struggles. And I think we just need to continue to push physicians to be vulnerable with their peers and to share what’s going on. 

DG: Dr. Mona Massood of the Physician Support Line agrees that, while it’s important to keep pushing for policies and programs to help prevent these issues, they can’t be avoided altogether. 

MM: Doctors don’t want to be seen as heroes. We want to be seen as human. We want to be allowed to have intense emotion, to not have all the answers, to be vulnerable.

DG: Caring for people at their sickest and most scared will never be easy. 

But admitting that and coping with its consequences should be easier.

I’m Dan Gorenstein and this is Tradeoffs.