Most physicians don’t access mental health care, new report shows

In the span of Dr. Jesse Ehrenfeld’s career as an anesthesiologist, he’s lost three colleagues to suicide, and he’s only in his 40s.

Those losses weigh heavily on Ehrenfeld, who also serves as the executive director of the Advancing a Healthier Wisconsin Endowment at the Medical College of Wisconsin.

“For me, it’s been very personal to have lived through those losses and to think about how the system has failed these physicians ― my colleagues ― because the problem is not the person. The problem is the system we drop these people into,” Ehrenfeld said.

That system is at the center of a new report published by JAMA Network Open Aug. 14. The report, co-authored by Ehrenfeld, underscores the severe mental health treatment gaps of physicians, the culture of fear and stigma that deters help-seeking, and the profound consequences for physicians.

After years of conversations on the topic with friend and colleague Dr. Daniel Saddawi-Konefka of Harvard Medical School, the two physicians teamed up with Dr. Christine Yu Moutier, chief medical officer at the American Foundation for Suicide Prevention, to better understand the unique mental health challenges physicians encounter.

One-third of physicians struggle with depression, nearly a quarter with anxiety, and 10% have post-traumatic stress disorder, rates far higher than the general population.

In particular, female physicians have a 53% higher rate of dying by suicide compared with women in the general population. Certain specialty-specific physicians, such as anesthesiologists, general practitioners, psychiatrists and general surgeons, may also have elevated rates of suicide, according to the report.

Additionally, the report highlighted physicians’ increasing vulnerability to substance use disorder and problematic alcohol use. In the last 15 years, harmful or risky drinking has skyrocketed, affecting 27% of physicians.

Simply put, most physicians with mental health conditions don’t seek help. Much of that, according to the report, stems from a medical culture that expects doctors to work around the clock, respond to human suffering with stoicism, perfect their duties, and normalize burnout and inadequate self-care.

As medical students, it’s seen as a strength to stay up all night, work 100 hours a week, say yes to everything asked of you, and perform your duties with an almost superhuman level of perfection, Ehrenfeld said.

Those tendencies, often attached to perfectionist personality traits, “operate very strongly in the background” of medical culture, said Dr. Mariah Quinn, chief wellness officer at UW Health in Madison.

“As physicians train, they’re very acculturated by those who’ve come before them,” said Quinn, who was not involved in the new study. “There’s a lot of expectations about what it means to be clinically excellent.”

That only grows as medical students progress in their careers from training to practice. According to the study, stigma as a barrier to care emerged in 30% of early-year medical students, 53% of final-year students and 58% of resident physicians.

And then, baked into the profession is another powerful deterrent from seeking care: an archaic, and persistent, notion that a medical professional with mental health conditions equates to professional incompetence. Studies from the report show a punishing cycle: When medical students disclosed a history of psychotherapy in applications for residency programs, medical licensing and credentialing, they were less likely to be interviewed and accepted.

For example, the report referenced a 2007 survey that revealed about one-third of state medical licensing board directors would sanction a physician based on a mental health diagnosis alone.

In other words, it’s not a problem limited to any one facility or organization, Ehrenfeld said, but a systemic one.

The problem of always being on and willing to do better

In his second year of medical school, Ehrenfeld recalled being at an operating table with particularly sharp corners and stooping down to pick something up. As he stood, he rammed the corner of his eye into the table corner hard enough to lose consciousness.

Though he was sent home, a supervising doctor called him the next day telling him he needed to return for a shift to make up for leaving the night before, he said.

“I told him no, that it was a completely inappropriate, unreasonable, unrealistic request. I stood up for myself but it’s just expected that I would come back,” Ehrenfeld said.

That sense of stoicism was almost Dr. Michael Stadler’s undoing.

Ten years ago, Stadler was on the verge of leaving the medical field. An ear, mouth and throat surgeon at the Medical College of Wisconsin at the time, he’d adopted a hardened mindset over the years that didn’t diminish the sense of pain and dread he felt inside each time a cancer patient encountered an unanticipated complication.

And it didn’t diminish the heavy feeling of guilt he endured whenever a patient would look him in the eye and ask, Why did you do this to me?

Could I have done better? he would ask himself just as often.

One evening at the dinner table with his wife, also a surgeon, she asked him how he was doing. He soon found himself crumpled in her arms crying hysterically. He had so many sick patients, desperate to be cured of their cancers. In a culture where nobody speaks about their grievances, who could he turn to for help?

“We don’t generally or historically talk about these things. We are not candid and transparent with our peers. We don’t say, ‘I too vomited before every surgery for the first two months of my career.’ We don’t talk about those things,” Stadler said. “I felt isolated and alone.”

Wisconsin is one of the only states without confidential resources for health care professionals

Every state but three has a professional health program that serves as a confidential resource for health professionals to access mental health and substance use treatment, along with other health issues that may affect their practice.

Wisconsin is not one of them.

Ehrenfeld and Stadler are pushing to change that. Stadler is championing a landmark initiative with the Advancing a Healthier Wisconsin Endowment, the philanthropic health arm of Medical College of Wisconsin, called the Health Workforce Wellbeing initiative.

Those efforts will be implemented by the Wisconsin Hospital Association in partnership with the Dr. Lorna Breen Heroes Foundation ― in memory of the New York emergency room doctor who died by suicide in the early days of COVID-19.

The first phase of the grant will work to reform intrusive licensing and credentialing questions that probe into a medical professional’s mental health conditions and their history of psychotherapy. Those challenges aren’t limited to physician licensure, Ehrenfeld said, but affect all health professions.

And it’s not just a challenge for the state Medical Examining Board. When medical professions seek credentialing at different facilities, there isn’t consistency in the types of questions on the form, Ehrenfeld said. Getting hospital privileges at Wisconsin’s various health institutions sometimes requires mental health disclosure, although some organizations, like UW Health, have adjusted their questions to remove these disclosures.

The next phase will work in the space of education, helping medical professionals better understand burnout — both what drives it and how to distinguish it from underlying mental health issues.

Burnout can be an especially murky thing in the health care workforce, said Quinn from UW Health. It’s often underestimated and discounted as a normal expectation of the job.

“One of the reasons it feels so murky is people feel like they don’t know what to do with burnout because of how normalized it is,” Quinn said.

The final phase will create a health care coalition that breaks professionals out of their silos, Stadler said.

During COVID-19, Stadler witnessed a systemwide trend to meet health care professionals where they were at, whether that meant giving medical professionals a free meal after their shift, setting up a respite room in the hospital for breaks, or setting up group grief sessions where colleagues could communicate freely.

As society moved on from COVID, Stadler noticed these types of interventions also wound down. But many health professionals continue to crave such robust and deliberate care.

“We shouldn’t need a pandemic to step up and take care of each other,” Stadler said. “We went back to the grind of what we knew health care to be: without those important support structures around our people.”

Natalie Eilbert covers mental health issues for the Milwaukee Journal Sentinel. She welcomes story tips and feedback. You can reach her at neilbert@gannett.com or view her X (Twitter) profile at @natalie_eilbert.