Opinion: Doctors Are Facing a Mental Health Crisis. We Must Make it Easier for Them to Get Help

See the person, not their disease. While this teaching — originating from Canadian physician Sir William Osler — has been a foundation of medical training since 1850, medicine has failed to follow this principle when it comes to our own doctors. To practice in California, physicians must apply for a license in a process that asks invasive questions about our mental health history. Any affirmative answer could lead to devastating penalties.

There are three questions about mental health on the application form, but the first is the most concerning. The question asks applicants “Are you currently enrolled in, or participating in any drug, alcohol, or substance abuse recovery program or impaired practitioner program?” Answering yes to this or either of the other questions will prompt the licensing board to conduct an “individualized assessment” to determine whether and under what conditions the applicant might be granted a license, the form says.

However, while the second and third questions ask whether the applicant to disclose the condition only if they currently have a mental health or other conditions that would “impair” or “limit” their “ability to practice medicine safely,” the first question does not. This needs to be changed. Applicants should not be forced to disclose they are in treatment for a condition if that treatment means they are able to practice medicine safely.

This question fosters a toxic stigma, undermines physician wellness, and ultimately detracts from the quality of patient care. It is for these reasons that the first mental health question on licensure applications must be amended to promote a healthier medical community.

Our doctors are experiencing an alarming mental health crisis. Approximately one physician dies by suicide each day in the United States — a rate twice that of the general public and a loss that means a million patients lose their doctor to suicide each year. Physicians experience higher rates of stress, burnout and depressive symptoms than the general population. Trainees, meaning resident and fellow physicians, who often work 80 hours a week while shouldering chronic financial strain and crippling student debt, are at particularly high risk. Suicide is the leading cause of death among male residents, and the second leading cause of death among female residents, only behind cancer.

This crisis is made worse by a pervasive culture of silence around mental health in medicine, rooted in fear and stigma. Forty percent of physicians report that they are reluctant to seek mental health treatment due to licensure concerns. Residents who disclose mental health concerns and take protected medical leave can be required to agree to invasive and punitive “return to work agreements.” Recently, over 400 UC San Francisco trainees signed a petition demanding the university allow trainees with medical conditions to have representation and negotiate the terms of these agreements.

Last year, a member of the California Medical Board insisted the question about doctors’ mental health history must be kept to “catch bad physicians.” This not only encapsulates how mental health is perceived but reveals a glaring contradiction. We don’t fault physicians with insulin-dependent diabetes or punish them for appropriately managing their blood sugar. Why is a physician who seeks mental health treatment “bad?” This harmful culture is why some residents I know pay cash and use a pseudonym in therapy to avoid a record of their treatment. It’s why many choose to suffer in silence, which causes decreased empathy and increased medical errors. It’s why, even with the dire physician shortage, many choose to leave clinical practice entirely.

We must break free from the fallacy that physicians are superheroes who should never need help. Not only do some of us need surgery, or cancer treatment, but we also get depression or have bipolar disorder. How many more of us will we lose to suicide before we act? To deny or punish treatment in an inherently stressful job is a grave disservice to our profession and the patients we serve. Patients do better when doctors are well, and when doctors better reflect patients’ lived experience. Reforming the mental health question on licensure applications would help reduce stigma and make physicians more comfortable seeking treatment. This is a first and crucial step to creating a culture where seeking mental health care is viewed as a sign of strength and an essential component of professional responsibility.

We urge legislators and the California Medical Board to support Assembly Bill 2164, which aims to reduce stigma and encourage treatment by removing the requirement to report mental health conditions that are being adequately treated. We hope this initiates a cultural shift where mental health conditions are met with compassion and eventually medicine embodies a standard of responsibility and respect where discussing mental health conditions becomes needless. In the meantime, we ask that the mental health question be revised to promote a more compassionate and effective medical community that acknowledges the humanity of both patients and physicians.

Dr. Max Blumberg is a resident physician at UCSF Medical Center and a member of the Committee of Interns and Residents/SEIU, the largest trainee union in the country.