COVID-19 one year later: The pandemic’s impact on physician mental health

Michael Myers, M.D., has made physician mental health his life’s work. Myers is a doctor’s doctor and provides mental health services and treatment for physicians. He is a professor of clinical psychiatry at SUNY Downstate Health Sciences University in Brooklyn, New York, and recently published a book titled Becoming a Doctors’ Doctor: A Memoir. He sat down with Medical Economics® to talk about the immediate and long-lasting impact of the COVID-19 pandemic on the emotional health of physicians who are living through it. The following transcript was edited for length and clarity.

Medical Economics® (ME): How did you become a doctor’s doctor?

Myers: One of the pivotal factors was that I lost one of my roommates, a fellow medical student, to suicide. And that was a long time ago, that was in 1962. We often talk about stigma associated with mental illness in students and in physicians. It was unbelievably severe, in terms of its stigma, (and) that’s a little bit better now. But fast-forward, I had no idea at the time that I might end up in psychiatry, or as a specialist in physician health, then it came back to me later as I was becoming more experienced to looking after physicians and their family members during my training. And so what I did when I finished my training, which was in 1973 … for the next 35 years was half-time private practice and half-time academic work. And after years of a general psychiatric practice, I was looking after so many physicians and their family members that they decided to restrict my practice. So … all I saw were physicians and their family members, right up until the end, and that was a total of 35 years

ME: Before we talk about the coronavirus 2019 (COVID-19) crisis, I wonder if you could paint a picture of what the state of mental health among physicians is in general?

Myers: What we read and see in the medical media, of course, is the high index of burnout in today’s physicians, and we’ve been seeing that now for I’d say almost 20 years —ballpark figure 50% of practicing physicians suffer from one or more symptoms of burnout. And it varies from one specialty to another. So that’s the short answer.

The longer answer is a little more complicated. I think we’re not hearing from a huge cohort of physicians who actually love what they do. They’re happy being physicians but many of them will say they are under more stress than other hardworking people. We don’t have a monopoly on this, of course, but that’s the way we talk. I also know that because I interview so many applicants to our medical school. If the applications to medical school are sky-high, in fact, they’ve gone up even since COVID-19. There’s this other group of doctors who will become my patients over the years. Doctors are human, too. So we can suffer from anxiety disorders, depression, trouble with alcohol or other drugs, PTSD, things like that, that people in our general society suffer.

ME: Let’s talk a little bit more about the pandemic. What is it like for physicians living through this crisis day to day?

Myers: It’s been really tough. … What we did in our department of psychiatry, because we’re not on the immediate front lines, is we offered weekly support groups, for the hospitalist, for the emergency medicine doctors, for the critical care specialists. And then we also offered weekly groups for another group of physicians who were a little bit removed from the front lines. And then we also had groups, of course, for medical students and for residents.

What we were seeing and witnessing in those early days and weeks was shock. Anxiety about contagion, about bringing contagion to one’s own family. Some of our doctors didn’t go home; they would stay at the hospital or in rentals. The isolation was so difficult. As you know, patient families were not allowed to be in the hospital and patients were dying so rapidly. And it was really, really awful for our doctors on the front lines.

I remember so vividly in our groups how so many of them felt useless or that they really weren’t doing anything. I think what that came from was almost like an algorithmic approach to medicine, the things that we’re used to doing. They didn’t have the toolkit. But what my colleagues and I reminded them of is that they were basically doing so much for their dying patients by just being present, by communicating with their families through FaceTime, holding the phone up to (the patient’s) ears. Basically, the humanistic touch of that kind of work.

Because of the unprecedented nature and scale of this event, even physicians such as emergency department physicians were just sort of melting toward the end of the day or toward the end of the week because of the unrelenting pace. That sense that, “I’ve done everything I can and it still didn’t work.”

(Many physicians) have probably heard of the term “moral injury.” That’s the very important work of two individuals, Dr. Wendy Dean and Dr. Simon Talbot. That concept really fits what so many of the physicians were experiencing, especially in situations where perhaps there wasn’t enough PPE (personal protective equipment) or where they were having to reuse their dressing gowns or their masks, things like that. They’re having to make a decision as to who gets a respirator. And then, of course, the separation from their loved ones. This is really about a health care system that needs revamping. It needs to make major changes so that physicians and other health professionals aren’t put into those kinds of conflicts.

ME: During this pandemic we’ve seen our health care providers begging and pleading with the community to wear masks. We’ve seen nurses and doctors in tears on television. And so we’re also seeing a totally different side of our physicians and providers. Is this affecting health care providers, to actually see themselves in this light? Is it affecting their sense of efficacy?

Myers: I think it’s a good thing, quite frankly, that this has gotten play in some respects. It’s our humaneness, of course, in the face of tragedy, in the face of a pandemic. And yet, in my mind, it doesn’t take away at all from the training, the expertise, integrity and skill of our highly trained front-line health professionals. This is just another piece of them. It’s the human part that is expected at one level to absorb what they are facing.

Now, this has to be watched, though, because individuals still have to have proper rest, they still have to have proper food. They have to make sure that they’re getting breaks. They can’t always be workhorses. In fact, many physicians even before the pandemic felt that they have been sort of used and abused, that they’re just a cog in a wheel. And that’s been some of the contributing factors to that huge cohort of physicians who have felt burned out, and what Dr. Dean and Dr. Talbot would say is an example of moral injury.

Some people recoil at the term “burnout” because they feel that it blames the health professional even though it’s occupationally induced, and they feel sometimes is equated with a lack of resilience. And it’s not that at all; it’s their inability to really practice the craft in the way that they were trained.

In fact, I remember in the first couple of weeks of the pandemic, some physicians would say that the work they were doing in the ICU had actually made them feel better. They said: “I was feeling kind of burned out before the pandemic hit. But now I feel I’m doing the work that I’m trained to do. Yes, I wish I was saving more lives. But I feel I am providing value.”

ME: What should physicians be out looking for, for themselves and their colleagues, as the pandemic winds down?

Myers: I have been preaching and writing for years … across all health professionals, that we must be our brothers’ and sisters’ keepers. Now, I know that firsthand, because being a psychiatrist, I know how elusive some illnesses can be. In other words, somebody can be slipping into a problem with alcohol or drug use. Or they can slip into a depression and not realize it, that it’s actually beginning to affect their well-being, the work that they do, and things like that. So that’s why the next step is for all of us to pay attention to our own self, our own symptoms and signs, and we need to listen to those loved ones of ours who are concerned about us and reach out to us, our parents, our spouses, our kids. And then of course, each other.

It’s can be very simple. “Are you OK?” And if you get a dismissive response, and I think it’s best to follow up with “Are you really OK?” and then to create a safe place where an individual can open up a little bit. I learned a long time ago, too, that when people are feeling quite ill, it’s very hard to make those phone calls, to call somebody and ask for help. So I often recommend that you make that phone call.