The Current Mental Health Status of Physicians in North America

In this post we will be discussing a particularly informative scoping review article that was published in October of 2019 in the journal, BMC Public Health. In this article, A Scoping Review of the Literature on the Current Mental Health Status of Physicians and Physicians-in-training in North America, authors Mihailescu and Neiterman discuss the existing literature regarding the mental health status of physicians and physicians-in-training, as well as the prominent mental health concerns and barriers to accessing mental health services for this sample.

What did they do?

Using data collected from the 91 studies the authors sought to answer the following questions:

1. What type(s) of mental health concerns among physicians are commonly discussed in the literature?
2. What are the reported causes of mental health problems in physicians and what solutions are available to improve the mental wellbeing of physicians?
3. What are the barriers to seeking and providing care to physicians suffering from mental health problems?

Why did they do it?

Physicians are at a particularly high risk to experience mental health concerns due to the nature of the services they provide. Physicians, as well as physicians-in-training, are exposed to particularly high stress working environments and irregular working hours, which makes them a high risk group for experiencing mental health difficulties. While there exists a fairly extensive literature that explores the mental health status of physicians and individuals working in related fields, there have been no reviews that summarize this collection of literature.

How did they do it?

Articles included in the review (n = 91) were published in peer reviewed journals between January 2008 and January 2018. Using the articles included in the review, the authors derived 6 primary themes: (1) description of mental health concerns affecting physicians and physicians-in-training; (2) prevalence of mental health concerns among this population; (3) possible causes that can explain the emergence of mental health concerns; (4) solutions or interventions proposed to address mental health concerns; (5) effects of mental health concerns on physicians and on patient outcomes; and (6) barriers for seeking and providing help to physicians afflicted with mental health concerns.

What did they find?

Of the 91 included articles, 36 studies focused on practicing physicians, followed by papers on residents (n = 22), medical students (n = 21), and those discussing medical professionals with different levels of training (n = 12).

The authors found that most of the available literature focused on burnout and stress (n = 69), followed by depression and suicidal ideation, and wellbeing and general mental health. It was found that 30-60% of all physicians and residents are impacted by burnout and other mental health concerns, with residency training shown to produce the highest rates of burnout. Unbalanced schedules and increased administrative work duties were identified as the primary causes of mental health concerns for physicians and physicians in training. The high-pressure nature of the medical profession was also highlighted as a cause for mental health concerns, along with structural issues such as government pressure and budget cuts.

Only a limited number of papers discussed the effects of mental health concerns, which was a sub-focus of this review. The authors found that overall, poor mental health in physicians was associated with decreased mental and physical health of patients. Mental health concerns in physicians were also associated with reduction in work hours and number of patients seen, as well as lower job satisfaction.

Relative to solutions and interventions for the identified issues, the authors of this review identified four levels of interventions as suggested by the literature:

1. Primary prevention: Increase awareness of physicians’ mental health and develop strategies that can help prevent burnout from occurring in the first place; implement programs that can help increase resilience among physicians to help withstand burnout.
2. Tertiary prevention: Focus on strategies targeting individuals already suffering from poor mental health; mindfulness-based training and other similar programs to increase self-awareness.
3. Workplace/institutional interventions: Focus on changing workplace policies and organizational culture; reduced administrative hours, offering access to mental health services outside of the place of employment, promoting a less competitive workplace culture.
4. Governmental level interventions: Identify the link between government policy (healthcare reform, budgeting) and the level of service and care that can be provided by physicians.

What does it all mean (our take)?

We chose to review this article because we understand the tremendous pressures that doctors are faced with on a daily basis. In many cases, doctors are quite literally responsible for making decisions that can have life or death implications. Accordingly, it’s critical that we protect doctors as best as we can, as it is evident that the mental health of providers has downstream effects on their patients.

But how do we do it? The authors of this great study provide some information about potential solutions to address provider mental health problems - and we agree that these are all great places to start. This needs to become a priority...especially now, as demands on providers are higher than ever before. It seems likely that by working together, leveraging technology, and providing a safe, secure, and accessible behavioral healthcare environment, we can provide the type of support that these providers need.