5 ways to improve physician mental health

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Rebekah Bernard, MD, a family physician at Gulf Coast Direct Primary Care in Fort Myers, Florida. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.

The practice of medicine in our current healthcare system is making physicians sick, with levels of burnout and mental strain increasing across every specialty. 

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Burnout has become so bad that physicians are increasingly leaving the workforce, with the 2016 Physicians Foundation Report reporting that 49% of doctors were actively making plans to decrease patient care either by entering early retirement, changing to a nonclinical role or switching to a lower volume concierge-type practice.”[1] Even more sadly, about 400 physicians per year stop seeing patients for the most tragic of cause: because they take their own lives.

The good news is that there are steps that physicians can take to improve our well-being. One of the best ways to start the process of healing is through work with a psychologist.

Dr. Bernard

According to Steve Cohen, PsyD, it’s best to use psychology “as a preventive or prophylactic measure.  By the time you feel overwhelmed and on edge, you are probably entering crisis or burnout mode.  Working with a psychologist before you feel lost or overwhelmed can help you to avoid conflict and even medical errors due to exhaustion and frustration.”

And while psychology can help us to cope with our own emotional stressors, there are other less obvious benefits that doctors can gain which will help to improve our day-to-day lives.

1.      Improve relationships. I love to say: “The people who really need a psychologist usually won’t go. That’s why the rest of us have to.” I really believe this to be true. There are so many people that we encounter every day who are desperately in need of professional help, but they simply lack the insight or the inclination necessary to take that step. These people are often incredibly challenging to work or live with. A psychologist can teach us ways to interact more effectively with difficult people in our lives, or how to best communicate based on different personality types. Psychology can also help us decide when it’s time to end emotionally harmful and toxic relationships.

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2.     Get better results for your patients. We often have a multitude of issues to address in a short amount of time in our office. Psychology can teach effective ways to help patients prioritize their problems, help us to communicate our message more clearly and allow us to understand the barriers to compliance. Psychology can also help us to learn to acknowledge and process the negative emotions that occur every day in our job-such as frustration and anger that certain patient types can elicit in us (“transference”), or sadness and hurt that comes from being the bearer of bad news.  

Next: Avoiding the stigma of seeking care

3.     Defuse tense situations. There are some amazingly simple techniques that psychology can teach us to defuse even the most stressful situations. For example, when faced with an angry person, simply repeating back their own words and showing empathy (“You are angry because you have been waiting an hour. I can see how that would be very upsetting.”) can often completely alleviate a bad situation. Another example is learning how to respond to comments that are personally hurtful, such as inappropriate sexual remarks. The very straightforward technique of just repeating back the offensive statement in a calm and controlled manner, and then verbalizing that the remark is not appropriate (“You say that I look sexy today? That is a sexist thing to say, and not appropriate to say to your doctor/employee.”) works incredibly well to take back control of a negative situation.

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4.     Maximize work efficiency and find work-life balance. Uncompleted charts stacking up?  Psychology can help you learn to stop procrastinating and get your notes done by avoiding perfectionism and insecurity that makes us over-document. Running late all the time at the office? Psychology can teach us how to schedule realistically, and how to smoothly transition long-winded patients. The list goes on and on.

5.     Take control of your life. Sometimes doctors feel completely trapped-perhaps by medical school debt, a non-compete contract or a large mortgage. But the reality is that even when the choices don’t look great, we still do have choices. We can continue to work in our current system, using psychology to learn strategies to work around the challenges. Or we can decide to make a complete change by getting a different job, working locum tenens or even stepping outside of the system completely by opting out of Medicare and third-party payers. 

Avoiding the stigma of seeking psychological care

First, we should all be aware that the Mental Health Parity Act, updated under George W. Bush in 2009, requires that health insurance companies cover psychologic care to the same degree as they cover physical care.[2] Finding a psychologist that accepts your health insurance plan may be another story, but theoretically, group health insurance should cover psychological counseling.

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With that being said, we do need to be conscious of our state licensing board requirements. While some medical boards ask only about current impairment from mental health issues, other states ask more vague questions about past issues, or ask if you have ever sought help for mental health. 

Next: Psychology can help

With a 2009 study arguing that questions on mental health actually violate the Americans with Disability Act,[3] as well as the surge in physician burnout and suicide, groups like the American Medical Association are urging state boards to focus mental health questions to only current impairment.[4]

If you are in a state with more aggressive questions about mental health, you may be reluctant to see a psychologist using your insurance, and perhaps it makes sense to seek care in an anonymous fashion. Some doctors report doing this by seeking help in another town from where they live, using a pseudonym or paying cash to avoid a paper trail. 

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Fortunately, there may be another option. Some county medical societies are now offering physician wellness programs that pair doctors with local psychologists to provide strictly confidential care. The Lane County Medical Society in Oregon was the first county medical society to create a physician wellness program in 2012. Its  goal is to help physicians “find the balance between the demands of their work and personal lives,”[5] and many other counties are following their lead, usually paying for a certain number of visits as a member benefit. 

The common denominator of these programs is that they ensure complete confidentiality so that physicians don’t feel anxious about any type of stigma or adverse consequence to seeking help for mental stress.

Check to see if your local medical society offers a physician wellness program, and if not, consider asking them to start one. Regardless of how you choose to get help, please remember that if you made it through college, through medical school, through residency-you are intelligent, you are hardworking, and you ARE resilient! But you are not perfect, and the stress that we face as physicians does take a toll on our psyche. Psychology can help.

[1] http://www.physiciansfoundation.org/uploads/default/Biennial_Physician_Survey_2016.pdf

[2] https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/mhpaea_factsheet.html

[3] https://www.ncbi.nlm.nih.gov/pubmed/19474558

[4] http://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2016.12b6

[5] http://lcmedsociety.com/index.php/providerwellness/