There is absolutely no shortage of articles on physician burnout. Physician burnout is not only associated with a loss of clinical productivity but also has health consequences. However, burnout is more understood, talked about, and accepted than physicians with mental health disorders (maybe somewhat euphemistically many may argue). Unfortunately, the incidence of physician depression is staggering— nearly twice the incidence of the general population. More concerning is the incidence of physician suicide since physicians are more likely to complete the suicide process, from thought to action completion.
This paradigm is not new— physicians from multiple cultures, faiths, and eras have recognized this phenomenon. Through the centuries, another problem hasn’t changed: we have a stoichial and severely erroneous belief that physicians are infallible and therefore not susceptible to disease, especially mental disease. The stigmatization of mental health disease amongst the general population is bad enough; however, physicians have greater difficulty accepting the symptoms of mental health disease. Since many mental health symptoms vary from provider to provider based on several factors, it makes recognition at a group level complex and difficult. Therefore, much of the burden of understanding mental health comes down to the individual provider.
This raises a very thorny question for physicians. While we are very good at advocating for patients, we are poor advocates of ourselves. In fact, many physicians recall the “awesome friendliest colleague and best doctor” type who went onto have mental health issues. It raises the question of whether this is a façade for physicians who want to “cover” themselves by appearing happy when they are really not. This is not an inherent mystery: physicians are more likely to have marital issues, divorces, have children later, and generally struggle with money management. None of the above has been a successful formula for personal happiness.
The fear of stigmatization over admitting to a mental health issue leads many physicians into self-doubt and guilt (the “am I doing enough for my work?” syndrome). Very few physician groups have a plan for dealing with fatigue or burnout, much less depression. As the models have become leaner and leaner to accommodate greater profit margins (medicine is a business) there is less wiggle room for physicians to take the needed time to deal with health issues. Furthermore, the aforementioned utilization of words like “burnout” “resilience” and “wellness” again somewhat lazily appropriates the burden of mental health back onto the physician, who seemingly is poorly equipped to deal with it.
Physicians as a group are inherently unique, many are self-driven from a young age to become doctors and help people. Weekends and evenings are often spent studying or preparing for endless streams of examinations and projects. Holidays are often spent on call or working in the hospital. Many physicians marry other physicians and this creates 2 sets of schedules to be concerned about. Unlike law and other professions, physicians aren’t paid by the hour, but are expected to put numerous unpaid labor hours into patient care in the name of “good medicine” and “taking care of my patients.” This obviously impacts personal and family time, and depression and suicide disproportionately affect male surgeons and anesthesiologists.
Coupling prolonged training times with a small number of specialty trained physicians in these fields, it is not unsurprising that the impact of the job is higher and this may be reflected in higher suicide rates, although a lot of urgent studies are needed in this area.
In summation, we as physicians are at a crossroads in terms of addressing mental health issues in our own population. Given the progression of medicine towards reducing physician empowerment, this behooves us as a profession to carefully study the inputs leading to increased physician mental health disease. If we don’t help ourselves, who will?
Arvind Chandrakantan, MD, MBA, FAAP is a practicing pediatric anesthesiologist in Houston, TX at Texas Children’s Hospital and Baylor College of Medicine. The views expected herein are his personal opinions and do not reflect any entities, professional and public societies, or the viewpoints of his employers.
