Writing for the New York Times, Seema Jilani, a pediatrician, humanitarian aid worker, and Fulbright scholar, explains why so many physicians struggle with mental health issues—and what needs to be done to reduce the stigma preventing them from getting the care they need.
'An occupational hazard for physicians'
According to Jilani, mental health issues have been "an occupational hazard for physicians" even before the pandemic.
During their residencies, many physicians face "sleep deprivation, hunger, constantly being told [they're] not a good enough doctor and working a torturous 100-hour week, all while six figures in debt," Jilani writes—which significantly impacts physicians' mental health.
For example, a 2015 systematic review and meta-analysis published in JAMA found that 29% of resident physicians experienced depression or depressive symptoms—much higher than the 8% of Americans who had depression in any given two weeks between 2013 and 2016.
The pandemic has also likely worsened physicians' mental health: A survey conducted in 2020 and presented at the American Psychiatric Association estimated that as many as 36% of frontline physicians suffered from post-traumatic stress disorder.
In addition, physicians have a higher risk of death by suicide than many other professions, with an estimated 300 to 400 physicians dying by suicide in the United States every year—about a doctor a day.
The stigma of mental health care among physicians
"The culture of medicine discourages doctors ... from crying, sleeping or making mistakes," Jilani writes. "Worse, we can even be punished for seeking mental health care."
As of 2021, medical boards in 37 U.S. states and territories include questions asking physicians to disclose any mental health treatments or conditions. According to Jilani, answering those questions "could result in the medical board reviewing our personal medical records, possibly in psychiatric and drug testing, and perhaps even in having our medical license reviewed, suspended or revoked, all under the guise of establishing our professional competence."
As a result, many physicians choose to not seek out mental health care, even when they need it. In a 2017 study, almost 40% of physicians said they worried seeking mental health care would jeopardize their ability to get or renew their medical licenses. Similarly, a 2016 survey of female physicians found that almost half believed they met the criteria for a mental illness but avoided care because of their fear of licensing boards.
In addition, Glen Gabbard, a clinical professor of psychiatry at Baylor College of Medicine, said physicians often struggle to admit they need mental health care in the first place because they're "supposed to know everything in a life-threatening crisis. There isn't room for self-doubt."
And when physicians do seek help, they may have to do so in the same hospitals where they work, running the risk of being recognized by both patients and colleagues. In addition, some physicians may seek out colleagues for a quick "curbside consult" for a prescription instead of getting more comprehensive care.
"This all has helped create an underground market of sorts for physician mental health care," Jilani writes. "... If you must seek mental health care, do it quietly. Find a therapist outside your city who only documents the bare minimum in your chart, pay with cash only, don't let it be billed to your insurance company. Make sure there's not paper trail."
To reduce the stigma of mental health care among physicians, Jilani recommends state licensing applications and hospital credentialing forms eliminate questions about physician mental health. Other ways to improve physician mental health include more time off, comprehensive parental leave policies, and sufficient hazard pay.
"It is time we collectively agree that physicians are worthy of the same compassion we give our patients," Jilani writes. (Jilani, New York Times, 3/30)