Managing and Treating Physician Depression

Every physician knows their career will have its ups and downs. Stress is a part of every physician’s job, even when you don’t work in a high-stress specialty such as emergency medicine. But there’s stress, and then there’s serious burnout. And as rates of physician burnout have increased in recent years, so have rates of physician depression—and suicide.

Physician Depression and Suicide Rates Are Up

Reports since the 1880s show physicians have a much higher rate of suicide than the general public. While not every physician suicide is the result of untreated depression, statistics show the already high rate of physician depression has likely increased during the pandemic.

The Medscape Physician Burnout & Depression Report 2023 surveyed 9,100 physicians and found 53 percent of physicians reported feeling burnout and 23 percent reported feeling depressed. Additionally, The Medscape Physician Suicide Report, 2023, shows 9 percent reported suicidal ideation, and 1 percent had actually attempted suicide — double the rate of the general population. The rate of depression was up 8 percent since 2018.

Other surveys and some older research overviews have found even higher rates of depression specifically in residents — up to 40 percent. But with the staffing, financial and emotional stresses of the pandemic, residents aren’t the only physicians at risk.

Too Many Physicians Don’t Get Help

If physicians seek help for their depression, they can find very effective treatment, from talk therapy to medication to promising new protocols still in clinical trials. Unfortunately, there is still significant social and professional stigma associated with admitting any mental health struggle. But depression—or anxiety or any other mental health condition—is not a character flaw, it’s an illness. As physicians, we should be more aware of this than anyone. Unfortunately, we’re still much less likely to seek help than the general public.

Depression is a medical condition. Just as you shouldn't ignore symptoms of a bad headache and blurring in your vision, physicians shouldn’t ignore symptoms that are indicative of depression, such as:

• Changes in eating habits (eating too much or too little)

• Diminished pleasure in formerly enjoyable activities

• Fatigue

• Feeling guilty or worthless

• Feeling hopeless or that life isn’t worth living

• Feeling sad for no particular reason

• Hypersomnia or insomnia

• Inability to focus

• Suicidal ideation

Some of us may suffer in silence because we know too much and think we can take care of ourselves. Over half of physicians in the Medcsape survey said they could “deal with [suicidal thoughts] without help from a professional.” Beware the old adage, “The doctor who takes care of themselves has a fool for a doctor.” Others worry that seeking treatment will affect their licensure or job standing. 

Untreated Depression Affects the Workplace

While depressive symptoms can make life miserable for the physician who has them, they can also negatively impact patient care. 

Insomnia can lead to cognitive dysfunction. If a physician is feeling depressed and withdrawn, they are likely to have difficulty with patient or coworker interactions, which inhibits their ability to provide effective medical care. Studies show doctors who are depressed are also more likely to make clinical errors than those who aren’t depressed.

Steps Physicians Can Take

There are ongoing initiatives at the national level to make it easier for physicians to seek mental health care without the fear of stigmatization. State licensing questions about mental health treatment may even be in violation of the Americans with Disabilities Act. But there are ways physicians can seek help privately:

• Contact your Employee Assistance Program (EAP), which is required to maintain confidentiality (unless your employers requests that you talk to them).

• See another physician for medication assistance, such as antidepressants.

• Visit a Physician Health Program, which is also required to maintain confidentiality.

Doctors may also want to call the anonymous Physician Support Line at 888-409-0141 for suggestions. Physicians actively contemplating suicide should call or text 988 to reach the 988 Suicide & Crisis Lifeline.

What Administrators Can Do

Physicians reported increased compensation, additional staff and a more balanced workload would improve burnout, but not all burnout correlates with depression. And even if increased salaries and staffing is in your budget, it may only mitigate, not treat, clinical depression. 

One key thing administrators can do is to make it easier for physicians to seek mental health care without repercussions or stigma. Creating a work community where improving physical and mental health is encouraged can help with both burnout and depression. 

Taking steps to recognize signs of burnout in staff before they worsen is equally important. Some types of physician “interventions” may help stubborn providers seek the help they need. Ensuring your workplace benefits include access to confidential counseling services can make it easier for physicians to get the care they need.

What St. Luke’s Is Doing

At St. Luke’s Health, all of our physicians are also part of the Baylor College of Medicine faculty. The faculty support network offers robust mental health support, in addition to other aspects of career support. We provide counseling resources along with referrals not only to medical psychologists, but also clinical psychiatrists if needed. 

Our commitment to physicians extends to their mental health because treating patients is only part of the St. Luke’s Health mission. We understand truly compassionate and excellent care isn’t possible unless our physicians are in a good mental space.