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Invited Commentary
January 21, 2022

The Health Care Workforce Under Stress—Clinician Heal Thyself

Author Affiliations
  • 1Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York
JAMA Netw Open. 2022;5(1):e2143167. doi:10.1001/jamanetworkopen.2021.43167

The nature and extent of the novel COVID-19 pandemic has been unprecedented, touching all aspects of society. An emerging body of literature has highlighted the substantial mental health toll affecting broad swaths of the general population during the pandemic.1 Health care workers have been particularly vulnerable to the negative mental health effects associated with the COVID-19 pandemic, with high self-reported rates of depression (50.4%) and anxiety (44.6%) among clinicians across diverse practice settings.2 In the setting of these findings, what have been the near and long-term consequences of these mental health stressors for health care workers? In the study by Myran and colleagues,3 the authors looked at the change in the incidence of outpatient visits made by physicians related to mental health and substance use during the COVID-19 pandemic. Their sample of 34 055 practicing physicians in Ontario, Canada, used health administrative data to look at health care visits related to mental health and substance use, finding the number of visits per 1000 physicians increased by 27% and the absolute proportion of physicians with 1 or more mental health and substance use visits within the year increasing to 13.4% during the first 12 months of the pandemic compared with the prior 12 months.

Although the study’s use of population-level data limits our ability to examine granular associations between mental health stress and variables, such as individual COVID-19 volume/load exposure, the overall findings of increased mental health care use among the physician population is an important contribution, reiterating the looming mental health crises among health care workers in the wake of the pandemic. That the authors of this study focused on specific behavioral health codes in their analysis may have underestimated the true incidence of mental health symptoms expressed by physicians, given the historical stigma associated with mental health symptoms and disease within the profession.4

This parallel fear of being labeled with a mental health disorder within the profession of medicine has existed long before the current pandemic. Be it out of a culture of reticence and fear of professional/personal repercussions, health care workers have shown a historical hesitation to seek support and treatment for mental health disorders.5 Taken in this context, despite the alarming increase in mental health visits described by Myran et al3 in this study, their results are somewhat encouraging insofar as we are now seeing more clinicians seeking professional help and guidance for mental health concerns. Creating additional avenues or opportunities for health care professionals to obtain mental health services will be paramount, while cognizant of the unique challenge surrounding reticence in seeking care within the profession. In addition to providing and encouraging the use of local mental health resources for health care workers, the use of digital care programs (eg, digital health) as a means to scale and encourage adoption of mental health programs among health care professionals may show promise. The use of platforms such as telemedicine and guided/unguided digital programs offers novel avenues to increase adoption and support for mental health services in physicians, while also offering discretion and scheduling flexibility, thus potentially reducing traditional barriers to seeking mental health services among health care professionals. Recent work on a sample of 654 health care workers during the COVID-19 pandemic found that, although 57% of participants screened positive for acute stress and 48% screened positive for depressive symptoms, only 26% of these individuals reported engaging with “talk therapy.” Yet among this sample, 51% of the participants reported interest in engaging in some support, with 33% showing interest in online self-guided counseling.6 Future work focused on the safety and efficacy of such interventions will be critical, as will be the design of pragmatic trials to assess the adoption of such strategies in a diverse set of practice settings and health care professionals.

In addition, when discussing future strategies to best support our health care workforce, beyond individual level treatments, we should consider broader system challenges within both the culture of medicine and the occupational work environment our clinicians encounter daily. Prior to the COVID-19 pandemic, rates of clinician psychological stress and burnout were already endemic.7 The recent global events have likely accelerated and exacerbated the stressors long present in the practice of medicine. The destigmatization of mental health challenges experienced by the health care workforce will be vital toward encouraging clinicians to feel comfortable to seek mental health support without perceived adverse influence on personal or professional development. Addressing some of the broader occupational stressors many clinicians experience, from increased patient volume, documentation burden, to staffing models, also may serve as future targets of intervention to ensure clinician well-being.

The heroic efforts of the health care workforce during the COVID-19 pandemic have extracted a great toll on the mental health of many health care professionals. Prioritizing clinician mental health will not only be vital toward supporting clinician health and professional longevity, but also toward ensuring a health care workforce well equipped to face the challenges of the ongoing pandemic and future public health challenges on the horizon.

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Article Information

Published: January 21, 2022. doi:10.1001/jamanetworkopen.2021.43167

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Chang BP. JAMA Network Open.

Corresponding Author: Bernard P. Chang, MD, PhD, Department of Emergency Medicine, Columbia University Irving Medical Center, 628 W 168th St, New York, NY 10032 (Bpc2103@cumc.columbia.edu).

Conflict of Interest Disclosures: None reported.

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