and yet, they are less likely to seek mental health treatment than the general population.

Why is there such a stigma surrounding mental health among physicians?

And what can we do to change it?

Let’s talk about it.

Dr. Jubbal, MedSchoolInsiders.com

We are facing a mental health crisis among doctors.

According to research, more than one in five physicians report feeling depressed.

Even more concerning, male physicians are nearly one and a half times more likely to

commit suicide than the general male population and female physicians are nearly two and a

half times more likely than the general female population.

It’s not just attending physicians who are struggling either.

It is estimated that nearly half of all medical students suffer from anxiety and nearly a

third from depression.

Moreover, according to the American Foundation for Suicide Prevention, 28% of residents experience

a major depressive episode during training compared to only 7-8% of similar-aged individuals

in the U.S. population.

As alarming as these statistics are, what is perhaps even more concerning is that the

true prevalence of mental health issues among medical students, residents, and attending

physicians is likely much higher as underreporting has historically been a huge barrier to addressing

the mental health needs of doctors.

There are many reasons why a physician may not feel comfortable coming forward about

their mental health issues, but let’s start with the culture of medicine.

The stigma surrounding physician mental health starts early in medical training.

Despite having similar rates of depression to their nonmedical peers when they enter

medical school, research has shown that, on average, medical students’ mental health

worsens over the course of their careers.

Why is that?

To start, getting into medical school and becoming a doctor is highly competitive.

Everyone is trying to achieve the highest grades, the best test scores, and the most

research to match into their desired specialty.

This immense pressure to perform can often lead to feelings of inadequacy and impostor

syndrome which can quickly turn into anxiety, depression, and more serious mental health

issues.

Next, there’s the workload.

Becoming a doctor requires countless hours of studying and hard work.

Aspiring physicians must endure sleep deprivation, long nights, weekends, and work after hours

and on days off – and the workload doesn’t necessarily decrease when you become an attending

physician either.

The average attending physician works around 52 hours per week; however, there are many

specialties where working 60, 70, or even 80 hours per week is not uncommon.

When medicine is the primary focus of your life and you’re working these types of schedules,

it’s common for self-care and hobbies to take a back seat to your career.

Despite the prevalence of mental health issues among doctors, few seek medical treatment

due to the potential consequences of disclosing mental illness.

One study from the University of Michigan found that medical students with moderate

to severe depression frequently agreed that “if I were depressed, fellow medical students

would respect my opinions less” and that “faculty members would view me as being

unable to handle my responsibilities.”

Mental illness is often perceived as a sign of weakness and, as a result, many students

keep their feelings to themselves and suffer in silence.

By the time a medical student completes medical school, goes through residency, and becomes

an attending physician, these beliefs are deeply ingrained.

Instead of not wanting to appear weak to their peers and instructors, now it’s their colleagues

and administrators.

When you’re the one that’s supposed to be taking care of others, it can be difficult

to admit that you’re struggling yourself.

The next reason physicians don’t seek help for mental illness is the fear that it will

impact their ability to gain licensure.

According to a 2016 study published in the Mayo Clinic Proceedings, approximately 40%

of physicians reported that they would avoid getting mental health care for this exact

reason.

Although it is actually against the law - specifically the Americans with Disability Act - to restrict

a physician’s right to practice on the basis of mental illness, there is still a gray area

that exists that can discourage physicians from seeking help.

To start, many state licensing boards ask questions regarding a doctor's history of

mental illness, addiction, or substance abuse on applications for medical licensure and

renewal.

Those that disclose this information may be asked to provide medical records outlining

their treatment and be granted only “conditional licensure.”

The intended purpose of these questions is to help protect patients by ensuring doctors

are “fit” to practice; however, an unintended consequence is that they can also discourage

physicians from seeking help.

The irony is that by deterring doctors from seeking mental health treatment, these questions

ultimately put patients at even greater risk as physicians who are struggling with mental

illness are more likely to make medical errors that they ordinarily wouldn’t make.

Lack of energy, trouble concentrating, difficulty making decisions, anger, and irritability

are all symptoms of depression that can negatively impact a physician’s ability to practice.

According to Medscape’s 2022 Physician Burnout & Depression Report, 23% of depressed doctors

reported feeling less motivated to be careful when taking patient notes, 14% reported expressing

their frustration in front of patients, and 11% reported making errors that they might

not ordinarily make.

Although you may hear this and think it is justification for including these mental health

screening questions, the reality is that they are causing more doctors to suffer in silence

and allow their mental health to reach the point where it is affecting their work.

With mental health, like most things in medicine, an ounce of prevention is worth a pound of

cure.

It is much better to address mental health issues at the first signs of trouble instead

of letting them progress to much more severe issues.

Doctors need to be able to get help before it impacts their ability to do their job.

To address this issue, the Federation of State Medical Boards came out with new recommendations

in 2018 that urge state medical boards to omit these questions and instead rephrase

them to focus only on current impairment - which is more meaningful in the context of a physician’s

ability to provide safe care to patients in the immediate future.

Many state licensing boards have since omitted some of these questions from their licensing

applications; however, few have adopted them fully.

As such, some medical license applications continue to deter physicians from seeking

mental health treatment.

Even if we can get more states to adopt these recommendations, many hospital privileging

applications continue to ask questions regarding mental health history as well, so there is

a great deal of work that must be done before physicians can feel safe seeking mental health

care.

If we are to make significant progress toward improving the mental health of our physicians,

we must start by normalizing mental illness.

According to the CDC, approximately one in five Americans will experience a mental illness

in a given year and more than 50% of Americans will be diagnosed with a mental illness or

disorder at some point in their lifetime.

This means that there is a good chance that you, me, and everyone else watching this video

will experience struggles with mental illness at some point during our lifetime – and

yet, we often treat mental illness like it only affects a small percentage of us.

Furthermore, we don’t often have stigmas for other organ systems, so why is there such

a strong stigma associated with mental health?

If you break your leg, nobody judges you for going to the hospital and getting it taken

care of.

But if you’re struggling with your mental health it’s viewed as a reflection of your

character and you’re seen as weak.

Does it make sense?

I don’t think so.

Part of the reason is that brain function and mental health are not nearly as well understood

as many organ systems, and this opacity results in us attributing certain issues to character

flaws rather than biochemical or pathophysiologic origins.

This stigma doesn’t just harm doctors either — it harms patients too.

Despite being victims of mental health discrimination themselves, these deeply ingrained views towards

mental health can negatively affect the care that doctors deliver to patients with mental

illness.

When it’s ingrained in you that mental health is synonymous with weakness, it doesn’t

just affect how you perceive yourself but also how you perceive others.

These implicit biases towards patients with mental health issues have been shown to negatively

impact the care that these patients receive.

Studies have demonstrated that people living with mental illness commonly report feeling

that their symptoms are not taken seriously when seeking care for non-mental health concerns.

They have also demonstrated that people treated for mental health often receive poorer care

for physical health problems - likely due to physical symptoms being misattributed to

a patient’s mental illness.

This, in turn, creates delays in diagnosis and treatment which ultimately negatively

impacts care.

As you can see, the mental health stigma among physicians is an issue that impacts all of

us.

This is not an issue that will be fixed overnight but one that we will have to consistently

work at.

We need to take a good hard look at the issue of mental health among physicians and start

making strides to break down these barriers to seeking treatment.

Only then will we be able to make meaningful progress towards happier and healthier physicians.

Thank you all so much for watching.

If you enjoyed this video, be sure to check out my videos on How to Manage Stress as a

Student or Why Are Doctors Miserable?

| The Burnout Epidemic.

Much love and I’ll see you guys there.