Three noted psychiatrists offered advice on dealing with the stress and burnout associated with practicing in the time of the COVID-19 pandemic, during an MDLinx webinar held Oct. 13, 2022.

The webinar, “The psychiatrists' report: A discussion on the state of our own mental health,” was moderated by Kristen Fuller, MD, an MDLinx medical advisory board member and writer (who contributes the weekly Real Talk column, among other features).

Watch the recorded webinar here.

Based on MDLInx's The psychiatrists' report: The changing state of our own mental health, this was the first in a series of MDLinx webinars to provide peer support and practical information to clinicians.

The panelists included Amanda Zeglis, DO, MBA, president of Premier Psychiatry, LLC, who has 9 years of experience in psychiatric medicine and was the primary author of the aforementioned report; Melissa Shepard, MD, a practicing psychiatrist and psychotherapist; and Maryna Mammoliti, MD, FRCPC, a Canadian psychiatrist and certified executive coach.

We've summarized the panelists' key takeaways and advice below.

 

Impact of telepsychiatry

Dr. Fuller asked the panelists about which factors they felt most impacted their work lives in terms of their own mental health and physician burnout.

Ever since the COVID-19 pandemic came about, there’s been a significant increase—in both a positive and negative way—in the patient population.

“Telepsychiatry was on the forefront, thankfully, before the pandemic,” Dr. Zeglis continued. “But once COVID hit, it really kicked things up a notch. … Telepsychiatry became the only way to access [care] in a majority of cases. … It was a good thing to feel like we had access to—and were able to serve—more people.”

Dr. Shepard stressed that caring for patients is its own reward. “If you can find meaning in what you’re doing,” she said, “that’s a big part of where compassion fatigue or burnout can be healed.” She said the additional administrative tasks that come with telepsychiatry can add to a practitioner’s frustrations, however. “I think that can be a lot more burnout-inducing” than treating patients, she said.

“As much as telepsychiatry allowed us to sustain access for our patients, it also eroded some of our boundaries,” said Dr. Mammoliti. “It eroded when we started doing it from home because you didn't have that break from leaving your office or hospital.” She felt this lack of separation between home and office could be more emotionally draining than working in a professional setting.

 

Counteract burnout

Dr. Fuller asked the panelists if they had any suggestions for counteracting burnout and maintaining their passion for practicing medicine.

One strategy Dr. Shepard suggested was a tactic she learned in medical school of adding comments to the “one-liner” in patient notes. “Instead of ‘42-year-old male with diabetes who presents with sepsis’ being the one-liner, [the attendings] would add in something personal and human about the patient, such as ‘42-year-old male who loves gardening and has two kids, has a history of diabetes and presents with sepsis.’ Somehow that changes everything when you approach that patient. In some ways, it just reminds you of why you got started in all of this. … It’s a tiny change that maybe will help you get some of that passion back in a subtle way.”

She also spoke of how some physicians keep a “thank-you drawer” to collect notes of gratitude from patients. “You keep it in this box, and if you're having a bad day, go in there, open it up, read about how you helped somebody, and it can give you energy to keep going,” she said.

 

What’s causing burnout?

Discussing causes of burnout, Dr. Fuller suggested that dealing with insurance providers and lack of administrative support may be contributing factors. Dr. Zeglis felt the convergence of a shortage of psychiatrists and therapists with a critical rise in demand due to the pandemic was another major cause.

We forget sometimes that we're also humans who are dealing with a pandemic and real-life things.

Dr. Shepherd recalled an instance when her husband was sick during the pandemic. “I had this crisis at home that I had to deal with,” she recalled, “while also struggling with the fact that I couldn't turn off my private practice, and people who needed help.”

Dr. Mammoliti said the increase in patient expectations that’s occurred since the onset of COVID-19 is a stressor. “Everybody has these expectations that somehow we're going to fix these things that we just can't,” she said. “It did escalate in the last couple of years. … There's all this increasing demand when we're still the same people, we still have the same training. … So that resulted in a lot of conflict.”

 

Sharing mental health status

Dr. Fuller asked the panelists if they had ever talked about their own mental health on social media, or with patients or colleagues.

Dr. Shepard recounted how doing so ultimately helped patients. “During the pandemic, I noticed when I started talking about some of my struggles, people started coming out of the woodwork and saying, ‘That’s something I experience too,’” she recalled. “I’ll get messages all the time saying things like, ‘Thank you so much for talking about this.’ We're all a lot less alone than we realize. We're just not talking about it a whole lot.”

“Deep societal stigma is still there and is going to take a while to undo,” Dr. Shepard added. “And that's part of why it's so difficult for us to talk about it.”

“It also depends on your environment,” Dr. Mammoliti said. “Many physicians are in very toxic workplaces where talking about mental health is going to be used against you. … Peer support is one of the best anti-burnout ways of dealing with that or even [with] processing difficult patient cases. When we're triggered by our patient cases—whether it's because you have been threatened or because it's a sad case, you know that peer support in disclosing your emotional distress, that's all about emotional safety in your work environment.”

 

Toxic environment red flags

Dr. Fuller asked the panelists what advice they’d offer medical students about dealing with a toxic workplace.

Leave. Survive and leave.

“Start planning your exit before you know there is a big issue,” Dr. Mammoliti said. “I always teach that to my medical students who rotate with me, to say, ‘Look, this is a job. There's lots of jobs. It's not a failure. It's a change. It's not working for me. I'm changing.’”

“We put a lot of pressure on ourselves to make things work,” Dr. Shepard said. “And not just in our jobs, but in life in general, we tend to stay in these toxic environments a lot longer than we should.”

Dr. Mammoliti described a toxic environment as one “where I expect you to be exactly like me, and if you don't see things the same way or do the same things, it's a betrayal.” In toxic environments, she added, saying no to taking on an extra shift or patient, or to joining a committee, are seen as offensive behavior.

Dr. Zeglis mentioned that some physicians, such as those in rural areas, don’t have the option to change jobs. In such instances, she suggested finding time to disconnect from the toxic environment, and prioritizing self-care in simple ways like having an extra cup of coffee or taking a longer shower.

 

What would help?

Dr. Fuller asked the panelists if they thought more time off, shorter work shifts, higher compensation, and fewer administrative duties would help prevent burnout.

“Everybody is a different person,” Dr. Zeglis responded. “I think certain situations will help some people.” She felt money wasn’t always the answer, nor was reducing tasks. She predicted a shift in these factors, based on how well physicians can communicate their needs, and how receptive leadership is to finding compromises.

There’s really no amount of money somebody can pay me to burn out even more.

“I'm a huge fan of taking time off, going on vacation, and spending more time away from medicine," Dr. Fuller continued. “It depends on the individual and how they can unwind and heal themselves.”

 

Should physicians seek therapy?

Dr. Fuller asked the panelists if they thought mental healthcare should be mandated for physicians.

Dr. Mammoliti said she didn’t like the concept of “mandated” because it implied forcing people, and in her experience with patients, when therapy is mandated, “there’s no growth. It’s a waste of your time as a psychiatrist or therapist.”

She suggested that therapy for young physicians during medical school would be very helpful, “because we bring a lot of baggage into medicine, but also if there is abuse that starts in medicine. ... So if we had therapy from the beginning, it would help a healthier formation of your physician identity in terms of allowing you boundaries. … I think that might be a much better intervention.”

Dr. Shepard felt that providing physicians the time and money for therapy would be very helpful, as mandating it without offering such help would just frustrate them more.

“There should be more options,” Dr. Zeglis said, “and [they] should be readily available as opposed to, ‘Where do I find it? How do I go about doing it? How do I know that my privacy is going to be protected?’”