Burnout Relief, Made Easier | MedPage Today

Carolyn Roy-Bornstein, MD
Carolyn Roy-Bornstein, MD
6 Min Read

Roy-Bornstein is a writer and a retired pediatrician.

Last week, Massachusetts hospitals, local health plans, and healthcare systems all committed to eliminating invasive, stigmatizing questions about mental illness and addiction from their credentialing processes. The move was supported and applauded by the Massachusetts Medical Society and the Massachusetts Health and Hospital Association as part of their ongoing commitment to physician well-being.

Credentialing Questions as Barrier to Mental Healthcare

It has long been standard operating procedure for these institutions to require physicians to answer questions about past mental health treatment and past substance use in order to obtain or maintain privileges and credentials in hospitals and insurance plans.

These questions have long been understood to discourage physicians who may be suffering from symptoms of burnout and depression from seeking the care they need. This theory was recently backed up by national survey data. Over 40% of physicians surveyed this year reported not seeking care or treatment they needed for depression or burnout for fear that their employer or the board would find out.

This is slowly beginning to change. Several state licensing boards, including Massachusetts’, have already eliminated these kinds of questions from their licensing procedures. Now, more of the industry is following suit.

It Gets Personal

Lorna Breen, MD, was one such physician who felt the pressure of these invasive questions.

She was a young, talented emergency medicine physician working relentlessly and heroically through the coronavirus pandemic. Breen had no previous history of mental illness (known or suspected), but her family recognized that she was suffering from overwork and exhaustion and helped get her checked into a hospital to get treatment.

According to her family, just a day or two into her treatment Breen told them, “Now that I’ve gotten help, it’s gonna ruin my career. I’m gonna lose my license to practice medicine.” After she died by suicide, her family learned that Breen’s fears were not unfounded. Hospitals and medical boards did indeed require physicians to answer questions about past treatment for mental health issues such as depression. Their foundation, the Dr. Lorna Breen Heroes Foundation, has been instrumental in effecting the elimination of these types of questions from several state licensing boards’ credentialing processes, including in Massachusetts.

The Dismal Statistics on Physician Burnout and Attrition

Morale and engagement were already suffering among physicians before the coronavirus pandemic when 38% of the medical workforce reported experiencing some signs of burnout, according to the American Medical Association (AMA). That figure jumped to a stunning 62% 2 years into the pandemic.

One in five of us physicians plan to leave medicine altogether, according to the vice president of professional satisfaction at the AMA. Physician suicide numbers are equally alarming. Physicians contemplate and complete suicide at higher-than-average rates. Over 300 physicians per year die by suicide. It is the most common cause of death, after accidents, in medical students and male residents.

I have long contended that the dismal statistics surrounding burnout and attrition among physicians do not take into consideration a large portion of us who don’t really want to quit. We’d rather not retire early. We just want to rekindle the meaning and locate the joy that we once had in our jobs. The culture is slowly starting to change in medicine, recognizing that we are humans not superheroes. We make mistakes. We cry. We bleed. And we need help.

It Takes a Village: Individual and Corporate Approaches to the Problem

That help can come at many different levels. Individual efforts to build resilience and find meaning in the job can come through greater patient connection, through engagement with the humanities, and through the support of our family and friends.

But we also need a top-down approach with buy-in from healthcare leadership. This new Massachusetts initiative demonstrates a recognition from the corporate community that the mental health and well-being of its physician workforce is a priority, and it isn’t just a handful of us doctors who are struggling. We are all in this together.

Hopefully this will be one less barrier for physicians separating them from the care and treatment they need so we can get back to our first love: caring for our patients.

Carolyn Roy-Bornstein, MD, is a retired pediatrician and the writer-in-residence at the Lawrence Family Medicine Residency program. Her new book, Writing Through Burnout: How to Thrive While Working in Healthcare, is forthcoming.

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