Doctors Coping with COVID, Part 2

Season 1: Episode 64
September 10, 2020

Photo by Ralf Heß licensed under CC BY-NC-SA 2.0 

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.

Listen to the full episode below, read the transcript for this episode (and for part one) or scroll down for more information.

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.  

Burnout

This syndrome is driven by chronic job-related stress, though is not considered an official disease. The three core symptoms are emotional exhaustion, cynicism and decreased sense of purpose. But capturing the true extent of burnout among physicians is tricky because definitions and ways of measuring it vary.

Depression

A well-defined clinical condition, depression has a range of symptoms —fatigue, insomnia, diminished pleasure in normal activities, feelings of worthlessness — and triggers — the death of a friend or family member, divorce or sudden job loss.

Suicide

At its most severe, distress among doctors can lead to suicidal thoughts and attempts. Estimates vary but a 2016 JAMA study found that 11% of medical students reported having suicidal thoughts and a recent analysis suggests physicians face a higher risk of suicide than other professions.

0 %
of physicians, on average, experience symptoms of burnout but estimates vary widely¹
0 %
of physicians fear getting care to treat a mental health condition²
$ 0
billion lost by health systems each year due to burnout-driven attrition³

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.

The Stigma

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.

Personal Concerns

Many physicians are reluctant to share that they are struggling with a mental health condition, in part, because they don't want patients or colleagues to view them as incompetent or unfit to do their job. While burnout from work can impact the quality of care doctors provide, there's no evidence that simply having a diagnosis of a mental health problem like depression or anxiety means a doctor is any less capable of providing care for patients.

Medical Licensing

More than half of state medical licensing boards ask questions about mental health that are broad, invasive, or vague — such as have you ever been diagnosed with depression, anxiety? A 2017 study, published in Mayo Clinic Proceedings, found that about 40% of physicians said they would avoid seeking care for a mental health issue because they fear losing their medical license.

Disability Insurance

Some physicians need disability insurance, and these insurers can use a doctor’s mental health history as basis for denying them coverage or raising the cost of it.

The Solutions

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 bandwagonThe 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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Episode Resources

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)

National Suicide Prevention Lifeline

Physician Support Line

Suicide Prevention (Substance Abuse and Mental Heslth Services Administration

Episode Credits

Guests:

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!