A Physicians Foundation survey indicates that 2 years into the COVID-19 pandemic, physicians are struggling with feelings of anxiety, anger, and burnout.
The pandemic highlighted the need for adequate mental health support for physicians, and while progress has been made, there’s more work to be done.
Meaningful change will require policymakers and institutions to improve physician workflows and connect doctors with support resources. Further licensing reform is also needed.
Times are tough for US physicians. Emerging research is elucidating just how challenging the medical profession has become in the years since the onset of the COVID-19 pandemic.
The Physicians Foundation has released part two of its three-part survey on the state of physician well-being. The survey, as well as one of the leading physicians behind it, offer insights as to how the medical profession and institutions can better support doctors.
Inside the survey
The Physicians Foundation queried doctors between June 24 and July 3, 2022, receiving 1,509 responses.
The data showed a physician workforce that’s struggling with its well-being more than 2 years into the COVID-19 pandemic.
Six out of 10 surveyed physicians who were surveyed said they experienced inappropriate levels of anxiety, anger, or tearfulness. One-third of respondents said they felt hopeless or experienced purposelessness during the survey period. Half indicated they had withdrawn from family, friends, or coworkers.
These negative emotions and experiences may be contributing to burnout rates. For 2 consecutive years, six in 10 physicians said they “often have feelings of burnout,” according to the survey, representing a 20% increase from four in 10 in 2018.
Change of focus needed
Gary Price, MD, a plastic surgeon and president of the Physicians Foundation, told MDLinx that it’s essential to reframe the issue of physician burnout.
"Prior to the pandemic, there was a lot of attention being paid to making physicians more resilient."
— Gary Price, MD
“The appropriate response to canaries dying in the coal mine really isn't to send out for tougher canaries,” he added.
Instead, Dr. Price said policymakers and healthcare institutions should focus on making the system more resilient and better able to respond to the needs of doctors and other healthcare workers.
Meeting physician needs
The survey data indicated that those needs are not being met. A third of physicians do not believe that suicide prevention resources even exist—let alone are easy to access. Perceptions of support are slipping further.
In 2021, 71% of surveyed physicians said their colleagues were helpful to their mental well-being, according to the Physicians Foundation report. That sank to 62% in 2022. As for whether their medical practice or group was helpful, 40% said it was, but this was down from 53% the year prior. Only 22% said their hospital or healthcare system was helpful (down from 35% in 2021).
The Physicians Foundation asked doctors to evaluate 12 evidence-based, well-being actions their employers could take. These suggested actions included:
Removing low-value work
Including reducing EHR clicks and minimizing inbox notifications (which 89% of respondents rated as very or somewhat helpful)
Giving physicians more autonomy toward quality and the patient experience
Eliminating prior authorizations
Half or more of the doctors surveyed said their employers rarely or never do anything about eight of the 12 total evidence-based, well-being actions listed. For example, 63% said that their employers rarely or never did anything to reduce those EHR clicks or inbox notifications.
"What you’re seeing is a very dramatic stress added on top of a workplace environment for physicians that already was toxic before the pandemic occurred."
— Gary Price, MD
"What the pandemic did was add to all the stresses that are the classic predictors of burnout—the sense of a loss of autonomy on the physician’s part, as when they have spent time seeking pre-approval for a test that they, the physician, had already determined to be necessary,” Dr. Price said.
Every battle for pre-approvals, every extra click, and every hour of documentation done at home has brought the American physician to this point, he added. Adding insult to injury, this extra work isn't contributing to patient care. But this isn’t where the obstacles end.
Among the physicians surveyed, 80% said that stigma around physician mental health—and seeking mental health support—is persistent. Four in 10 said they were afraid (or knew a doctor who was afraid) of seeking mental health support due to the potential licensing, credentialing, and insurance implications. Only a third felt that their workplace places a priority on physician well-being.
Some of this is cultural, Dr. Price said. Physicians may believe that admitting the need for mental healthcare will be perceived as a weakness. “That’s part of our culture that needs to change,” he added.
Medical licensing, credentialing, and insurance applications need to change too, he said. These applications, as well as hospital medical staff applications, often repeat overly intrusive questions about physician mental health, prompting the fear that a doctor could lose their livelihood for seeking support.
"We see this time and again in reports on physician suicide. So that's something that's got to change."
— Gary Price, MD
Advocating for change
This is one of the areas in which the Physicians Foundation is pushing for reform. Dr. Price said there are 17 states in the US that have adopted recommendations to remove intrusive mental-health questions from licensure applications. The organization is part of a group advocating for their removal in all 50 states.
From a regulatory standpoint, Dr. Price said policymakers need to eliminate what he called “checkbox” work.
“Regulators need to be more cognizant when they write regulations that they’re not adding that kind of work to a physician’s day without any clear benefits to the patient’s care,” he said.
This also applies to healthcare systems, Dr. Price added.
"We need to pay attention to how physicians do their work each day, and what's happening in the process of that work that's causing them frustration."
— Gary Price, MD
Until reform takes root, Dr. Price suggested that struggling doctors use the 988 Suicide & Crisis Lifeline. They can also review the Physicians Foundation Vital Signs campaign, which may help doctors spot symptoms of burnout in themselves or colleagues and get support.
Ultimately, Dr. Price said the change required to end stigma and properly support physicians will be systemic.
"We’re not going get at it with yoga or sensitivity training."
— Gary Price, MD
What this means for you
The Physicians Foundation survey results suggest that the COVID-19 pandemic applied additional stress to an already overburdened physician workforce. Meaningful burnout reduction and improvement of physician well-being will require system-wide changes, such as those that improve physician workflows, provide effective resources, and eliminate intrusive questions about mental health on licensing applications.