Three lessons from Vox’s story on physician mental health

In a 4,700-word piece titled “The doctors are not all right,” Vox Senior Health Correspondent Julia Belluz explores the structural barriers in place that make it difficult for doctors to access mental health care.

The article highlights stories of physicians who have died by suicide, COVID-19’s impacts on physician mental health, and efforts to make it easier for doctors to access care.  Here are three lessons learned from the piece:

 

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Deteriorating mental health and suicide are “occupational hazards” of the profession:

Within the medical field, suicide is known as an “occupational hazard.” A study referenced in the article estimates an average 119 doctors take their own lives in the United States each year – though this is likely to be an undercount, says the study’s lead author Dr. Katherine Gold. The article states:

The toll could be as large as 300 to 400 deaths per year — according to an oft-cited estimate roughly double the suicide rate in the general population.”   

Physicians also face higher rates of depression, including in the early years of medical school and residency. Belluz writes:

The problems emerge in the high-stress years of medical school, and by the start of residency — when doctors’ DNA was found to age six times faster than that of their non-physician peers — rates of depression increase fourfold in the first four months. Across all residency programs, an average of one-third of doctors meet the diagnostic criteria for major depression. Suicide was the second most common cause of death after cancer among these newly minted doctors between 2004 and 2014.”

Dr. Pamela Wible, a physician and mental health activist cited in the article, says systemic contributors to mental health problems are the norm in medicine, and that the COVID-19 pandemic has only made the situation worse.

 

“Medicine is, ironically, a profession that punishes some doctors for getting mental health care

The article tells the stories of Dr. Scott Jolley and Dr. Lorna Breen — two doctors that died by suicide amidst the COVID pandemic. Both doctors knew they needed mental health care, but both were concerned that receiving care would put their jobs in jeopardy due to barriers built into the system.

One of those barriers is a fear of what can happen to doctors who receive treatment. In dozens of states, medical boards ask physicians sweeping questions about their health histories that would require them to disclose a diagnosis or treatment for mental illness. Similar questions come up when doctors apply for hospital credentials or insurance reimbursements. A disclosure can trigger a call to appear before the state board, a demand for medical records, or even a psychiatric evaluation. In the worst cases, doctors may be restricted in how they practice medicine or even lose their licenses.

Belluz describes this as the “hidden curriculum.” She writes that medical boards in 37 US states and territories ask questions requiring physicians to disclose mental health conditions.

Nearly 40 percent of physicians reported being reluctant to get care or treatment for a mental health condition because of medical license repercussions, according to a survey published in 2017 in Mayo Clinic Proceedings. In another survey of women physicians, half said they believed they had a mental illness but had not sought care, in part for fear of licensing boards.”

Vox says many of the doctors they spoke to for the story said “they’ve avoided getting mental health care, gone out of state for treatment, or paid out of pocket to avoid billing their health insurer.

Groups like the American Medical Association have called on state licensing boards to require physicians to only disclose mental health conditions that currently impair their judgement or their ability to care for patients.

 

The movement to improve mental health care for doctors is gaining momentum”

Across the country, lawmakers, physicians, and impacted families are working to make it easier for physicians to access mental health care.

In May of this year, the Senate Health, Education, Labor, and Pensions Committee passed the Dr. Lorna Breen Health Care Provider Protection Act, which aims to prevent burnout, suicide, and behavioral health conditions among health care professionals.

The bill would create grants to teach health care professionals about strategies to avoid suicide and burnout, establish an education and awareness program to encourage seeking support and treatment for mental health concerns, and would establish a comprehensive study on provider burnout and the impacts of the pandemic.

The article says better data collection is also needed to fully understand and address the problem.

“’If it’s a problem anyone actually cares about, then there should be publicly available tracking and some effort to stop it,’ one Boston-area doctor, who has lost two colleagues to suicide and spoke on condition of anonymity for fear of workplace retaliation, told Vox. ‘In what other industry would it be acceptable for talented and high-profile people to be jumping off buildings and everyone to stand by scared to comment?’”

Belluz also writes that some states – including Michigan and Virginia – have “introduced ‘safe haven’ laws that protect the mental health medical records of health care professionals and allow them to seek care without fearing any repercussions.

But ‘the biggest systemic fix is simply to remove the mental health questions,’ Gold says, echoing other reformers. This would have to happen not just on state licensing applications but everywhere doctors face them, from hospital credentialing to insurance reimbursement forms.