The COVID-19 pandemic has taken a toll on physicians' mental health, but it has also prompted initiatives that may support physicians' well-being in the years ahead.

Many surveys have examined how the COVID-19 pandemic has affected physician mental health in a particular set of physicians or during a specific time period in the past 3 years. But there still needs to be a definitive analysis of the long-term impact on the profession.

Medscape's Physician Burnout & Depression Report 2023, based on survey responses from 9175 US physicians in mid-2022, shows that the pandemic continues to take a toll:

• 79% of physicians said that COVID-19 either significantly or somewhat affected their work-life happiness in the past year.

• 53% of physicians feel burned out, with about 43% saying that it has a strong and severe impact on their life. Also, 30% said they had been burned out for more than 2 years.

• 65% of respondents said that burnout had a negative impact on their relationships; additionally, about 21% of physicians said they were depressed, either clinically or colloquially (feeling sad or down).

• Of those physicians who said they were depressed, 22% listed the COVID-19 pandemic as a significant contributor to their depression. Other factors were job burnout, world events, and being a physician.

Other surveys confirm COVID-19's lingering effect on the physician workforce. In the 2022 Survey of America's Physicians conducted in mid-2022 by the Physicians Foundation, 60% of the 1509 US physicians surveyed said that they had experienced feelings of anger, tearfulness, or anxiety in the previous year. Other findings from that survey were:

• One third of the respondents reported feelings of hopelessness or no purpose.

• Half reported withdrawing from family, friends, or coworkers.

• Six in 10 physicians said that they often have feelings of burnout, up from 4 in 10 before the pandemic.

• 17% increased their use of medications and/or alcohol or illicit drugs in the past year, and 11% said that they had initiated medication and/or alcohol or drug use in the past year.

Of about 1300 physicians in Canada responding to a survey conducted by Daniel T. Myran, MD, MPH, of the Ottawa Hospital Research Institute and colleagues, 62% reported being somewhat or extremely stressed most days in late 2020.

About 30% of the 3128 physicians and 27% of the 303 residents responding to the American Medical Association's Coping with COVID-19 for Caregivers Survey in mid-2020 reported experiencing high stress. Half of physicians attributed that high stress to fear of exposure; for residents, it was 53%. Nearly half of physicians and residents reported burnout symptoms.

Physicians who contributed their perspectives to Medscape's Burnout & Depression Report 2023 identified the things that contribute most to their burnout: too many bureaucratic tasks, lack of respect from coworkers, and too many work hours, among other issues. But 55% of respondents either said that their workplace has no program to reduce stress and/or burnout, or they don't know whether such a program exists.

"Physicians are tired of hearing about how burnt out they are with little to no changes to address it," Gary Price, MD, president of the Physicians Foundation, and Robert Seligson, its CEO, wrote in an introduction to their organization's survey results. "It is only when we break stigma down and when health leaders take systemwide action that we will see a lasting change…. By prioritizing physician well-being, patient outcomes will improve, because to care for others, physicians must first be cared for themselves."

US Surgeon General Vivek Murthy, MD, MBA, agrees. Writing in The New England Journal of Medicine in May 2022, he summarized the toll COVID-19 has taken on America's physicians and their healthcare colleagues. Then he said, "The time for incremental change has passed. We need bold, fundamental change that gets at the roots of the burnout crisis. We need to take care of our health workers and the rising generation of trainees."

The COVID-19 pandemic has triggered several initiatives that may lead the way to systemic changes in individual health systems and the healthcare industry at large.

The Lorna Breen Act. As the first wave of the COVID-19 pandemic bore down on New York City in the spring of 2020, Lorna Breen, MD, an emergency department physician, was among its victims. She and her colleagues worked with insufficient supplies, oxygen, beds, and personal protective equipment. She saw death after death during her 12-hour shifts, sometimes covering two emergency departments miles apart, and struggled to find cab rides home because drivers did not want to risk being exposed to the virus by a healthcare worker.

When Breen called her sister in early April, she was nearly catatonic, having not slept in more than a week. She had no history of mental health problems, but she was worried — and unwilling to seek help because she feared she would lose her medical license or be ostracized by her colleagues. Less than 3 weeks later, Breen died by suicide.

Her family started a nonprofit organization, the Dr. Lorna Breen Heroes' Foundation, with the goal of reducing burnout among healthcare professionals and improving their well-being and job satisfaction. The foundation's vision: a world where seeking mental health services is universally viewed as a sign of strength for healthcare professionals.

The foundation successfully advocated for federal legislation to support its mission, and in March 2022 President Biden signed the Dr. Lorna Breen Health Care Provider Protection Act into law. Among other things, the act:

• Establishes grants to train healthcare professionals, students, and residents in evidence-based strategies to prevent and reduce burnout, mental health conditions, substance use disorders, and suicide.

• Creates a national education and awareness campaign to encourage healthcare professionals to seek support and treatment for mental and behavioral health issues.

• Seeks to identify and disseminate best practices for reducing and preventing burnout and suicide among healthcare professionals.

• Establishes grants for employee education, peer-support programming, and mental and behavioral health treatment. Healthcare providers working in current or former COVID-19 hotspots will be prioritized.

• Funds a comprehensive study on mental and behavioral health and burnout among healthcare professionals, including the impact of the COVID-19 pandemic on their health.

ALL IN: Well-Being First for Health Care campaign. A coalition of healthcare organizations, including the American Hospital Association, American Medical Association, and American College of Emergency Physicians, convened in early 2021 to conduct a campaign with two goals:

• Prioritize the well-being of the healthcare workforce and ensure that individual healthcare workers feel valued and supported; and

• Make meaningful progress against the mental health and well-being challenges that healthcare workers face.

Among other things, the campaign is funding grants to help individual organizations support the well-being of their workforces.

• Northwestern Medicine will train physicians and advanced practice providers in the skills needed to serve as wellness change leaders and address the systemic drivers of burnout in their clinical environments.

• Upstate Medical University in Syracuse, New York, will provide peer support groups to improve practitioner well-being.

• The Philippine Nurses Association of America and the University of Texas Cizik School of Nursing will expand their culturally responsive intervention program for Filipino American nurses to other locations across the country.

• Rutgers Biomedical and Health Sciences will expand its physician peer support programs to serve more health professionals and students.

Surgeon General's Advisory. In May 2022, Murthy declared the burnout crisis in healthcare to be a national priority and issued directives for health systems, insurers, government, training institutions, and other stakeholders.

Among the directives:

• Physicians' administrative burdens must be reduced. The goal is to reduce clinicians' documentation burden by 75% by 2025. This will require insurers to reduce requirements for prior authorizations, streamline paperwork requirements, and develop common billing forms. Electronic health record systems must be improved to make it easier for physicians and other users.

• Access to mental healthcare for healthcare workers must be improved. This will require increasing the mental health workforce, strengthening the mental health parity laws so that insurers cover services as they should, and using virtual technology to increase access to mental health professionals.

• A culture that sustains well-being must be supported. Licensing bodies must not punish healthcare professionals for reporting mental health concerns or seeking help. "It's time to break the traditional silence surrounding the suffering of health workers," Murthy wrote. "As gratifying as our work is, it can also be profoundly isolating, especially when we feel we can't let our colleagues know if we're not OK — a feeling that millions of health workers, including me, have had during our careers."