Why in the world do we constantly talk about physician well-being?
It’s a topic that has been discussed with increasing frequency in recent years, but since the COVID-19 pandemic began, the focus on needing to preserve our emotional and mental health has been amplified. Much of it is because of the increased stress we all feel from COVID, from needing to care for our patients and focus on them at the risk of our own safety and that of our families. But it has also highlighted many of the failings of a tragically broken health care system.
So, what do we do? I wish I had a grand answer for you, but the honest answer is, “What we can.”
We’re all familiar with the trends and many of the stats. Physicians have higher suicide rates, higher rates of mental illness, burnout at crazy high levels, blah, blah, yadda, yadda, we get it already. So why do we keep talking about it? Because the truth is that we are not getting it.
Those rates continue to increase, and we all know what bad patients doctors are. We don’t take care of ourselves, we are typically not willing to take our own advice, and the need to reform the system seems so daunting and exhausting that we simply can’t muster the energy needed to do it.
We also have a lot of fear. Many states ask questions in their medical licensing applications about whether we’ve received treatment for mental illness, and we don’t want to lose our license if we answer truthfully. (Ironic, isn’t it? We don’t want to lose our license to practice medicine in a system that created the difficulties that beset us in the first place.) Is the fear warranted? Yes … and no.
There certainly are examples of people who have lost their license for receiving treatment for mental illness. But this concern is overblown. State licensing boards have, as a rule, changed their stance to emphasize support, not punishment. States continue to alter the language of their licensing applications to avoid asking about specific disorders and therapies, instead asking simply if a physician has any untreated disorder that could impact their practice of medicine. The proportion of those who have received treatment for mental illness and answered their licensing questions truthfully without being penalized for that far outweighs the proportion of those who have had difficulty with a medical board for those answers. We just never hear about them.
However ― and I think this is the real kicker ― we are more likely to make errors that get us in trouble with a licensing board for not treating an existing behavioral health condition than for doing so. Yes, not taking care of ourselves actually does put our patients at greater risk of harm.
Another irony of the situation is that we are having a huge discussion in medicine about how we “don’t talk about our struggles.” Many of us are really tired of hearing that line, especially when the conversation turns to “resilience,” which amounts to a tacit indictment of any struggling physician as residing in a cage exclusively of their own making. So many of us feel blamed that we “can’t handle” the demands of such a cruel god as medicine.
So, it’s time to go beyond talk, and workshops, and conferences, and retreats, etc., etc., and confront the issue head on. That means asking tough questions. What’s the hardest thing about practicing medicine for you? What hurts the most? What contributes most to burnout, or mental illness, or just an overall dissatisfaction with your job? Once you’ve figured out what that is, my simple advice to you is to change it.
I don’t mean taking on powerful lobbyists from large corporations and special interests that are against changing the status quo; I mean change some of the simple things. Talk with your colleagues about what you want changed and figure out on what level such a change could be made. Is it clinic-specific? Is it an issue with the hospital or clinic system for which you work? Is it a state regulation or law? A payer? Approach those in charge and talk with them. Although we tend to view health care administrators in a negative light, with intentions that are far different from our own, most of them do want to help where they can. Work with them to change the simple things. Changing everything at once is impossible, and some of the biggest problems are so broad and complex that we can’t make any meaningful changes on our own. We can’t change everything that wears us down in our profession, but we can change some small things that will have meaningful impact. It not only helps us, but also will help others.
There’s no way around it — practicing medicine is hard. Even without relative value units, or restrictive insurance companies, or documentation requirements, etc., it’s still hard. We’re always facing the possibility of death or loss of quality of life in our patients. Oftentimes we are facing these difficulties without being able to help much or to actually “fix” anything, even if a patient’s pharmaceutical formulary does cover their needed medication. But don’t beat yourself or others up for the Leviathan that is American health care ― that is barbaric to physicians and patients alike. Do what you can. I promise that you will achieve some beneficial outcomes that can be built on to improve the system as a whole.
And then we can stop talking about physician well-being.
Kyle Jones, M.D., is an associate professor in the Department of Family and Preventive Medicine at the University of Utah School of Medicine. He also is director of primary care and medical director for utilization management at the Neurobehavior HOME Program, a patient-centered medical home for those with developmental disabilities. You can follow him on Twitter @kbjones11.