Physicians often recognize that their colleagues are suffering. They want to help. And their help is appreciated. Knowing what to do is key to helping individual clinicians and the organizations in which they work.

Many health systems have promoted self-help strategies — meditation, mindfulness, yoga, and so forth — as ways that physicians can stave off or reduce burnout.

Although there are many things that physicians can do to promote their own mental health, the root causes of burnout and depression must be addressed to truly solve the medical profession's crisis.

"What is most important is that the onus for physician mental well-being shifts from the personal to the systemic," Michelle A. Williams, dean of the faculty at Harvard T.H. Chan School of Public Health, and colleagues wrote in The Hill.

Physicians responding to Medscape's Physician Burnout & Depression Report 2023 identified the things that contribute most to their burnout:

• Too many bureaucratic tasks: 61%

• Lack of respect from administrators/employers, colleagues, or staff: 38%

• Too many hours at work: 37%

• Lack of control/autonomy over my life: 31%

• Insufficient compensation/salary: 34%

• Increasing computerization of practice (electronic health records [EHRs]): 25%

• Lack of respect from patients: 23%

• Government regulations: 14%

• Stress from treating patients with COVID-19: 8%

Physicians not only know what's causing their burnout, they also have ideas on how their organizations can address those problems. Respondents to a 2022 survey by Physicians Foundation identified specific actions that need to be taken.

The top priority, cited by nearly 90% of respondents: Removing low-value work, including reducing EHR clicks and minimizing inbox notifications.

Two more actions were also heavily endorsed. A full 87% of respondents want physicians to be given more flexibility and autonomy to adjust quality and patient experience goals, and 85% said that insurance approvals such as preauthorization must be removed.

Beyond that, more than 50% of physicians said that these actions would help reduce burnout and depression:

• Eliminating unnecessary training requirements.

• Eliminating barriers to mental health access, such as credentialing questions that ask about prior mental healthcare.

• Ensuring adequate mental healthcare outside of employee assistance programs.

• Creating penalties for violence, threats, and/or discriminatory behavior against healthcare workers.

• Designating a chief wellness officer to oversee and align all clinician well-being efforts.

• Consider voluntary redeployment for nonclinical staff to the frontlines.

Although many — perhaps most — health systems and medical practices have some sort of initiative to help physicians cope, the efforts do not always resonate.

The Physicians Foundation reported that only 40% of respondents found their medical practice or group to be helpful in dealing with their burnout and depression. And only 22% found their hospital or health system to be helpful. A disturbing note: Both of those percentages fell sharply from the 2021 survey.

Physician leaders must ensure that their health systems embrace interventions that can help.

During the first weeks of the pandemic, the Harvard T.H. Chan School of Public Health started #FirstRespondersFirst, a campaign to help frontline healthcare workers with everything from personal protection equipment to mental health support. As the pandemic passed the 18-month mark, the campaign pivoted to focus on providing tools to help individuals and organizations address the mental health and well-being needs of frontline health workers.

"Hospitals across the nation must implement more of the evidence-based interventions that we now know to be effective against burnout," wrote Williams, who is also an epidemiologist by training, and colleagues.

Several of those interventions are promoted in the 2022 Healthcare Workforce Rescue Package created by the National Academy of Medicine Action Collaborative on Clinician Well-Being, and Resilience and the CEO Coalition, a group of hospital and health system CEOs trying to improve the safety of healthcare workers.

The five evidence-based actions correlate with what physicians have identified as helpful actions. The rescue plan is designed to be initiated quickly — within 3 months — and create a foundation for a health system's long-term well-being.

These are non-normal times; adjust expectations. Systems should give clinicians more flexibility and autonomy by, for example, using crisis documentation protocols to reduce physicians' documentation burdens during the ongoing health crisis. Working with their legal, compliance, and information technology leaders, physicians should identify documentation that can be paused or eliminated.

Get rid of stupid stuff. Physicians know what activities constitute low-value work, and health systems should aim to reduce these activities. Optimization specialists can reduce EHR clicks for common workflows. Inbox notifications should be minimized, and mandatory training requirements should be eliminated unless absolutely necessary.

Address the staffing crisis. Registered nurses, licensed practical nurses, and medical assistants can be trained to "upskill" their duties. Executives can be sent to the bedside. Nonclinical staff can be given opportunities, on a voluntary basis, to help frontline clinical staff.

Designate a well-being executive. The clinician mental health crisis requires high-level support and accountability. A senior leader may need to be assigned responsibility on an interim basis until long-term resources are identified. The goal is to appoint a chief wellness officer to oversee and align all clinician well-being efforts. This work should align with the organization's diversity, equity, and inclusion efforts.

An employee assistance program is not enough. Three additional mental health supports are needed: (1) a high-quality mental health counseling program; (2) a peer-support program; and (3) psychological first aid training for all staff members who are responsible for leading others.

More than one third of physicians have checked in with a colleague who they believed to be experiencing mental health distress, according to the Physicians Foundation survey. And those efforts are appreciated: 62% of physicians found their colleagues to be helpful in addressing their burnout and depression.

Like any difficult conversation, it can feel daunting to approach a coworker to discuss personal issues like mental health. Educating yourself in advance through courses such as this one can help. Another good resource is the National Alliance on Mental Illness's Frontline Wellness website.

If you decide to check in on a colleague, choose the right time and setting. This generally should not be the moment you notice an unusual behavior or comment that triggers your concern, and it shouldn't be in a chaotic hospital hallway. Rather, create the opportunity for a conversation in which you won't be interrupted and distracted by other obligations. Plan for a time when your colleague will not be overly tired, and choose a location where the conversation will be private.

Choose your words carefully so that your colleague does not feel criticized, threatened, or shamed. Show yourself to be patient, understanding, and caring. For example: "You seem to be kind of agitated today. Is everything OK?" or "I want to check in with you because you don't seem to be yourself lately. Everything going OK?"

Regardless of how your colleague responds, listen carefully, acknowledge what you are hearing, and offer your support and willingness to help. You are not the person to solve their problem; your role is to have a conversation. Try "How long have you been feeling like this?" or "That's a really difficult situation. Would you like to tell me about it?" or "How can I support you?"

Be prepared for resistance or even denial from your colleague during that first conversation. Remain patient and caring. Words that might be useful: "I care about you, and I'm here whenever you're ready to talk."

The first conversation is just step one. Do not expect your colleague to reach out to you; be proactive and follow up after a short time. Make it clear that you are ready to offer support for however long is needed.

Because of the medical profession's mental health crisis, all physicians should know the warning signals that a colleague may be at risk for suicide. The Physicians Foundation offers what it calls "vital signs":

• Increasing use of medications and/or alcohol or illicit drugs

• Talking about wanting to hurt themselves or die

• Extreme mood swings

• Feeling hopeless or having no purpose

• Being negative about professional and personal life

• Having inappropriate outbursts of anger or sadness

• Withdrawal or isolation from family, friends, and coworkers

• Talking about being a burden to others

• Acting anxious or agitated

• Behaving recklessly

• Being uncomfortable, tired, or in extreme pain

The foundation also recommends that physicians develop a personal crisis management plan for themselves or a colleague. The idea is that planning for a crisis in advance can support physicians — and their colleagues who want to help — when a crisis occurs.

The plan involves writing answers to these questions:

1. What are my personal crisis warning signs (thoughts, images, moods, situations, behaviors)?

2. What are my healthy internal coping strategies that I can rely on in times of emotional distress? These might include relaxation techniques, physical activity, mindfulness practices, or other things you know to be helpful.

3. Who are a few people/what are the social settings I might turn to for relief? Identify individuals and their phone numbers.

4. Who can I ask for help? Again, write names and numbers to make it as easy as possible to act on the information during a crisis.

5. Who can I contact when I am in crisis? Write the name and phone numbers for the primary care clinician, the counseling professional, and the organization's employee assistance program, if available.

• State-sponsored Physician Health Programs are affiliated with state medical societies. Contact information for each state's program is available from the Federation of State Physician Health Programs.

• Free counseling from licensed mental health professionals is available for physicians via the Emotional PPE Program.

• The Therapy Aid Coalition, started during the COVID-19 pandemic, provides free or low-cost therapy, supported with grant funding.

• Peer-to-peer support — tag line: No One Cares Alone — for physicians is available for free through PeerRxMed.

• Volunteer psychiatrists are available 16 hours a day to provide free and confidential support on the Physician Support Line. No appointment is needed. Call 1-888-409-0141.