COVID Frontline Docs Concerned About Seeking Mental Health Care

Kerry Dooley Young

October 28, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

A new poll of emergency physicians on the frontlines of the COVID-19 pandemic shows many are concerned about seeking mental health care for fear of stigma and potential negative effects on their career.

The results of the nationally representative poll, conducted October 7-13 by the American College of Emergency Physicians (ACEP), showed almost half (45%) of 862 emergency physician respondents reported being uncomfortable seeking available psychiatric care. The poll had a margin of error of plus or minus 3 percentage points.

The findings provide new insight into both the challenges of serving in emergency medicine during the pandemic and the persistent barriers to mental health care in terms of stigma and concerns about potential career setbacks.

In the poll, 42% of respondents said they have been feeling much more stress since the start of COVID-19, with another 45% report they were feeling somewhat more stressed.

When asked about causes of stress related directly to COVID-19, 83% cited concerns about family and friends contracting COVID-19. Also factoring into emergency physicians' stress and burnout were concerns about their own safety (80%) and lack of personal protective equipment or other needed resources (60%).

In the poll, 29% of respondents reported having excellent access to mental health treatment and 42% reported having good access. Despite this, 30% of respondents still reported feeling there was a lot of stigma in their workplace about seeking mental health treatment, with another 43% reporting they felt there was some stigma.  

Poll results also showed that 24% of respondents were very concerned about what might happen with their employment if they were to seek mental health treatment, with another 33% saying they were somewhat concerned.

In recent years there have been efforts to break down cultural roadblocks in medicine that deter many physicians from seeking mental health treatment, but more needs to be done, said Mark Rosenberg, DO, MBA, who was elected president of ACEP at last weekend's annual meeting, ACEP20.

"The pandemic emphatically underscores our need to change the status quo when it comes to physicians' mental health," Rosenberg said.

As previously reported by Medscape Medical News, current efforts to remove such barriers include initiatives to limit inquiries into clinicians' past or present mental health treatment.

In May, the influential Joint Commission issued a statement urging organizations to refrain from asking about any history of mental health conditions or treatment. The Joint Commission said it supports recommendations already made by the Federation of State Medical Boards (FSMB) and the American Medical Association to limit inquiries on licensing applications to conditions that currently impair a clinician's ability to perform their job.

Also supporting these efforts is the Dr Lorna Breen Heroes' Foundation, created in honor of an emergency physician who died by suicide in April amid the pandemic. 

Breen had been working intensely in the response to the pandemic. During one shift, she covered two emergency rooms in Manhattan at locations 5 miles apart, according to a backgrounder on the foundation's web site.

At an ACEP press conference this week, Breen's brother-in-law, J. Corey Feist, JD, MBA, cofounder of the foundation, noted that some states' licensing applications for physicians include questions that fall outside of the boundaries of the Americans With Disabilities Act (ADA). He cited an analysis of state medical boards' initial licensing questions published in 2018 in the Journal of the American Academy of Psychiatry and the Law.

In many cases, states have posed questions that extend beyond an assessment of a physician's current ability to care for patients, creating a needless hurdle to seeking care, the paper's lead author, Carol North, MD, of the University of Texas Southwestern Medical Center, writes.

"Over the years, many medical licensure boards have asked applicants intrusive questions about whether they have any psychiatric history. This has created a major problem for applicants, and unfortunately this has discouraged many of those who need psychiatric treatment from seeking it because of fear of the questions," North and colleagues note. They cite Ohio as an example of a state that had overhauled its approach to questioning to bring it in compliance with the ADA.

Ohio previously required applicants to answer lengthy questions about their mental health, including:

  • Within the last ten years, have you been diagnosed with or have you been treated for bipolar disorder, schizophrenia, paranoia, or any other psychotic disorder?

  • Have you, since attaining the age of eighteen or within the last ten years, whichever period is shorter, been admitted to a hospital or other facility for the treatment of bipolar disorder, schizophrenia, paranoia, or any other psychotic disorder?

  • Do you have, or have you been diagnosed as having, a medical condition which in any way impairs or limits your ability to practice medicine with reasonable skill and safety?"

In the new version, the single question reads: "In the past five years, have you been diagnosed as having, or been hospitalized for, a medical condition which in any way impairs or limits your ability to practice medicine with reasonable skill and safety?"

Other states such as New York pose no mental health questions on applications for licensure.

Still, even when states have nondiscriminatory laws, physicians may not be aware of them, said Feist at an ACEP press conference. In addition to his work with the foundation, Feist is the CEO of the University of Virginia Physicians Group.

He said his sister-in-law Breen may have worried without cause about potential consequences of seeking psychiatric treatment during the pandemic. In addition, physicians in need of psychiatric care may worry about encountering hitches with medical organizations and insurers, he said.

"This stigma and this fear of professional action on your license or your credentialing or privileging is pervasive throughout the industry," he said.

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