Philadelphia Resource Guide for Medical Professional Well-Being
Although the well-being of physicians and other healthcare providers has been a major concern for many years, the profession is finally starting to see some hopeful signs that the issue is being addressed in a meaningful way. Resources and solutions for doctors struggling with mental health challenges are becoming more widely available and easily accessible. Recognizing that not only is physician well-being linked to the quality of patient care but also that dissatisfaction and disillusionment within the medical profession will only intensify with the current physician shortages. Many medical communities and associations are encouraging physicians to protect their mental health and finding practical and creative ways to help lessen their emotional burden.
The global pandemic brought the issue of clinician well-being to the forefront, as the world witnessed heartbreaking images of physically exhausted, emotionally devastated doctors and nurses, many with mask-scarred faces and tears in their eyes. Even as the crisis starts to abate with the arrival of vaccines, many wellness programs are likely to continue, as physician mental health will remain an important issue that must be addressed.
For the nearly 16,000 physicians practicing in the Philadelphia area, mental health resources are available at the national, state, and local level. In addition to taking advantage of available resources, physicians struggling with mental health conditions should be able to apply for disability benefits if their condition is interfering with their ability to practice medicine and they need to take some well-deserved time off.
Physician Well-Being Impacts Patient Care
The statistics on physician suicide, stress, and burnout are deeply troubling. 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.
Physician burnout is also a major mental health issue. According to a Medscape survey, in which physicians from 27 specialties were asked to rate their burnout on a scale of one to seven (one being that it does not interfere and seven indicating thoughts of leaving medicine), all but one specialty selected a four or higher. The top causes of burnout included too many bureaucratic tasks, spending too many hours at work, feeling like just a cog in a wheel, and increased computerization of practice.
Even more concerning is the negative impact of physician burnout and other mental health conditions on patient care. As Perri Klass, M.D., a pediatrician and writer noted in a 2017 New York Times article, “a growing body of research shows that physician burnout and depression are linked to medical errors and to the kind of depersonalized care that is often both less effective and less palatable.”
There has been some meaningful acknowledgement of the importance of well-being to a physician’s duties and responsibilities, in 2017 the World Health Association adopted an amended version of the Hippocratic Oath, to include the following language: “I will attend to my own health, well-being, and abilities in order to provide care of the highest standard.”
National Resources for Doctors and Healthcare Professionals
The American College of Physicians has published guidance and resources for promoting physician well-being and professional satisfaction. Resources include TED Talks, podcasts and webinars; wellness toolkits and apps; and medical humanism blogs. In 2015 the American Medical Association launched its STEPS Forward series to address physician burnout. The goal of the “practice transformation initiative, which offers a collection of interactive, online educational modules, is to provide strategies for physicians to revitalize their medical practices and improve patient care.”
In 2017 the National Academy of Medicine launched the Action Collaborative on Clinician Well-Being and Resilience, a network of more than 200 organizations committed to reversing trends in clinician burnout. The important initiative has 3 goals: raising the visibility of clinician anxiety, burnout, depression, stress, and suicide; improving baseline understanding of challenges to clinician well-being; and advancing evidence-based, multidisciplinary solutions to improve patient care by caring for the caregiver.
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, support, emotional space for physicians, who are often declaring their emotions and feelings for the first time.
State and Local Resources for Physicians and Other Medical Professionals
The Pennsylvania Medical Society has committed to addressing the causes of physician burnout and finding solutions for physician wellness. Last spring, at the height of the COVID-19 health crisis, some Philadelphia hospitals took steps to protect the mental health of healthcare workers. Some began coronavirus-specific wellness initiatives while others expanded existing programs for their employees to help them cope with the stress of the pandemic. At Einstein Medical Center, employees are offered virtual support sessions with psychiatrists and 24/7 hotlines for workers who are struggling to cope. Jefferson University Hospitals are offering employees yoga classes, virtual fitness sessions, and tips on how to home-school children.
Penn Medicine created a workforce wellness committee, which introduced resources such as free hotel rooms to rest between shifts and limit exposure of the virus to family members at home, a search tool to help staff find drop-in and childcare options, and sessions with trained coping coaches. The committee also launched a website for the public to submit messages of gratitude and encouragement. The messages and pictures are displayed on computer screens in Penn hospitals, so workers can see them.
Philadelphia hospitals should consider taking a page from the playbook of hospitals around the country that are implementing creative solutions to encourage physician wellness. One Minneapolis hospital set up 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 also in the works.
Physician Mental Health Disability Options
Healthcare providers suffering from mental health conditions may be able to recover disability benefits. Under most private disability policies sold to physicians, the insurance company must pay benefits if the physician is unable to perform the “substantial and material duties” of his or her 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. For example, 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.
Moreover, 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 even exclude mental health claims from coverage) to limit their liability for these types of claims. While this is an unfortunate development, particularly in the face of growing evidence of the harmful impact of stress and burnout on both physicians and their patients, if you provide proper, well-documented support for your disability claim, you will have a strong case for entitlement to benefits.
A Word About Licensing Concerns for Mental Health Treatment
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.
Currently, only 13 states have no mental health questions or 1-2 “current impairment” questions that do not specifically mention mental health. Pennsylvania asks only about drug-related impairment (“Do you currently engage in or have you ever engaged in the intemperate or habitual abuse or abuse of narcotics, hallucinogens, or other drugs or substances that may impair judgment or coordination?”)
Even if your license is questioned by your state medical board due to your seeking treatment for mental illness you could challenge the board by claiming that it is a violation of the Americans with Disabilities Act to discriminate on the basis of disability and that the mental health condition no longer impacts your ability to care for patients.