Physician Mental Health Care Visits Increased 27 Percent During the First Year of the COVID-19 Pandemic
01/21/2022
Annual rates of outpatient visits for mental health and
substance use among Ontario physicians increased by 27 percent during the first
year of the COVID-19 pandemic, according to a study published in JAMA
Network Open. There were 1,038 visits per 1,000 physicians during the first
year of the COVID-19 pandemic, compared to 817 in the previous year.
Overall, there were 26,266 mental health visits made by
physicians in the year before the pandemic compared to 31,936 in the first year
of the pandemic.
The proportion of health care visits by physicians related
to mental health also increased. Pre-pandemic, 23 percent of all outpatient
visits by physicians were mental health visits. In the first five months of the
pandemic, this increased to 28.3 percent, then returned to 23 percent during
the next seven months as all-cause visits increased.
Physicians, like other health care workers, faced enormous
work-related stressors during the pandemic. These included potentially greater risk of exposure to COVID-19, concerns of
infecting their friends, family and colleagues, and challenging workloads.
“Surveys of physicians during the COVID-19 pandemic have
found increased reports of depression, anxiety and burnout. However, because
these surveys generally only capture a single point in time and many had a very
low response rate, it was unclear how reflective they were of physician mental
health overall,” said lead author Dr. Daniel Myran, a family physician, public
health and preventive medicine specialist, and postdoctoral fellow at the
University of Ottawa Department of Family Medicine and The Ottawa Hospital. “To
help understand how COVID-19 has been impacting physician mental health we
looked at changes over time in health care visits by physicians.”
Dr. Myran and his colleagues linked anonymized data from
34,000 practicing physicians in Ontario to the health administrative databases
at ICES. They looked at all in-person and virtual care outpatient visits to a
psychiatrist or primary care physician that were coded as related to mental
health or substance use.
The study’s findings suggest the pandemic has placed a
considerable strain on the mental health of physicians. “We found a large
increase in mental health visits by physicians during the first year of the
COVID-19 pandemic, which raises real concerns about worsening physician mental
health,” said Dr. Myran. “We found that more physicians were accessing mental
health services during the pandemic, and that physicians who accessed services
did so more often.”
“Physician mental health can be a sensitive topic, so
protecting physician privacy was a key part of this innovative research. A
specialized team ensured all physician data was anonymous and that it was never
possible to identify an individual physician,” said co-senior author Dr. Peter
Tanuseputro, a physician-scientist at The Ottawa Hospital, ICES, and the
Bruyère Research Institute and assistant professor at the Department of
Medicine, University of Ottawa.
There were no significant differences in increases of mental
health visits between men and women, older and younger physicians, urban or
rural physicians, or between physicians who cared directly for patients with
COVID-19 in the emergency department or admitted to hospital and those who did
not.
“We were surprised to see no change in mental health visits
by physicians who provided direct care to COVID-19 patients in hospital, as in
other studies they reported greater mental health impacts,” said co-senior
author Dr. Manish Sood, a physician-scientist and Jindal Research Chair for the
Prevention of Kidney Disease at The Ottawa Hospital, and associate professor at
the University of Ottawa. “We did notice that this group of physicians, which
included individuals in critical care, emergency medicine and internal
medicine, already had lower rates of mental health visits pre-pandemic. This
could mean they have greater resilience, more reluctance to seek care, or have
work schedules that are a barrier to seeking care. However, it’s important to
note that our study only looked at the first year of the pandemic, and the situation
has changed since, particularly with the omicron variant now putting incredible
pressure on the healthcare system.”
The researchers note that the expansion of virtual care
options during the pandemic may have played a role in increased mental health
visits by physicians.
“There is a lot of stigma in the medical profession when it
comes to mental health and accessing services,” says Dr. Tanuseputro. “It’s
possible that virtual appointments reduced some of these barriers because they
fit more easily into a physician’s schedule and were less visible to their
colleagues.”
Aside from insights into the COVID-19 pandemic, the research
team also noticed some general patterns about mental health visits by
physicians when they looked at the over 50,000 visits included in the study.
First, female physicians had higher rates of mental health
visits compared to male physicians (1,059 per 1,000 physicians vs. 596 per
1,000 physicians), which is consistent with what’s seen in the general
population.
Second, some specialties had far more mental health visits
than others. For example, psychiatrists had the highest rate of annual visits
at 3,442 per 1,000 physicians while surgeons had the lowest rate of visits at
370 per 1,000 physicians.
“Not all physicians are the same, and some specialties face
different pressures and realities. The differences we saw between specialties
may be explained by specialty-specific attitudes towards seeking care for
mental health,” said Dr. Sood. “For example, previous studies have shown that
many psychiatrists report routinely attending therapy for both personal and
professional reasons, while other work has highlighted that surgeons are less
likely to seek mental health care due to perceived stigma. These findings
suggest on ongoing need to destigmatize physician mental health, and to
encourage physicians to seek mental health care when they need it.”
“While the pandemic may have exacerbated physician mental
health concerns, our study suggests that many of these concerns predate the
pandemic,” said Dr. Myran. “Going forward, mental health interventions for
physicians should focus both on stressors specific to COVID-19 as well as
pre-pandemic factors, many of which may require system-level changes and
reinvestment in the healthcare system.”
“Physicians were experiencing burn out from overburdened and under-resourced
health systems long before the pandemic,” says Dr. Katharine Smart, President
of the Canadian Medical Association. “This study illustrates the impact of the
pandemic on an already exhausted physician workforce. When we talk about health
system capacity, we are often talking about people — the physicians, nurses,
and many other health professionals who care for us all. We must prioritize
their health and well-being as we navigate future waves of the pandemic and
plan for a post-pandemic health system.”
This study was funded by ICES, Canadian Institutes for
Health Research, the Canadian Medical Association, and the Academic Medical
Organization of Southwestern Ontario. Data sources include ICES and the Canadian
Institute for Health Information. This was the first published study from HELP MD, a novel
data-driven research initiative to better understand and improve physician
health and wellness, funded by the Canadian Medical Association.
Mental health resources for physicians
Full Reference: Trends in Physician healthcare
visits for mental health and substance use during the COVID-19 pandemic in
Ontario, Canada. Daniel Myran, Nathan Cantor, Emily Rhodes, Michael Pugliese,
Jennifer Hensel, Monica Taljaard, Robert Talarico, Amit Garg, Eric McArthur,
Cheng-Wei Liu, Nivethika Jeyakumar, Christopher Simon, Taylor McFadden,
Caroline Gerin-Lajoie, Manish Sood, Peter Tanuseputro. JAMA Network Open. Jan
21, 2022.
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