Content warning: This article discusses suicide.
A profound and escalating crisis is steadily unfurling within the medical community. As physicians navigate the complexities of patient care, demanding schedules, and a rapidly evolving health care landscape, the toll on their mental well-being has reached an alarming crescendo.
Burnout, stress, and a palpable sense of emotional exhaustion permeate the halls of hospitals and clinics. With a surge in the number of physician suicides,1 the medical community is issuing an urgent call to action to address the root causes of this crisis and provide a lifeline for those on the frontlines of patient care.
In a groundbreaking paradigm shift, physicians are now becoming the architects of their own mental health support systems. As the demands on health care professionals intensify, providers have now introduced an array of mental health tools and programs, drafted from their own experiences and aimed at reclaiming the well-being of themselves and their peers.
As we navigate this physician-led mental health revolution, the profound impact of these resources becomes evident — not only as a testament to the resilience of these health care workers, but also in signaling a cultural shift that prioritizes the mental health of those who dedicate their lives to healing others.
The American Hospital Association states that the fear of losing medical licensure is a key driver of physician suicide.
A Health Care Crisis
At the forefront of the revolution, Stefanie Simmons, MD, is the Chief Medical Officer of the Dr Lorna Breen Heroes’ Foundation and a board-certified emergency medicine physician.
“We know that practicing medicine in and of itself is a risk factor for mental health, that physicians and nurses have higher rates of depression, anxiety, and substance use disorder than the background population,” she said.
The Dr Lorna Breen Heroes’ Foundation is named in honor of Dr Lorna Breen, the emergency room director at New York Presbyterian Hospital who died by suicide on April 26, 2020. After a 3-week period of treating COVID-19 patients and contracting the virus herself, she returned to the emergency room at the height of the pandemic.3 As her mental health suffered, she was afraid to get help because of the impact that it could have on her career.
Although the COVID-19 pandemic shed a harsh light on the physician mental health crisis, these providers have been facing higher rates of mental health crises long before 2020. In 2005, male physicians had a 70% higher likelihood of dying by suicide than men in the general population, whereas female physicians were 250% to 400% more likely to die by suicide than women in other professions.1 A meta-analysis published in 2016 also found that the prevalence of suicidal ideation was 11.1% among medical students.2
Increased awareness of these alarming issues has prompted both systemic and individual efforts to support physicians’ mental health. However, physicians are advocating for prompt and proactive changes, particularly given the tragic consequences that have already occurred.
Robyn Tiger, MD, the founder of the trauma-informed wellness coaching practice for physicians, StressFree MD, has personally lost 3 medical colleagues to suicide. “We are as a collective seeing things differently and people are trying to make those changes, but we’re not there yet,” she stated.
Dr Simmons spoke to the stigma that plays a major role in physicians’ reluctance to seek mental health care in training and practice.
“There’s internalized stigma,” she expressed. “You have folks who are very much conditioned, both in pre-training and then during their training to be self-reliant and they fear that it says something negative about themselves that they seek care, particularly for their mental health.”
Additionally, institutionalized stigma exists in “the policies, procedures, rules, and regulations that stigmatize mental health care for health care workers, such as questions on state licensing and hospital credentialing applications that ask about a history of diagnosis and treatment of mental health conditions but not physical health conditions or other impairments,” Dr Simmons emphasized.
To address this crisis, efforts must target both internal and external stigma through individual mental health counseling and self-care, peer support networks among physicians, and policy reform so that physicians may seek help without fear of institutional repercussions.
Supporting the Individual Physician
“I can’t fix the health care system. There are people working on that and I don’t know if I’m going to see that actually fixed or changed even in my lifetime, but I can work at the level of the human,” said Dr Tiger.
Dr Tiger’s practice, StressFree MD, is dedicated to elevating the health and well-being of the whole physician through lifestyle medicine, a branch of medicine focused on preventive health care and self-care.
“I’m actually the doctor’s doctor,” she said.
StressFree MD takes an evidence-based approach on the key pillars of lifestyle medicine:
- Stress prevention and relief;
- Healthful nutrition;
- Restorative sleep;
- Physical activity;
- Social connection; and,
- Avoiding risky substances.4
Dr Tiger said that all pillars are interlinked, but when the first 5 are in order “we’re less likely to reach for those risky substances, the overdrinking, the drugs.”
“I call them also just escapes — internet shopping, gambling, maybe over-exercising, whatever it is that you’re doing… You’re escaping,” she continued.
Dr Tiger helps physicians meet these pillars through one-on-one coaching sessions tailored to their needs. She said that many physicians prefer coaching because there is no medical record, and thus, no stigma. However, she also stressed that coaching does not replace the need for a mental health care professional.
“The mental health care professional helps you process your experiences, helps you really understand what’s been going on, and get to the place where you were, and then the life coach actually helps you move forward from that place. So that’s really the distinction,” Dr Tiger said.
In addition to self-care practices, both Dr Tiger and Dr Simmons agree that removing barriers and providing mental health resources for physicians is critical for the health care system as a whole.
“Without physicians, nurses, nurse practitioners, and [physicians’ assistants] to do this work, we don’t have a health care system and that impacts all of us,” according to Dr Simmons. “Whether you’re a health care worker or family member or even a potential patient as we all are, this is something that folks should pay attention to, advocate for, and help support.”
In response to the immense mental health stigma faced by health care workers, a beacon of support has emerged in the form of the Physicians Support Line. The Physicians Support Line is a free, confidential hotline and mental health support service specifically designed for physicians and staffed by volunteer psychiatrists.
The program aims to “to normalize pursuit of mental wellness by physicians and medical students, to encourage unity and empathy among physician colleagues, [and] to provide a resource for physician and medical student emotional wellness to healthcare organizations and institutions.”5
Conceived and run by a group of psychiatrists, the Physician Support Line is a testament to the power of physicians addressing the mental health needs of their peers. This initiative strives to create a safe space where physicians can express their fears, frustrations, and vulnerabilities without judgment.
The support line offers “empathic and active listening, motivational interviewing, supportive therapy, collaborative problem solving, and cognitive behavioral techniques to manage acute stress, panic, depression, and insomnia.”6 These volunteer psychiatrists, who possess a personal understanding of the demands of the medical profession, lend a compassionate ear and evidence-based guidance to those in need.
As a confidential assistance that does not have to be reported as a therapy service, the Physician Support Line plays a crucial role in promoting the well-being of physicians and contributing to a culture that prioritizes mental health within the medical community.
Removing the Institutional Drivers of Suicide
The American Hospital Association states that the fear of losing medical licensure is a key driver of physician suicide.7 To address this issue, the Dr Lorna Breen Heroes’ Foundation works with medical groups, outpatient clinics, hospitals, and other health care organizations to support the mental health of their workers through its ALL IN: Caring for Caregivers program. First launched in Virginia in 2022, 26 states and more than 100 hospitals have participated thus far, and Dr Simmons said additional states are slated to get involved in 2024.8
In the ALL IN program, organizations go through 3 phases of change to eliminate barriers to mental health care.9 “The first step is to remove stigmatizing language from licensing and credentialing, so that dovetails with some of our advocacy efforts,” Dr Simmons said. The Heroes’ Foundation also encourages organizations to adequately communicate these changes to reassure health workers. “Step 2 is for leaders within the organization to take part in health care leadership education around professional well-being so that they understand the drivers of burnout and lack of mental health care access for health care workers.” Phase 2 ends with the creation a 12-month action plan. Finally, Phase 3 focuses on operations and places organizations into communities of learning to accelerate positive change in their action plan.
Dr Simmons also recommended that individual health care practices should take steps to provide mental health care access to their employees. For her, that means longitudinal health care as opposed to a limited number of employee assistance program visits, which do not prescribe diagnoses or long-term treatment. Health care practices should also optimize their work environment to reduce unnecessary stressors, which benefits everyone involved.
“If we can start working on some of those systemic or operational issues, then life gets better for clinicians as well,” Dr Simmons stated.
In addition to the Dr Lorna Breen Heroes’ Foundation, other organizations have implemented resources to support mental health workers. For example, the American Psychiatric Association Foundation offers a video toolkit with strategies for health care leaders to remove barriers and improve access to timely and effective mental health care within their organizations.
These physician-crafted mental health resources — lifestyle medicine and self-care coaching, a confidential physician support hotline, and institutional reform programs such as ALL IN — highlight the solidarity and shared experiences experienced by those within the medical field. Although the medical community still faces profound challenges in addressing the physician mental health crisis, these resources can help empower physicians to reach out for support as they encounter the pressures of their profession.
If you or someone you know is struggling or in crisis, help is available. Call or text 988, chat 988lifeline.org, or contact the Crisis Text Line by texting TALK to 741741.
This article originally appeared on Psychiatry Advisor