Trigger warning – this page contains references to themes of depression, suicide, and addiction.
As the physician shortage worsens, healthcare leaders face increasing challenges with both recruitment and retention. Attracting new physicians requires more and more effort (not to mention money), and of course, it’s never been more important to keep the ones you have.
We often discuss innovative physician recruitment strategies and effective physician retention plans to address both challenges. However, for these to be impactful, leaders must understand physicians on a deeper, human level and not just as employees. It is unrealistic and unfair to expect physicians to exceed their bandwidth constantly. Healthcare organizations must prioritize providing physicians the support needed to protect their mental health.
Prevalence of Mental Health and Addiction Problems in Healthcare
Conversations about physician mental health are often centered around reducing physician burnout. However, while burnout and depression are typically discussed together, the two are not inherently connected – something the American Medical Association’s VP of Professional Satisfaction, Christine Sinksy, MD, addressed in a 2021 interview for AMA News. Sinksky explained that burnout is a syndrome caused by external work circumstances, while depression is a medical condition caused by a variety of factors, both biological and external. She also notes that while a significant percentage of depressed physicians are also suffering from burnout, only a small percentage of those who are experiencing burnout are clinically depressed.
While being a physician does not directly cause depression, depression rates are notably high in physicians – approximately one in four physicians report feelings of depression, according to a 2023 Medscape study. Even more concerning, multiple studies have found physicians have higher rates of suicide than any other profession. Opioid addiction is also disproportionately high among physicians and other healthcare providers. Studies show that 10-15% of healthcare providers will misuse substances at some point in their careers, and rates of prescription drug abuse are five times higher in physicians than in the rest of the population.
The Stigma of Seeking Help
One can only speculate about why physicians struggle with mental health and substance abuse disorders at these disproportionately high rates. However, we can start to see why, when they do suffer, physicians may be less likely to seek treatment. In the aforementioned Medscape study, 41% of physicians suffering from depression said they would not get help for fear their employers or the medical board would know. To maintain licensure requirements and credentials, physicians must routinely answer questions about the presence of mental health conditions. While answers in the affirmative may not immediately cost them their licenses, they will undoubtedly raise some red flags, which is enough to deter many physicians from seeking assistance.
This was true for Dr. Lisa Lerner, a dermatologist in Boston, who took her own life in 2021. Dr. Lerner’s husband told NPR that while she recognized she was dealing with profound depression, she feared what would happen in disclosing her seeking treatment. Instead, she avoided getting the necessary help, and the result was devastatingly fatal.
A Movement for Change
Dr. Lerner and others with stories alike have resulted in a movement to stop licensing boards and insurers from asking about mental health and addiction history on forms to renew licenses and credentials. Where change has been implemented (in more than 20 states), licensing boards ask only about current, untreated conditions that might prevent physicians from providing quality patient care. This allows physicians who have received or are receiving treatment for depression or addiction not to disclose the information.
Of course, addiction may come with legal charges that must be addressed, but here, too, there is a push for more empathy for physicians with a history of addiction. The NPR article highlights the story of Dr. Peter Grinspoon, a primary care physician who has been in recovery from opioid addiction for 15 years. His substance abuse disorder caused him to lose his license temporarily and required him to submit to drug testing for five years following his reinstatement. He now helps other physicians through addiction recovery and argues that physicians in recovery should be welcomed back into practice with more support.
How Can Leaders Respond?
While correlation does not prove causation, it certainly seems that the demanding, high-pressure nature of a physician’s career puts them at greater risk of burnout, depression, addiction, and suicide. So, what can healthcare leaders do to improve the job itself and uplift those it belongs to?
Addressing Burnout
The most common organizational response to physician burnout is implementing wellness and stress management programs, such as physician support hotlines, mental health programs, facilitation of physical activity, etc. However, these tactics do little to address the root of the problem – administrative burdens, lack of autonomy, productivity pressures, long hours, etc. While tackling those issues is important and may work to prevent high levels of burnout, it is unlikely to decrease rates of depression significantly.
Addressing Depression
The most impactful change leaders can make to prevent depression in physicians is to remove the stigma around it. By establishing a culture prioritizing healthcare professionals’ mental and physical well-being, leaders convey to physicians that they are encouraged and expected to care for themselves. As flight attendants say, “Put on your own mask first.” Conduct routine screenings for depression and make sure to have multiple resources available to those who need them. Most importantly, physicians should be confident that they will not experience repercussions from their employers if they leverage those resources.
Addressing Addiction
Leaders must establish clear and compassionate intervention protocols to guide managers in dealing with suspected cases of physician opioid addiction. Collaborate with addiction specialists and mental health professionals to ensure a supportive and effective intervention process. Prioritize the well-being of the physician while safeguarding patient safety, and of course, comply with reporting requirements while maintaining confidentiality and respecting the rights of the physician. Supporting your physicians through addiction recovery is crucial, but extending your compassion to potential candidates is also important. We advise healthcare organizations to avoid automatically screening out physicians who have overcome addiction in their recruitment process. If a candidate is qualified for the position, grant them a level playing field and evaluate for overall fit.
Addressing the root causes of burnout and prioritizing wellness is likely to improve circumstances for all physicians, not just those suffering from burnout and depression. As a result, a better culture is curated, and physicians will be more fulfilled long-term. Additionally, a candidate deciding between two offers will most likely choose the organization with the more compassionate and supportive environment. In this way, addressing the complex issues of burnout, depression, and addiction will not only help those physicians who need it most, but it will also serve to improve both retention and recruitment at your organization.
Would your organization benefit from a physician recruitment partner who can advise and consult on recruitment and retention best practices? Reach out to the team at Jackson Physician Search today to learn how our track record of trust and transparency helps organizations hire physicians, physician executives, and advanced practice providers who fit, succeed, and stay.
