Focus On: Physician Burnout
Focus On: Physician Burnout
March 20, 2020
4 min read

Physician Mental Health: ‘We are not Immune’

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Megan E. Riehl, PsyD
Megan E. Riehl

Navigating physician burnout starts with recognizing that we are not immune to the mental health issues that plague our profession on a national level.

Physicians perform at the top of their intellectual ability and are often willing to push themselves to extreme limits to achieve in various aspects of their lives. While we all operate in life with certain levels of anxiety, a health care provider may let some of that anxiety dictate how they make decisions that ultimately impacts self-care and healthy decision making. We worry that if we choose to lighten our load, something bad is going to happen. Or maybe we will miss out on career advancement. Negatively predicting the future is a common cognitive distortion associated with anxiety.

In reality, you’re good to nobody if you’re not good to yourself. One step to good self-care is setting personal boundaries without apology. If that means that you take some time off or, discuss openly with your colleagues about coverage or delegation, then so be it. If we can create a culture where that’s more acceptable and where we have each other’s backs, that allows people to practice better self-care. It also sets an example for young physicians like those featured in our cover story and medical students when we say it’s okay to step away from work and that it’s okay to vocalize the need for boundaries.

Modeling Good Self-care

Often, once we start to set some boundaries around our time, we actually benefit more, because we are not as burned out, we’re not as exhausted. Securing time to devote to passion projects can renew a sense of joy and energy that you won’t experience by saying yes to things that are not meaningful or cause resentment. We can learn boundary setting and practice it, in turn modeling it across your division or department.

Senior faculty can be a model and contribute to environments in medical settings that are more conducive to self-care and flexibility. Though there are often institution-wide changes that must occur, there are actions we as mentoring physicians can also take.

Riehl, pictured here with her family, reminds all physicians to really ask themselves ‘How am I doing?’ and to recognize each individual’s boundaries and personal needs when answering honestly.
Riehl, pictured here with her family, reminds all physicians to really ask themselves ‘How am I doing?’ and to recognize each individual’s boundaries and personal needs when answering honestly.
Source: Megan E. Riehl, PsyD.

When somebody stops by your office and their affect is a little off or they are looking a bit more disheveled, we can be the one that says, ‘Hey, how are you doing? How are you actually doing?’ Look them in the eye and connect with them. Genuine human connection goes a long way. If you create that space where a colleague or a medical student that you’re mentoring feels safe, it opens up the lines of communication to potentially help them assess what kind of support they need.

Advocacy Needed

We do recognize that physicians are in a conundrum in some states when they seek professional support. In some areas, if a physician discloses a desire to seek out mental health care, and if they want to use insurance, they have to have a mental health diagnosis. Then, in some states, you’re mandated by your licensing boards to report that diagnosis and you can be benchmarked for it.

These restrictions can prevent physicians from seeking out the most evidence-based care for very common symptoms such as anxiety and depression. At the worst, physicians may use unsafe means to get prescriptions or even self-medicate with substances. But even at the best, it further stigmatizes that if you have a mental health condition that there’s something wrong with you. And that’s not the case.


There’s advocacy work that needs to be done around physicians and their mental health care, confidentiality and privacy.

Open Dialogue, Changing Pressures

Each physician has to make the decision that’s best for him or her, even if it means cutting down hours or going part time. That decision doesn’t have to be forever. It can be what you need at a certain point in your personal or professional life.

We have to conduct open conversations about what we each need with our employers and supervisors. We must push past the fear of the ‘what ifs’ to say clearly, ‘This is what’s going on in my family right now. I am devoted to my career. I’m motivated. But I also need some flexibility. How can we work together so that I can continue on my career trajectory, but also my commitment to my family?’

We have to acknowledge that our feelings change – children are born, parents grow old, relationships matter in our personal lives. You might think it’s going to be one way, then something happens to motivate you in a very different way. Instead of making assumptions about what the reality is going to be in your work environment, allow yourself the space to have open dialogue. Without those discussions, you will never see the advocates you have in your supervisors – women who have navigated motherhood and medicine or men who have balanced caring for a sick parent or a mentor who can help advocate for you in your passion projects.

OK not to be OK

It’s OK to not be OK. If you really ask yourself, ‘How am I doing?’ and if the answer is ‘I’m not doing very well,’ mental health services can change your life. Too many people get comfortable just being uncomfortable.

We can let the needs of others or the brief professional successes overshadow how we are truly feeling. When the brief burst of endorphins from an achievement passes and you feel yourself overwhelmed, lacking energy and feeling dread about how you will make it through until your next academic or professional win, it doesn’t have to be that way.

There are ways to find joy and peace on a day to day basis. But you may need some professional guidance to learn how to achieve this. Therapy doesn’t have to be forever, but it can have a swift impact on your outlook. As anxiety or depression lifts, your energy, your mood, your activity level improves, and all of that makes your quality of life a lot better. So, if you’re not feeling OK, it’s OK. Take the time now to ask yourself what you need to make health changes.

– Megan E. Riehl, PsyD
Clinical psychologist
University of Michigan