The nature of the work physicians do — helping people overcome illnesses, managing chronic conditions, and even saving lives — is perhaps the most significant source of job satisfaction among providers. But the role they play is a double-edged sword. Physicians must live with the psychological consequences of not being able to help people heal. A physician may witness one or more patients die during their shift, yet must return to work ready to provide the same high-quality of care whether they are emotionally or mentally prepared to do so.
Long hours, social isolation, heavy patient loads, compassion fatigue, bureaucracy, and lack of work-life balance, exacerbate the stress many physicians routinely experience, contributing to alarming physician burnout rates. In early 2020 alone, 42 percent of physicians reported feeling burned out, with more women (51 percent) reporting feeling burned out than men (36 percent).
Despite their backgrounds in medicine, physicians often do not seek or undergo ongoing mental healthcare. Many do use positive coping mechanisms to help them deal with the stress, such as practicing mindfulness, acknowledging gratitude, confiding in a loved one, or exercise. However, these chronic stressors put them at risk of developing maladaptive coping mechanisms, such as overeating, alcohol, and self-harm. Nationally, one physician commits suicide each day — a rate twice that of the population at large.
Even in less extreme cases, the stress and resulting mental health conditions physicians face can impair their ability to provide quality care, leading to lower levels of patient satisfaction and health outcomes, mistakes, and even patient harm. Chronic stress is also a leading cause of physicians leaving the profession. Physicians across the country must have access to and are encouraged to participate in mental health and wellness programs long before patient care is compromised or physicians are on the cusp of quitting.
The Pandemic and Physician Mental Health
The coronavirus pandemic has placed a national spotlight on the healthcare challenges physicians face. Unfortunately, it has also amplified them as COVID-19 cases have overwhelmed hospitals and healthcare systems throughout the country since inception. At the onset, physicians sought to treat a barrage of patients suffering from a virus for which there was no known effective treatment regimen.
As we know, severe COVID-19 complications have often proved fatal. Many physicians have found themselves witness to mass casualties. However, with hospitals and healthcare systems overrun, they find themselves compelled to return to work or else called back into service to do what they could, despite the effects on their psychological impacts on their well-being.
Despite the significant stress many physicians face on the frontlines of the COVID-19, it remains challenging to connect physicians and mental health resources. Many may be on the verge of burnout at this moment. Yet, they avoid seeking work-based mental health resources or formal counseling outside of work for many of the same reasons they avoided doing so pre-pandemic.
Why Many Physicians Don't Seek Mental Healthcare
Like much of the population, physicians fear stigmas associated with mental healthcare. Despite recent poll findings that 87 percent of emergency physicians are experiencing more stress since the pandemic, nearly half (45 percent) are uncomfortable seeking mental health treatment. Further, more than a quarter (27 percent) stated they have avoided doing so. Most (73 percent) cited perceived stigmas at work, while 57 percent feared for their job if they sought treatment. Physicians often share high professional expectations and feel inordinate professional pressure to perform at a high level, contributing to increased stress and burnout levels. Sometimes, they view mental health conditions as a weakness.
Unfortunately, these concerns both predate the pandemic and are not baseless. As per a recent Washington Post analysis, 90 percent of state medical licensing applications include questions about mental health and past diagnoses. In some cases, physicians have been sent to physician health programs (PHPs) of varying quality. Physicians need programs they can trust to help them without negative consequences for their current position or medical career.
Establishing a Physician Mental Healthcare Program
Despite the negative headlines some PHPs have generated, they have valuable lessons for those seeking to establish a mental healthcare program for physicians in their healthcare system or hospital. North Carolina's PHP found that over 90 percent of its physicians in 2017 reported improved mental health outcomes after completion of its program. The majority of these physicians participating dealt with substance abuse issues, workplace stress, and anxiety — all conditions which can potentially put patients at risk.
Successful mental health programs can have a significant impact on patient outcomes. There is strong evidence that physician burnout is associated with diminished patient quality of care, higher incidence of safety-related care issues, and poor health outcomes among physicians themselves. By reducing the stigmas and barriers to mental healthcare, healthcare systems and hospitals can improve the quality of care they offer and reduce safety-related human errors.
Chris Bundy, President of the Federation of State PHPs, notes that successful programs like North Carolina's program begin with education and outreach designed to stigmatize mental healthcare treatment and dispel common concerns about potential career consequences of seeking treatment. Physicians should also be aware of any financial costs of treatment at the outset. Programs that provide generalized support around the job and situation-specific phenomena known as burnout also should maintain a list of mental health providers with substantial experience with specific conditions, such as depression. Finally, effective programs should be designed in tandem with organizational interventions designed to reduce physicians' job-specific stressors.
Pre-pandemic, a common stressor was the long hours and heavy patient caseloads physicians faced. In the wake of COVID-19-inflated caseloads, more physicians are facing burnout than before. One effective intervention that can provide your clinical staff much-needed relief is the use of contingent staffing. VISTA stands ready to help with a cadre of qualified, licensed physicians who can provide your team with much-needed relief and support. Learn more about how VISTA Select can help manage cost savings all while addressing physician burnout.