Physicians, and tomorrow’s doctors, are struggling with their well-being, a new study finds. Experts call for changes to encourage doctors, residents and students to get the help they need.
While more physicians are struggling with burnout, it appears that a growing number of tomorrow’s doctors are experiencing their own battles with mental health.
The Physicians Foundation’s 2023 Survey of America’s Current and Future Physicians found that six in 10 doctors report feelings of burnout. That’s up from four out of 10 doctors in 2018.
But medical students are also struggling, and in some ways, their well-being is worse than doctors, the survey found.
Three out of four medical students reported inappropriate feelings of anger and anxiety, compared to 53% of physicians. More than half of medical students (55%) said they felt hopeless, while about a third of doctors (34%) and 43% of residents shared such sentiments. Nearly two-thirds of medical students felt debilitating stress.
Almost half (45%) of medical students say they know a colleague or peer who has considered suicide.
Training for a career as a physician has always been difficult, but the latest findings are disturbing, said Gary Price, president of The Physicians Foundation.
“I was surprised that the level of burnout symptoms in medical students is significantly higher than older physicians and even young physicians in residency training,” Price tells Chief Healthcare Executive®.
Having said that, too many doctors are struggling with burnout, Price says.
“Sadly, the overwhelming take home message from the 2023 survey is that burnout levels haven't eased at all among physicians, despite, hopefully the worst of the pandemic being behind us,” Price says. “That points to the fact that the changes that need to be made in our organizations and systems are just as urgent as they were before the pandemic.”
Stefanie Simmons is chief medical officer of the Dr. Lorna Breen Heroes Foundation, which focuses on improving the mental health and well-being of healthcare workers. The organization is named in honor of a young emergency physician, Lorna Breen, who died by suicide early in the COVID-19 pandemic.
In an interview with Chief Healthcare Executive, Simmons points to the challenges today’s medical students have faced.
“These students have been medical students during a global pandemic, and during huge shifts in the way health care is done in this country. And it's dizzying to them,” she says.
Simmons also points to the concerns medical students have about the rapid changes taking place in healthcare.
“They feel like the rug has been pulled out from under their feet, in terms of what to expect,” Simmons says. “And yet they're still being trained in a very traditional fashion, to do medicine in a very specific way. And they're afraid that that profession they're being trained for isn't going to exist by the time they get out of their training.”
(See part of our conversation with Gary Price and Stefanie Simmons in this video. The story continues below.)
Revise the curriculum
Simmons suggests medical schools should revise their programs to include more training in dealing with stress, how to cope with witnessing human suffering, how to debrief, and knowing when to seek help from a professional.
She also cited the importance of making the hospital environment more conducive to the needs of staff. Hospitals should offer better family leave policies for residents and students who are beginning their families, along with good health insurance so they can get the healthcare they need.
“In some ways, we were talking about how to build a better canary, instead of improving the coal mine,” she says. “And that's what we really need to be doing, is building a better coal mine for these students to go and work in as professionals.”
Physicians, residents and medical students expressed one consistent sentiment. Nearly 8 out of 10 all say they perceive a stigma surrounding mental health and seeking mental healthcare among physicians.
Still, Price says it is encouraging to see that medical students recognize the value of getting assistance for their mental health needs.
“Medical students seem more willing to seek mental health care and support their fellow students with emotional and behavioral issues than older physicians,” Price says. “And as our survey report notes, this may reflect a generational change that their generation doesn't feel as much of the stigma about mental healthcare.”
Simmons also says medical students are more willing to seek assistance for their mental health needs, but they are finding that’s not always encouraged.
“They are used to talking about mental health,” Simmons says. “They are used to Tik Tok and Instagram and social media and online discussions about mental health. They are used to going to high schools and colleges with mental health services. And in many medical schools, the conversation is not the same. It is highly stigmatized. They are becoming aware that they will be asked in their licensing questions and their credentialing questions in their job interviews and their applications, about their history of mental healthcare, diagnosis and treatment.”
“And so it's a bit of a whiplash for them from being in an environment where mental health diagnosis and treatment and preventative mental health care is being encouraged, to a healthcare system that stigmatizes mental health are, and asks invasive and intrusive questions about a history of mental healthcare,” Simmons adds.
Stop asking questions
Four in 10 doctors said they were afraid to get help, or knew someone reluctant to seek assistance, because they were worried about it being asked in licensure and credentialing questions.
The Lorna Breen Foundation has been working to persuade states to change questions about mental health on applications for state medical licenses. The foundation announced Wednesday that 25 state medical boards have now revised their licensure questions, up from 17 a year ago. The foundation is also pressing hospitals to drop such questions.
The Physicians’ Foundation is also pushing to eliminate those questions. Price said it’s time to ”get questions off of medical licensing applications that imply that your license is in danger if you admit to receiving mental health care.” He also said those questions need to be eliminated from hospital credentialing and liability insurance questionnaires.
Price also says it’s important to allow physicians to seek help for behavioral health issues outside of their own health systems and hospitals, so they can maintain their privacy.
“If a physician employee wants to seek care for a behavioral health issue, they have to receive it within the same system they work in every day,” Price says. “And that's an incredible barrier because of the loss of anonymity.
“Our goal is to make sure that people seek care early, because before these problems become large problems,” Price said.
988 Suicide & Crisis Lifeline: Dial or text 988 to connect with someone. Help is available 24/7.
The American Foundation for Suicide Prevention offers resources for healthcare professionals.
NAMI: The National Alliance for Mental Illness offers “frontline wellness” resources for healthcare workers and public safety employees.