Physician and medical student mental health update: Has the situation improved as the pandemic comes to an end?

As the world recovers from the COVID-19 pandemic, physicians and medical students are finally experiencing the light at the end of the once seemingly-unending tunnel. After years of intense stress, isolation and grief, physicians and medical students are slowly getting back to a sense of normalcy. But how are our colleagues doing mentally? Now that society seems to be moving forward, has physician and medical student mental health improved as well? 

Roozehra Khan, DO, a critical care locum tenens physician whose job during the pandemic was to travel and cover at-need high surge areas, believes that, in general, the mental health of her colleagues seems to have improved now that the census is lower and acuity is at a minimum. However, she openly emphasizes how her mental health suffered, especially during the worst surges. Intensive care units have a national average mortality rate of 30% pre-pandemic, but during the pandemic the mortality rate of COVID patients skyrocketed to up to around 90%.

Despite doing everything possible to try and save patients, the devastation of losing so many would eventually take its toll. In 2021, after Dr. Khan experienced panic attacks for the first time during some of the worst surges, she reached out to a therapist through The Emotional PPE Project. After a year of weekly therapy, things started to get better: “It helped for the therapist to normalize what I was going through…and to have an outsider’s perspective that I was going through severe trauma [having so many patients die] and I was being way too hard on myself,” said Dr. Khan.

Though she observed differences in how her colleagues responded and coped during the pandemic, which seemed to have varied by gender, hospital location and hospital type (community versus academic), she told all of her colleagues about The Emotional PPE Project, especially since the burnout rates for ICU doctors were already at about 50% pre-pandemic. Dr. Khan attributes the improvement of her mental health to a year of therapy and continues to utilize coping skills she’s learned, such as setting boundaries. 

Building a toolbox filled with resources and coping skills is so important when dealing with the numerous layers of stressors that come with our profession. Mona Masood, DO, who is a psychiatrist and founder of the Physician Support Line, a free support lifeline for medical students and physicians, states that she has noticed two major changes now that the pandemic is under better control: the intentionality of prioritizing mental health, and a shift in the narrative and culture of physicians supporting and advocating for colleagues and medical students.

“Before [the pandemic], I think there was a lot of lip service about physician wellness and there continues to be some of that; however, I am seeing more and more that institutions and individuals are prioritizing resources geared toward mental health,” said Dr. Masood. “I think they’re trying their best to not just preach, but practice what they preach.”

When it comes to the shift in culture, Dr. Masood mentions how the previous dialogue of trainees having to suffer and the mentality of having to “pull yourself up by your bootstraps” is changing. Dr. Masood says, “I do think that we are wanting a change that is sustainable…and are really pushing toward making that change consistent, starting from the beginning of medical education with administrations in academic medicine, to looking within and looking to themselves as being the leaders in this change and advocacy for mental health amongst medical students and staff.” 

For medical students, the return to in-person classes and clinical rotations provides a sense of normalcy that is crucial not only for learning, but also their well-being. “Moving my life ten hours away from family, not knowing a single person, not being able to really socialize with my classmates and struggling to find ways to create a strong support system added to the challenges of medical school,” said Jessica King, OMS III, who started her first year of medical school in July 2020 shortly after the beginning of the pandemic.

Since the pandemic has gotten more under control, she said that she has seen “a connection among students in a social way that seems to be having a direct impact on medical students and even positively impacting their education.”

Omar Hernandez-Cruz, OMS II, notes similar observations: “I studied at university study rooms during the pandemic, and it was common to not see any other students. Now that the pandemic restrictions have eased up, the campus is more alive with events and, in general, more smiling faces.”

Though there have been general observations of improving mental health, we truly never know what each of our colleagues are going through, especially since levels of anxiety, depression and burnout have always been extremely high in our profession, even before the pandemic. Although ideally, the systems we work for and train under must provide ways to improve physician and medical student mental health on an organizational level, it is also important for us to learn and implement methods to prioritize our own mental health. Because once we acknowledge and become intentional about prioritizing our own mental health, we become stronger advocates for ourselves and our colleagues.

One way is to get support from a therapist who is a good fit for helping us accomplish our goals. King shares how she struggled a bit while studying for board exams and during the transition into third year and made the decision to find a therapist when she knew something was off: “When managing my own mental health, being honest with myself is always my first step. I noticed something was off and found a wonderful therapist and try to schedule meetings even if I know I am behind on Uworld questions,” said King.

Dr. Masood points out how we, as physicians and medical students, can approach working on our mental health by remembering that “change isn’t ‘aha’ moments – it doesn’t come suddenly, and it doesn’t persist without work.” She recommends focusing on one small change at a time, one habit at a time, then seeing it through. “We hone it, we strengthen it, before we try to make bigger changes,” she said.

Dr. Masood gives the example of how students may struggle with imposter syndrome and how their minds can get infiltrated with thoughts such as “Am I cut out to be a doctor?” Instead of focusing on feelings of whether or not they’re good enough, which is a big existential kind of thought, she recommends pausing those thoughts and breaking things down into one sustainable change that they can work on.

For example, if they are struggling with imposter syndrome because they always feel behind compared to their classmates, they can instead work on finding a different way of studying and recognizing that perhaps they learn a different way and need to find the best method that works for them. “So, we took a big struggle and made it a smaller one that we’re able to focus our energy on and work on,” Dr. Masood adds.  

Doing something outside of medicine to nourish interests outside of our careers can also be beneficial. Since dedicating our lives to a career in medicine requires endless hours of studying, allotting a realistic amount of time to participate in such activities is important, and even once a week, or a dedicated number of minutes in a day can make a difference.

When asked what he does to sustain his mental health, Hernandez-Cruz responded: “My strategy for reducing stress during medical school is to exercise at least once a week, relax during meals and at least one day a week, prioritize something other than studying.”

King mentions how she rediscovered old hobbies during her third year of medical school as well, such as gardening, cooking and knitting. “Making time to be a person outside of medical school is vital to success both personally and professionally,” “she said.

Although finding time in our busy schedules can be extremely difficult, being proactive about our mental health is a necessary step toward healing and recovering from one of the most extreme and severely difficult times for our profession. If you or a colleague is interested in mental health resources for physicians and medical students, you can check out the following resources:

• Physician Support Line
• Emotional PPE
• Physician Mental Health

If you know of other useful mental health resources for our colleagues, please comment and share below.

Related reading:

A candid approach to improving resident and physician mental health

The Lorna Breen Act: Why mental health matters