Physicians Taking Back Medicine: 'The Pitt' brings attention to physician wellness

Editor’s Note: Welcome to Physicians Taking Back Medicine, a podcast from Medical Economics. Hosted by Dr. Rebekah Bernard, each episode dives into the real-world challenges facing today’s doctors. The show will explore how doctors can reclaim their autonomy and shape the future of health care with candid interviews and actionable insights. Join Dr. Bernard and her guests each month as she guides you toward an empowered and sustainable medical career. The views expressed in the episode do not necessarily reflect the views of Medical Economics or MJH Life Sciences. Scroll to the bottom for show notes, including topics and timestamps,music credits and more.

Rebekah Bernard, M.D.

Host, Physicians Taking Back Medicine

Physician mental health is making headlines, thanks to the new HBO Max Medical Drama, The Pitt. If you haven't seen it yet, the program follows a team of emergency doctors and nurses led by head physician, Dr. Robby, who is managing a chaotic emergency department filled with boarding patients, drop-by administrators, and a score of medical trainees. At the same time, Dr. Robby is battling symptoms of post-traumatic stress disorder related to his previous experiences during the COVID-19 pandemic.

News outlets have picked up on the powerful physician response to this program, which has many doctors saying that they feel seen for the first time and applauding recognition of the importance of physician mental health. Others point to the show as a ‘call to action’ to improve the systemic flaws in our healthcare system that are causing a crisis in clinician wellbeing.

Mona Masood, D.O., and Nicole Washington, M.D., are psychiatrists who have long focused on physician wellness, founding resources to destigmatize and improve physician mental health. In 2020, Masood developed the Physician Support Line, a peer-to-peer network of volunteer psychiatrists offering free and confidential support to medical students and physicians. The line is available from 8 AM to midnight (ET) Monday through Friday. For physicians who need ongoing mental health care, Washington created Physician Mental Health, a directory of psychiatrists treating physicians.

COVID-19 accelerated work on physician wellness

While Drs. Mona Masood and Nicole Washington had been working on physician wellness for years, they said that their work accelerated during the COVID-19 pandemic. “I found myself discussing with colleagues, not just on this new virus, but also for the first time perhaps how we were doing—not only coping as physicians and this new role we found ourselves in, but how we were doing as human beings,” said Masood. “It was a conversation that I think we finally gave ourselves permission to speak about.”

As the pandemic developed, Masood said that she became alarmed at the conversations she was seeing on social media.“Physicians were telling each other how they felt, but they were saying it in a very intellectualized way—things like, ‘oh, does anybody have a good lawyer they use for writing a will?’” she said. “If you can read between the lines, they're saying that they're worried about their mortality, they're worried about not surviving this and what that would look like.” Masood said that she and other psychiatrists realized that something needed to be done. “We knew that we had to address this before it took over us or it ended us.”

Nicole Washington also noticed a need for increased physician support during COVID-19. “I bought the URL, physician mental health, back when I started my practice in 2017, thinking ‘I’ll probably do something with this one day,’” she said. “It sat in my dashboard for years untouched.”In March 2020, Washington began to notice physicians asking for psychiatry recommendations on social media and realized that there must be a better way for doctors to find mental health support.“We needed a central space for us to be able to go to find a psychiatrist who is willing to see another physician,” she said. “So that's kind of how I was born. I was on a locum’s assignment when the world was falling apart and it was in this hotel room that I was like, ‘okay, it's time to pull the trigger.’”

The importance of physician support

Mona Masood, DO emphasized that the Physician Support Line is not intended as a therapeutic doctor-patient relationship, but as a starting point for physicians in need of help. “It’s all anonymous. It is free of charge, and we don't report to anyone. You can call about any subject,” she said. “We have talked about anything from being burned out, if we even use that word anymore, to our frustrations with the healthcare system in America and moral injury of what we thought we were going to be as physicians and who we turned out to be and how that feels.” Masood said that callers may want to talk about family and marriage, loneliness and isolation, or lack of sleep. “It doesn’t have to be a crisis to call. It really is more important that you're giving yourself permission to center your own story and center your own wellness.”

For doctors that desire ongoing work on their mental health, Masood’s team provides resources. “If by the end of the call, someone is saying, ‘Wow, this was so eye opening to me on the benefits of working through something—I wasn't even aware of what I was actually going through and I would like to continue exploring this, then we have a number of resources for continuity of care,” she said.

One such resource is Nicole Washington, MD’s site, Physician Mental Health. “We have psychiatrists in most states, and since most of us are offering telehealth, it allows you to be able to get treatment outside your area, which is great for flexibility,” she said, noting that it also alleviates concerns that physicians have about ensuring privacy. “Most of us don’t want to see people that we may run into at medical society meetings or in restaurants or different activities around town,” she said. “Before telemedicine was popular, I had doctors drive three or four hours to see me because they didn’t want to be seen in their town.”

When to reach out for help

Rather than waiting for a crisis situation, psychiatrist Mona Masood said that physicians should seek help for early symptoms of distress, such as anhedonia and withdrawal. “Some of the first signs that you are not in the best place are if the things that you enjoy are not as enjoyable. If you’re not wanting to be around the people that you usually want to be with.” Masood said that it’s important for doctors to have an objective evaluation by a professional. “it’s like how we can't treat ourselves as physicians. In the end, we need somebody else to be more objective. It takes it off your shoulders and lets somebody else look at it and say, ‘Yeah, you know what, this doesn't sound so good.”

Psychiatrist Nicole Washington agrees. “We are used to functioning at a high level and we're used to running on fumes,” she said. “I think a lot of times we're not doing great, and we don't even know it because we just keep pushing through because that's the culture of medicine.”Washington said that physicians may have difficulty recognizing the need for help. “I have seen enough physicians over the years to know that we are horrible at recognizing how impaired we are,” she said. “I have even seen quite a few psychiatrists who have said, ‘It took me a while to realize that I was depressed or was having anxiety to the point that needed medication,’ and we’re in this every day.”

Washington said that it’s important to be self-aware and to listen to the voices of those around you. “If other people are telling you, ‘I think something's wrong,’ or you start to notice that functionally things aren't great,” she said. “And of course, if you’re experiencing hopelessness, thoughts that things would be better off if you weren’t here—even if not active suicidal thoughts—those are reasons to see a psychiatrist and have a medication discussion.”

Getting mental health treatment as a physician

Psychiatrist Nicole Washington said that doctors seeking help often express concern about repercussions from medical boards. “They will say, ‘Can you not create a record? Or can this be kept from the board?’” she said. “So, the first thing is, I don't report anything to the board. Boards don't just come to me and say, ‘Hey, are you seeing this doctor, or give me a list of doctors that they have licensed.’ You would have to have shared with them that you were seeing someone.” Further, Washington finds that most boards are not seeking to restrict licenses of physicians seeking help. “I write lots of letters to boards, I've spoken to lots of board representatives, and I have yet to have a board revoke somebody's license because of depression or anxiety,” she said.

Washington noted that many physicians prefer to pay out-of-pocket for visits to avoid insurance scrutiny, adding that many psychiatrists are cash based, due to the challenges of insurance reimbursement. Washington recommends that doctors talk with their accountants about whether the expenses can be used as a tax deduction. She said that most of her physician patients see her monthly when they start working together, but that she is generally able to taper that to every three to six months, depending on diagnosis and clinical symptoms.

In my research, I found cash pricing for an initial psychiatrist visit to be anywhere from $300-600, with follow-up visits running $150-300—and up. While this is not inexpensive, some consider psychiatric care as an investment in their future, noting the potential for financial gain as physicians feel better and become more productive. In addition, the overall cost of outpatient therapy may be less than many physicians pay for executive coaching and is far less expensive than losing the ability to practice medicine entirely.

Rebekah Bernard, MD is a Family physician in Fort Myers, Florida and the author of several books on healthcare, including Physician Wellness: The Rock Star Doctor’s Guide.

Music Credits

Medical Education by Art Media - stock.adobe.com

Episode timestamps coming soon.