A candid approach to improving resident and physician mental health

Who hasn’t heard the buzzwords “physician burnout” and “mental health crisis?” In today’s world, you’re unlikely to get through a single day without encountering them at some point. Medical professionals have come a long way in advocating for the mental health of all physicians. May has now become synonymous with mental health advocacy. With the NRMP Match taking place a little over six weeks ago, we have a new class of residents poised to enter training programs. What better time to improve physicians’ behavioral health than now?

The American Foundation for Suicide Prevention states that 28% of residents go through a major depressive episode during their training and 23% of interns have suicidal thoughts during their residency. It doesn’t seem to stop after residency either; a Mayo Clinic Proceedings article stated that 62.8% of physicians had at least one manifestation of burnout in 2021, compared with 38.2% in 2020, 43.9% in 2017, 54.4% in 2014 and 45.5% in 2011.

From research to surveys, the medical community is well informed about the current state of physicians’ mental health, begging the question, “Why does declining mental health continue to engulf a larger portion of the profession?” One step in the right direction is to encourage physicians to take a closer look at their own mental health. While an ounce of prevention is worth a pound of cure, prevention is not always possible. That being said, being aware of resources and techniques to help cope with stressors is invaluable.

Let’s start from the beginning. Stepping into a residency role can be a stressful time for any new physician. To help gain a better understanding of residents’ mental health, I consulted with Harold Levine, DO, an osteopathic psychiatrist and the Behavioral Health Chief Medical Officer at BayCare Health System, the largest provider of mental health services in the Tampa Bay (Florida) region. In addition, Dr. Levine serves as the program director for a psychiatry residency.

Starting with the mind, body and spirit, Dr. Levine advises residents to look at their mental health from a DO perspective. To keep these three components of well-being optimized, ask yourself the basics: Are you sleeping enough? Do you have proper nutrition? Are you exercising? Are you overextending yourself with too many obligations? The body can only go through so much wear and tear. If you do not have the basics aligned properly, you will be at a disadvantage from the beginning.  

You should make sure you have a support system. The support system is a hard one to keep intact, with all the moving a resident has to do. Most will leave their hometown to attend medical school, will move again for clinical rotations and then will move a third time for residency. Technology makes it easier to keep in touch with your support system, but having them physically there brings a personal aspect that technology cannot duplicate, according to Dr. Levine.

Combining the basics of sleep, nutrition, exercise and stress management with a solid support system add up to what Dr. Levine calls “good mental health hygiene.” These make up the foundation of our mental health. With a strong foundation, we set ourselves up to have better coping skills for what may come.

Most large healthcare systems have recognized the importance of offering behavioral health services to employees. Dr. Levine says his health care system offers physician employees several comprehensive employee assistance programs (EAP) and community mental health services. One program in particular that focuses on residents and attending physicians is called “Doc Be Well.” The issues covered are broad and extend beyond work stress, addressing family and social issues as well. Therapists and psychiatrists are available for face-to-face or virtual appointments. Consultations are provided with complete anonymity and no one outside of the patient/physician relationship is involved or notified. The goal is to get the physician the support they need.

Most residents and physicians have EAPs offered through their health insurance. EAPs are designed to offer employees immediate assistance and put them in touch with a therapist. Again, therapists can usually be reached virtually, and these services are good at opening the doors and getting you face-to-face with a mental health professional in a relatively fast timeframe.

The help for residents does not stop there. At the national level, the Accreditation Council for Graduate Medical Education (ACGME) is spearheading programs focused on the mental health of resident physicians. According to Dr. Levine, ACGME works to ensure residents needs are addressed through monthly evaluations that focus on everything from the development of core competencies in a chosen specialty to adaptability during each stage of residency. As a program director, Dr. Levine has noticed that each month brings new stressors for residents, including introduction of new attendings, nurses, social services and other hospital staff. The goal is to re-evaluate how these changes affect residents and intervene when and where support is needed.

If we break it down into small blocks, we can start the process of building up the behavioral well-being of physicians. Begin with Dr. Levine’s advice for implementing the basics: sleep, diet, exercise and not overindulging in obligations. Sometimes, even a strong foundation cannot withhold the magnitude of stressors residents face. If you find yourself at that point, reach out to your health care system and look for a program similar to Doc Be Well. If one isn’t available, your health plan will most likely offer an EAP that can open doors to mental health services. The goal is to reach physicians through as many avenues as possible, so no one falls through the cracks.

Related reading:

Physician and med student mental health update: Has the situation improved after the pandemic?

The Lorna Breen Act: Why mental health matters