Doctors Coping with COVID, Part 2
Season 1: Episode 64
September 10, 2020
The pandemic is exacerbating the struggle with mental health issues among health care providers. In part two of our series, we examine why more doctors don’t seek help, and the costly consequences that distress can have.
The Basics: A Snapshot of Physician Mental Health
Mental health problems in medicine can manifest as a constellation of conditions and syndromes — burnout, depression, suicidal thoughts. Each issue has its own unique set of causes and consequences though they can be hard to measure. Research shows, for instance, that physician burnout is associated with an increase in medical errors, worse quality of care and a greater likelihood of attrition.
And the pandemic is only making these issues worse. Small studies from China and Italy in the early days of the pandemic found frontline workers had a high risk of developing symptoms of depression, anxiety, insomnia and distress. In late June, the CDC found essential workers — including doctors and nurses — are about 50% likelier than other professionals to experience symptoms of depression, anxiety and PTSD related to the pandemic.
COVID has exacerbated mental health issues not only because of long hours, watching patients die alone, fear of getting sick but also because of a lack of basic personal protection equipment and adequate testing options.
¹Tait D. Shanafelt, Colin P. West, Christine Sinsky, et al. “Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2017.” Mayo Clinic Proceedings, 2019.
²Lisolette Dyrbye, Colin P. West, Christine Sinsky, et al. “Medical Licensure Questions and Physician Reluctance to Seek Care for Mental Health Conditions.” Mayo Clinic Proceedings, 2017.
³Shasha Han, Tait D. Shanafelt, Christine Sinsky, et al. “Estimating the Attributable Cost of Physician Burnout in the United States.” Annals of Internal Medicine, 2019.
Stigma surrounding mental health runs deep. It goes far beyond the halls of medicine but doctors, in particular, fear professional ramifications for reporting a mental health issue or seeking professional treatment.
Reforms to remove barriers to seeking mental health care were underway before the pandemic.
In 2018, the Federation of State Medical Boards — the organization that represents state medical boards — recommended either removing mental health questions or focusing questions on current problems which cause impairment of practice.
This year, more than three dozen professional medical and advocacy groups — including the American College of Emergency Physicians, American Medical Association, and American Psychiatric Association — have joined the bandwagon. The effort has led several state boards — including Ohio and North Carolina — to revise questions.
Now, because of the pandemic, legislators recently introduced two bipartisan bills to improve access to provider mental health. One, the Dr. Lorna Breen Health Care Provider Protection Act, named after a New York physician who died by suicide during the pandemic, aims to expand mental health training programs and launch a national campaign to encourage clinicians to get support and treatment.
While these policies, programs and recommendations represent important steps to help prevent or curb these issues, they won’t eliminate the problem entirely.
Mental health experts acknowledge that caring for people at their sickest is not easy, but it should be easier for physicians and nurses to seek help without consequences or fear.
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Select Research and Reports on Mental Health and Burnout:
Medical Licensure Questions and Physician Reluctance to Seek Care for Mental Health Conditions (Liselotte N. Dyrbye, Colin P. West, Christine A. Sinsky, et al; Mayo Clinic Proceedings; 10/01/2017)
Do US Medical Licensing Applications Treat Mental and Physical Illness Equivalently? (Katherine J. Gold, Elizabeth R. Shih, Edward B. Goldman, Thomas L. Schwenk; Family Medicine; 06/2017)
“I would never want to have a mental health diagnosis on my record”: A survey of female physicians on mental health diagnosis, treatment, and reporting (Katherine J. Gold, Louise B. Andrew, Edward B. Goldman, Thomas L. Schwenk; General Hospital Psychiatry; 09/15/2016)
Evaluating the Association of Multiple Burnout Definitions and Thresholds With Prevalence and Outcomes (D. Brock Hewitt, Ryan J. Ellis, Yue-Yung Hu, et al; JAMA Surgery; 09/09/2020)
Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students (Lisa S. Rotenstein, Marco A. Ramos, Matthew Torre, et al; JAMA; 12/06/2016)
Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019 (Jianbo Lai, Simeng Ma, Ying Wang, et al; JAMA Network Open; 03/23/2020)
Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020 (Mark É. Czeisler, Rashon I. Lane, Emiko Petrosky, et al; CDC MMWR; 08/14/2020)
Suicide Prevention (Substance Abuse and Mental Heslth Services Administration
Mona Masood, DO, psychiatrist in Philadelphia and cofounder of the Physician Support Line
Lisolette (Lotte) Dyrbye, MD, MPHE, director of the Mayo Clinic Department of Medicine Physician Well-Being Program
Katherine Gold, MD, a family medicine physician and faculty at the University of Michigan
Music composed by Ty Citerman, with additional music this episode from CC MIxter and Blue Dot Sessions.
Additional thanks to:
Mahshid Abir, Rick Summers, Steven Arnoff, Cynda Rushton, Neil Busis, Bryan Bohman, Lisa Rosenstein, Erin Connors, Cristina Mutchler, Thomas Schwenk, Rashon Lane, Bapu Jena, Mara Windsor and the Tradeoffs Advisory Board…
…and our stellar staff!