During Dr. Jesse Ehrenfeld’s time working as an anesthesiologist, he has experienced the loss of three colleagues to suicide, and he is still in his 40s.
Those losses have a significant impact on Ehrenfeld, who also holds the position of executive director at the Advancing a Healthier Wisconsin Endowment within the Medical College of Wisconsin.
“For me, it has been deeply personal to experience those losses and to reflect on how the system has let down these doctors—my colleagues—because the issue isn’t with the individual. The problem lies in the system we place them in,” Ehrenfeld stated.
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That mechanism lies at the core of a new report released byJAMA Network Open on August 14.The study, written jointly by Ehrenfeld, highlights the significant shortcomings in mental health care for doctors, the atmosphere of fear and shame that discourages them from seeking assistance, and the serious impacts on their well-being.
Following many discussions on the subject with friend and colleague Dr. Daniel Saddawi-Konefka from Harvard Medical School, the two doctors collaborated with Dr. Christine Yu Moutier, chief medical officer at the American Foundation for Suicide Prevention, to gain deeper insight into the specific mental health issues that physicians face.
Approximately one-third of doctors experience depression, almost a quarter face anxiety, and 10% deal with post-traumatic stress disorder, all figures significantly greater than those in the general public.
Specifically, female doctors experience a 53% greater risk of dying by suicide than women in the broader population. According to the report, physicians in certain specialties, including anesthesiologists, primary care physicians, psychiatrists, and general surgeons, might also face increased suicide rates.
Furthermore, the report emphasized the growing susceptibility of doctors to substance use disorders and excessive alcohol consumption. Over the past 15 years, hazardous or risky drinking has increased significantly, impacting 27% of medical professionals.
In short, the majority of doctors who experience mental health issues do not reach out for assistance. As highlighted in the report, a significant part of this issue arises from a medical culture that demands physicians to be available at all times, to handle human distress with emotional detachment, to excel in their responsibilities, and to consider exhaustion and poor self-care as standard.
As a medical student, it is considered a positive trait to stay up all night, work 100 hours per week, agree to every task assigned, and carry out your responsibilities with an almost superhuman degree of excellence, Ehrenfeld noted.
Those inclinations, frequently linked with perfectionist personality characteristics, “function powerfully in the background” of medical culture, according to Dr. Mariah Quinn, chief wellness officer at UW Health in Madison.
As medical professionals undergo training, they are significantly influenced by their predecessors,” noted Quinn, who was not part of the recent research. “There are numerous expectations regarding what it means to be clinically outstanding.
This issue becomes more pronounced as medical students advance in their careers, moving from training to actual practice. The study found that stigma as a barrier to care was reported by 30% of students in their early years, 53% of those in their final year, and 58% of resident physicians.
Then, embedded within the profession is another strong discouragement from pursuing treatment: an outdated and enduring belief that a healthcare professional with mental health issues indicates a lack of professional capability. Research from the report reveals a harsh cycle: When medical students revealed a history of therapy in their applications for residency programs, medical licensing, and credentials, they were less likely to be interviewed or accepted.
For instance, the report cited a 2007 survey indicating that roughly one-third of state medical licensing board directors would take disciplinary action against a doctor solely due to a mental health diagnosis.
In other words, it’s not an issue confined to a single facility or organization, Ehrenfeld stated, but rather a widespread one.
The challenge of constantly being available and striving to improve oneself
During his second year of medical school, Ehrenfeld remembered being at an operating table that had very sharp edges. He bent down to retrieve something and, as he straightened up, he hit the corner of his eye against the table so forcefully that he lost consciousness.
Although he was sent home, a supervising doctor called him the following day, informing him that he had to come back for a shift to compensate for leaving the previous night, he stated.
“I told him no, that it was entirely unsuitable, illogical, and impractical. I defended myself, but it’s just assumed that I’ll return,” Ehrenfeld said.
That feeling of resilience nearly led to Dr. Michael Stadler’s downfall.
A decade ago, Stadler was contemplating exiting the medical profession. As an ear, nose, and throat surgeon at the Medical College of Wisconsin, he had developed a tough exterior over the years, yet the emotional burden of witnessing cancer patients face unexpected complications remained deeply distressing to him.
And it did not ease the profound sense of guilt he experienced each time a patient looked him in the eye and asked,What made you do this to me?
Could I have performed more effectively?He would question himself just as frequently.
One night while dining with his wife, who is also a surgeon, she inquired about his well-being. He soon collapsed into her arms, weeping uncontrollably. He had numerous ill patients, all desperately seeking cures for their cancers. In a society where people don’t discuss their problems, to whom could he seek support?
We typically don’t discuss these topics, either generally or historically. We aren’t open and honest with our colleagues. We don’t admit, ‘I also threw up before every operation during the first two months of my career.’ We avoid talking about such experiences,” Stadler stated. “I felt lonely and disconnected.
Wisconsin is among the few states that do not offer confidential support options for healthcare workers.
All states except three offer a professional health program that acts as a private resource for healthcare workers to obtain mental health and substance abuse treatment, as well as address other health concerns that could impact their work.
Wisconsin is not among them.
Ehrenfeld and Stadler are working to bring about this change. Stadler is supporting a significant effort through the Advancing a Healthier Wisconsin Endowment, the charitable health division of the Medical College of Wisconsin, known as the Health Workforce Wellbeing initiative.
Those initiatives will be carried out by the Wisconsin Hospital Association in collaboration with theDr. Lorna Breen Heroes Foundation― in honor of the New York emergency room physician who took their own life during the initial phase of the COVID-19 pandemic.
The initial stage of the grant aims to address invasive licensing and certification questions that inquire about a medical professional’s mental health status and past therapy experiences. These issues are not confined to physician licensing, Ehrenfeld noted, but impact all healthcare professions.
It’s not only an issue for the state Medical Examining Board. When medical professionals apply for credentials at different locations, there is no uniformity in the types of questions asked on the forms, Ehrenfeld noted. Obtaining hospital privileges in Wisconsin’s different healthcare facilities sometimes involves disclosing mental health information, although certain organizations, such as UW Health, have modified their questions to eliminate such disclosures.
The following stage will focus on the field of education, assisting healthcare workers in gaining a deeper comprehension of burnout—both its causes and how to differentiate it from other mental health conditions.
Burnout can be a particularly complex issue within the healthcare workforce, according to Quinn from UW Health. It is frequently overlooked and seen as a typical part of the job.
“One of the reasons it seems so unclear is that individuals feel uncertain about how to address burnout due to its widespread acceptance,” Quinn stated.
The last stage will establish a healthcare coalition that helps professionals emerge from their isolated areas, Stadler stated.
Throughout the COVID-19 pandemic, Stadler observed a widespread movement to support healthcare workers where they were, such as providing them with free meals following their shifts, creating rest areas within hospitals for breaks, and organizing group sessions for grieving colleagues to express themselves openly.
As society progressed beyond the COVID-19 pandemic, Stadler observed that these kinds of interventions also decreased. However, numerous healthcare professionals still desire this level of thorough and intentional care.
We don’t require a pandemic to come together and look out for one another,” Stadler stated. “We returned to the routine of our familiar healthcare system: lacking those essential support systems for our community.
Natalie Eilbert reports on mental health topics for the Milwaukee Journal Sentinel. She is open to receiving story suggestions and comments. You may contact her atneilbert@gannett.comor view her X (Twitter) profile at@natalie_eilbert.
This piece first was published on Milwaukee Journal Sentinel:Doctors experience significantly higher rates of suicide, depression, anxiety, PTSD, and exhaustion. But what is the reason?
