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What physicians should know about available resources and benefits.
Physicians and other healthcare professionals face many stresses in their careers. From long work hours, high expectations, and a heavy administrative burden, to an immersion in human suffering, the need to adapt to a rapidly changing healthcare environment, and a fear of making mistakes, it is not surprising that symptoms of depression, anxiety, and other mental health conditions are common among physicians. Even before COVID-19, there was an unprecedented level of burnout in the profession with many physicians reporting high rates of dissatisfaction with quality of life and work-life balance.
Despite these alarming trends, the medical profession as a whole has a long way to go in prioritizing physician well-being and overcoming the societal stigma around mental illness. As research is progressively demonstrating the dire consequences of ignoring physician mental health and the positive impact of a variety of interventions on physician well-being and subsequent patient care, physicians should no longer have to suffer in silence.
Many physicians who are dealing with mental health issues have questions about available resources, as well as whether they will be able to receive disability benefits for their mental health condition, and what, if any, impact seeking treatment will have on their medical license.
According to the American Foundation of Suicide Prevention, 300-400 physicians commit suicide every year. Male doctors are 1.4 times more likely to kill themselves than men in the general population; female physicians, 2.3 times more likely. In one study of six medical schools, nearly 1 in 4 students reported clinically significant symptoms of depression. Almost seven percent said they had thought of ending their lives in the last two weeks. According to a more recent study, 29 percent of medical residents suffered from significant symptoms of depression.
An American Medical Association/Rand Corporation on Factors Affecting Physician Professional Satisfactionfound that the bureaucratic obstacles (burdensome administrative rules, regulations, and paperwork) to providing patients with high-quality care are major contributors to symptoms of burnout, including emotional fatigue, depersonalization, loss of enthusiasm, and even early retirement.
Despite what is clear evidence of the prevalence of mental health issues in the medical profession, many physicians who are suffering from symptoms of burnout, depression, anxiety, or PTSD, do not seek treatment. One well-documented reason is that, as with many high-performing occupations, many doctors are deeply uncomfortable acknowledging their own vulnerability. According to the American Foundation for Suicide Prevention, physicians report their hesitancy to draw attention to self-perceived weakness and concerns about reputation and confidentiality as the main barriers to seeking mental health care, in addition to time constraints.
A Consensus Statement published in JAMA over fifteen years ago noted that the source of physician hesitancy involves fears about licensing, a medical culture that can sometimes view help-seeking behavior as a marker of weakness rather than empowerment, discrimination in hospital credentialing, and consequences pertaining to personal and liability insurance due to disclosure of mental health diagnoses.
As for the effect of physician mental illness on patient care, research demonstrates that unaddressed mental health conditions, in the long run, are more likely to have a negative impact on a physician’s professional reputation and practice than reaching out for help early.
The impact of the COVID-19 crisis on the mental health of physicians and other frontline healthcare workers has made painfully clear the need to address and prioritize physician well-being. Fortunately, even before the pandemic hit, there has been a shift in professional attitudes toward encouraging physicians to seek help. While some barriers still remain, there are many available resources for healthcare professionals who are dealing with mental health issues.
As with most medical conditions, there are a variety of treatment options for mental health conditions. Depending on the severity of the issue, as well as whether it is chronic or acute, physicians can take advantage of easily accessible online education programs for physicians, reach out for help through support lines specifically established for physicians, or make changes to their workplace to encourage wellness. In addition to one or more of these treatment options, if your mental state is impacting your ability to provide care for your patients, you should seek help from a mental health professional.
In 2015, the American Medical Association launched its STEPS Forward series to address physician burnout to “provide strategies for physicians to revitalize their medical practices and improve patient care.”
In May 2020, in response to the COVID-19 crisis, a group of psychiatrists launched a free, national support line for physicians. The volunteer psychiatrists who staff the support line offer empathetic, active listening and provide a safe, supportive, emotional space for physicians who are often declaring their emotions and feelings for the first time. According to one of the psychiatrists who established the support line, Smita Gautam, MD of Northwestern University,
“we do some live interventions, some breathing techniques and help them problem-solve certain scenarios with cognitive behavioral therapy models...We are not telling them what they need to do. We’re helping them come to their own answer and to help them process their own emotions.”
For physicians working at hospitals, there may be resources available in-house to encourage physician well-being. Some facilities offer support groups, peer counseling, and sessions to teach physicians how to manage stress by meditating or keeping journals. Physician discussion groups incorporating elements of mindfulness, reflection, shared experience, and small-group learning have been shown to lead to an increase in empowerment and engagement.
One Minneapolis hospital created a “reset room” where physicians and other healthcare professionals can retreat if they need a moment to recover from a traumatic event or just to get away for a moment. The hospital, which developed an Office for Professional Worklife and created a wellness committee, also implemented scheduling (last appointment slot of the day changed from complex to routine care) and environmental (installing locally sourced art, often from the hospital staff) changes. A wellness center and a plan to streamline EHR are in the works.
If you are suffering from a mental health condition and are considering submitting a disability claim, there are certain steps you should take to ensure that your claim is accepted. If you apply for disability due to “burnout” and do not have supporting documentation from a mental health professional detailing a diagnosable condition, you may face an uphill battle with your insurance carrier.
Importantly, under most private disability policies sold to physicians, the insurance company must pay benefits if you are unable to perform the “substantial and material duties” of your occupation. Thus, generally speaking, if you suffer from a legitimate mental health condition that is interfering with your ability to practice medicine safely, you should be able to collect disability benefits.
To increase the likelihood that your disability claim will be granted, the first thing you should do is consult with a mental health professional to determine whether or not you have a diagnosable condition. Be sure it is the type of provider your insurance company will accept (some policies require a doctorate-level practitioner). Next, when you report your conditions and limitations to your insurance carrier, you must be precise. To receive disability you will have to report a specific condition on the claim form and include documentation to support the diagnosis.
Lastly, with the dramatic rise in physician burnout, many insurers are placing limitations on how long policyholders can collect benefits for mental health claims (some companies entirely exclude mental health claims from coverage) to limit their liability for these types of claims.
Many physicians who suffer from mental health issues are often reluctant to seek treatment because they fear it might jeopardize their license to practice medicine. According to a 2017 Mayo Clinic study, in the states where licensure applications ask the most sweeping questions about mental illness, physicians are most likely to be reluctant to seek treatment.
Liselotte N. Dyrbye, MD, who led the study, argued that rather than asking an unfairly broad question such as, ‘have you ever been treated for a mental health condition?’ the application should focus on the physician’s ability to perform the job today. A more reasonable question would be, ‘are you currently suffering from any condition, mental or physical, that keeps you from doing your job?’
Unfortunately, the Mayo Clinic study found that, despite the fact that groups including the American Medical Association, American Psychiatric Association, and the Federation of State Medical Boards recommend against it, two-thirds of states ask the broader form of the question. This could be causing physicians to forego treatment.
Although it is illegal under the Americans With Disabilities Act (ADA) to revoke licensure or otherwise prevent a physician from working due to a mental disorder, medical licensing boards get away with it because, as Dr. Dyrbye points out, states are caught between protecting the public from impaired doctors and a physician’s right to make a living.
Currently, only 13 states have no mental health questions or 1-2 “current impairment” questions that do not mention mental health. Connecticut, Hawaii, Michigan and New York are the most physician-friendly of all states with no mental health or impairment questions. Pennsylvania asks only about drug-related impairment. The worst states, which have highly invasive mental health questions not linked to current impairment and contain confusing, punitive, or adversarial language, are Alabama, Alaska, Delaware, Florida, Mississippi, Rhode Island, and Washington
In any event, physicians whose licensure is questioned by their state medical board due to their seeking treatment for mental illness should challenge the board based on arguments that it is a violation of the ADA to discriminate on the basis of disability and that the mental health condition does not impact the physician’s ability to care for patients.
Dominick V. LaGravinese Jr. is an Associate at the Disability Insurance law firm Seltzer & Associates. He focuses on disability insurance contracts, long-term disability arrangements, ERISA, employee compensation, and insurance bad faith for disabled professionals. Mr. LaGravinese graduated from Ave Maria School of Law in Naples, Florida, with a Juris Doctor degree. He is a licensed attorney in the states of Florida and Pennsylvania.