BY SANDRA JACOBS, VITAL SIGNS EDITOR
Illstration by Sioux Waks
While recent years have been punishing to physician mental health and overall well-being, an increased focus on this crisis has spurred action. As a result, stigma is starting to decrease and barriers are lowering for physicians seeking and receiving
help in Massachusetts, report leaders of MMS Physician Health Services (PHS).
“Our numbers are up in terms of the number of calls we are receiving,” says Mark Albanese, MD, medical director of Physician Health Services, an MMS corporation. “This is not surprising. People have finally gotten to the point of starting to overcome
some of the obstacles that might have prevented physicians from asking for help.”
A nonprofit corporation founded by the MMS, PHS aids physicians who have health conditions and personal and professional challenges, including alcohol and substance misuse, burnout and stress, psychiatric and mental health concerns, emotional trauma,
and medical, physical, or neurocognitive conditions potentially impacting the practice of medicine.
PHS annually supports about 400 Massachusetts medical students and physicians who are experiencing health-related and other challenges that have the potential to impact their work. Those who are referred to or seek out PHS receive an assessment and
confidential guidance and direction toward the most appropriate and helpful resources, which may include peer support, referral to treatment, and, for some, monitoring in conjunction with an Occupational Health Monitoring Agreement.
Mental Health Exceeds Substance Use as a Reason for Seeking Help
Historically, alcohol or substance misuse has been the leading reason for PHS referral. But in 2023, mental health (including burnout and stress) was the most common presenting problem, accounting for 30% of referred and self-referred individuals.
Substance use was the second most frequent presenting problem (25%), followed by problematic workplace behavior and communication (24%).
Increasingly, physicians are also seeking out PHS on their own, Albanese says. In 2023, self-referrals accounted for 37% of initial, confidential consultations; 34% were referred by an individual’s medical leadership or organization. Other referrals
came from training programs (9%); health providers such as primary care providers, psychiatrists, and therapists (6%); the state Board of Registration in Medicine (5%); and attorneys (4%). Another change is that more women are now seeking out
PHS than previously.
Increased Acknowledgment of Need Drives Reduction in Stigma
The obstacles to mental health care have long roots within a culture of health care in which physicians traditionally don’t ask for help for themselves, abetted by the licensing and stigma repercussions of doing so, says Albanese, a psychiatrist and
addiction specialist on the faculty of Harvard Medical School who served for 25 years on the PHS Clinical Advisory Committee before joining PHS staff.
But he sees “good news” of late. He points to the recent improvements in two processes that deterred physicians from seeking help. For example, the Massachusetts Board of Registration in Medicine has updated the licensing and relicensing application
questions related to health conditions. The questions are now less stigmatizing and intrusive, and they support involvement with PHS. In the same vein, Massachusetts soon after became the first state in which physicians, hospitals, health systems,
and local health plans worked together to destigmatize health questions in credentialing and recredentialing applications. Both changes resulted from significant advocacy by the MMS and like-minded partners.
Importantly, Dr. Albanese says there is a greater understanding — especially in the C-suite — of the administrative burdens on physicians, the crushing stressors of the pandemic, and its lingering repercussions. “Health care leadership in general
now gets it,” he says. “There’s an acknowledgement that there wasn’t three, four, or five years ago. The message wasn’t reaching the C-suite.”
Since 2018, the Massachusetts Medical Society and Massachusetts Health & Hospital Association have joined forces on a joint task force to address burnout. The task force, which has recently expanded to include allied clinician groups, meets regularly
to raise awareness about burnout and advocate for change within their own organizations and beyond.
Acknowledging Physician Trauma
Albanese notes an increasing acknowledgement that medical professionals, along with the rest of society, have been through this shared, global traumatizing time. “At least here in the Northeast, we are more open to talking about being traumatized,
being burnt out. It wasn’t so long ago that it wasn’t talked about,” he says. “But [even here], we never would have used the word ‘traumatized’ 10 years ago [to describe physicians].”
Executive Director Paul Simeone, PhD, MA, joined PHS in April 2023, directly from Southwest Florida’s Lee Health system, where he was vice president and chief medical executive of Behavioral Health. A clinical psychologist, he previously taught at
Harvard Medical School and other institutions for 30 years and served as associate director of Outpatient Psychiatry at the Cambridge Health Alliance.
Programs such as PHS, Simeone says, should be regarded as a public utility, with the purpose of providing confidential, highly skilled, and compassionate services to doctors and their families and contributing to a healthy physician workforce. “The
medical community, particularly physicians, the Board of Registration in Medicine, and hospital systems rely upon us for consultation,” says Simeone. “They would be bereft without our services.”
Preparing for the Next Generation of Physicians
Two active, long-standing PHS committees are conduits for learning about emerging needs for medical students and trainees. The Medical School Advisory Committee is a forum for medical schools to exchange information on student health, wellness, and
professionalism and to help develop strategies to educate and assist students who have, or who are at risk of having, problems with substance use, behavioral issues, or physical health. The Graduate Medical Education Committee provides a forum
to enhance awareness of PHS for training programs and, similarly, assists trainees who have, or are at risk of, behavioral or physical health problems or professional concerns.
“Our focus is to review our whole program and update where we need to in preparation for the next generation of physicians,” Albanese says. “They bring their own worldview to health care. We want to serve those who are just coming out of med school.”
Physician Health Services (PHS): Learn more at massmed.org/phs or email PHS@mms.org. To refer a colleague or yourself, call PHS confidentially at (781) 434-7404. You will speak with a mental health professional who will explain the PHS role, confidentiality, independence from BORIM, and next steps. Consultations are free, confidential, and voluntary. More information is available in the PHS 2023 Annual Report.
See recent MMS advocacy on physician burnout and well-being here.
