As the Omicron variant of COVID continues to sweep across the country, the mass-casualty event of the past 21 months continues to cast a shadow on the field of medicine, putting doctors at increased risk for depression and anxiety, which will affect our careers and our patients for years to come. While the determination and courage of my colleagues gives me hope, the reality is that we, and our patients, will suffer harm unless we make 2022 the year that all physicians — and especially those who are just beginning their medical careers — can get the essential mental health care services they need.
Depression and anxiety have always been occupational hazards for doctors. A systematic review of 31 studies published in the Journal of the American Medical Association found that 29 percent of practicing physicians reported depression, a rate twice that of US adults. Recent studies suggest that rates of depression and anxiety have increased among medical trainees since March 2020, with nearly half of this group now having depression or anxiety. It’s not just doctors who are experiencing a mental health crisis in this pandemic — Americans of all backgrounds have reported mental health struggles along with barriers to seeking care, such as lack of access to treatment and overcoming the stigma of mental illness. For physicians, however, there is also an actual legal barrier in many states to receiving effective treatment for their mental health needs: State medical licensing boards often ask invasive questions about mental health before granting a license to practice, a habit that has been shown to deter physicians from seeking treatment.
I have heard many doctors share their hesitation to seek counseling or medication for even mild anxiety or depression due to fear this would impact their medical license. One colleague (who gave me permission to share this story) confided that she was suffering from such anxiety that she was struggling to eat or sleep. When I asked if she had spoken with her doctor about finding a therapist and getting treatment for the anxiety, she said she had not, in large part because of licensing concerns. “My state asks about mental health history on the licensing application,” she said. “If I have to disclose this the next time I renew my license, I’m afraid I might not be able to practice.”
The 2020 death by suicide of Dr. Lorna Breen, an emergency medicine physician who suffered from depression after working to exhaustion through the height of the pandemic in Manhattan and who had told her family she was afraid treatment would result in losing her license, underscores the life-threatening consequences that can occur when fear of an archaic and punitive licensing process prevents doctors from seeking care.
An investigation by the Mayo Clinic and the American Medical Association confirms that these medical board licensing processes deter physicians from getting the help they need. Doctors may hesitate to move to certain states, which can worsen disparities and access to care in those areas. For medical residents, who are beginning their careers and forming their professional identities amid conditions that have challenged even the most seasoned hospitalists, a failure to fully recover from the trauma of living through an extended crisis could jeopardize their own safety and that of their patients long after this pandemic is over.
There are effective treatments for depression and anxiety, and barriers to treatment not only harm doctors, they also endanger patients. Evidence shows that physicians with inadequately treated depression or anxiety are at higher risk of medical errors, which puts patients at risk. When suffering clinicians are adequately treated, patients benefit.
Advocacy groups such as the National Academy of Medicine have been working for years to change dangerous and misguided licensing practices. In 2018, the Federation of State Medical Boards issued guidelines for physician wellness that included recommendations for state licensing boards about safe, ethical ways to identify impairment due to medical conditions, including mental health, while ensuring that doctors are capable of safely fulfilling their professional obligations. However, despite evidence about the prevalence of treatable depression and anxiety among physicians, and despite having a roadmap to make changes, a recent JAMA study found that two thirds of state medical boards do not comply with the best practices outlined by the FSMB.
A promising development is the recent passage of a bipartisan bill named for Dr. Breen, which funds advocacy about best practices to promote physician mental health (such as changing state medical licensing practices) and gives $150 million over three years to mental health referral and treatment programs for physicians.
Additionally, groups such as Emotional PPE and National Alliance on Mental Health are working to expand health care workers’ access to mental health treatment, and as more physicians share their mental health struggles, the stigma around seeking treatment will continue to lessen.
It is imperative that state licensing boards align with their own national best practice guidelines. If you want to support your doctor and protect the future of patient safety in this country, contact your state’s medical licensing board to ask them to change their licensing procedures to follow the Federation for State Medical Board’s recommendations.
Medical residents training during the pandemic have risked their physical safety by caring for patients with a dangerous virus, and witnessed scores of preventable deaths, while having less access to the supportive social bonding and time with family that usually buffers the stressors of residency. In the future, these residents will be leading the field of medicine and managing the health of this country. In 2022, we must begin to make the changes that could have prevented the loss of Dr. Breen, and make the medical profession a safer place for physicians to heal and to practice.
Dr. Susan Hata is an associate program director for the Mass General Hospital Internal Medicine-Pediatrics Residency Program, and the co-director for Wellness for the Mass. General Hospital for Children.