The unique mental health needs of physicians

Shin Ock, PhD, began her career as a clinical psychologist in medical settings. Working closely with physician colleagues, she quickly noticed the unique mental health needs they were facing. Along with burnout, physicians experience depressionopens in new window, anxietyopens in new window, and substance useopens in new window at high rates—and due to cultural stigma around mental health, they’re often less likely to seek mental health support from a professional than the general population. Psychologists are uniquely positioned to address these issues, whether individually in therapy or on a systematic level, consulting with organizations.

Ock became dedicated to supporting this population with psychotherapy, applying her psychological training with the unique cultural consciousness for medicine she gained working in health care. In 2022, Ock started her own private practice in Washington, D.C., with physicians comprising 80% of her patient load. Along with helping doctors manage work-related stressors that contribute to burnout, Ock supports physicians in connecting with their personal side and values outside of health care so they can lead fuller lives.

We asked her to explain that work, the stigma that can prevent physicians from seeking help, best practices for supporting their mental health, and how her strategies can aid all providers.

I see the whole gamut of human experience, but with physicians, they are often amplified with the particular stressors that come with their long training and demanding jobs.

Burnout continues to be a huge problem in health care. In general, too much is demanded of physicians beyond providing quality medical care. The number of patients they need to see is increasing, as is the complexity of patient needs. Reimbursement from insurance is decreasing. The involvement in private equity that makes health care a for-profit endeavor rather than one guided by patient needs or best practices also strains physicians. The increasing politicization of health care, the hydra of online medical misinformation, and increasing rates of violence against health care workers also contribute to their chronic, complex strain. Compassion fatigue can also create a huge emotional burden, especially when physicians aren’t given time or space to recover from seeing so much suffering. All of this has an erosive effect on mental health.

I also see a lot of anxiety and depression in my physician patients. Work is stressful, but many of them don’t have the tools to cope with the challenging feelings that come up in their jobs. Many physicians experience relationship strain because the stress of their job spills into their families. Doctors are trained to be good physicians but not necessarily to be thriving people. They often turn off parts of their emotions to survive the chronic strain they experience, but they don’t know how to return to a normal baseline. That’s why therapy can be so important.

Perfectionism is incredibly prevalent in this population. Physicians just want to do a good job in all things. Often, they feel like they need to protect some kind of image to be seen as a competent provider, which may mean not opening up about mental health struggles. They also tend to minimize their own suffering because they see so much suffering at work.

There can be a generational difference with this. More seasoned physicians tend to reach out at a point of external crisis—maybe they’re facing a malpractice issue, and they need help managing the crisis. Generally, younger providers are more open to seeking regular support. Some of my younger patients have even shared that they were given a stipend or other resources for therapy through medical school or residency. They tend to approach therapy more prophylactically.

My physician patients appreciate concrete action steps. They want to operationalize and perform, so it helps build trust when I’m more pragmatic and active, especially in earlier sessions.

Because so many physicians tend to shut down their emotions, I often must teach them there’s no circumnavigating emotions. Feelings aren’t a problem to solve, but an experience to go through and integrate. There can be a tremendous amount of panic at the idea of experiencing a challenging emotion for these people, so we work on distress tolerance, self-regulation, and normalizing difficult emotions.

No matter what I’m doing, I try to explain the evidence base for the specific intervention when I’m working with physicians.

Physicians are already good at compartmentalizing their struggles. That becomes challenging because so much of their work leeches into and robs from their personal lives. I try to remind them that work is an essential and vibrant part of their life, but it’s not the only or most important part. I try to help them highlight the other important aspects of their identities to notice how much over-focusing on work costs the other parts of their lives. We work on self-advocacy, solidifying their identity and values so they can advocate for themselves and begin making decisions that align with their core values.

Yes, because so many of the stressors I’ve mentioned are systemic issues, they impact health care workers at all levels. The bottom line is that the health care system is struggling, and the people on the front lines are bearing the brunt of these issues. Physicians and all health care workers need our compassion, support, and most important, systemic changes.

Burnout and the sense of hopelessness often get worse when health care providers speak up about something or make changes in their work environments, but don’t see any improvement over time because leaders aren’t listening. I had a patient who left their position recently describe how her leadership had assumed “things had gotten better” for them when, in fact, my patient had just stopped bringing up their concerns. Eventually, even the most tenacious people stop speaking up.

I would encourage leaders to take time to truly listen to the providers they work with and consider concrete short- and long-term steps to address the issues that their providers identify. When someone tells you they are having a hard time with something, even if it’s with an organizational policy, consider the solutions they propose without penalty. Always take it seriously if a provider tells you they need something to change, especially if it’s affecting their ability to do their jobs well.