Mental health in sports medicine
introduction
The mental health of sports medicine physicians and providers can overall be difficult to evaluate. This week’s post will be a little different in light of some recent events that have occurred personally. It made me take a step back, think about and realize some things about our profession.
Mental health and physicians can be a very difficult thing to evaluate for many reasons. Most mental health studies are by survey, as that is one of the only ways to measure certain metrics. There are no lab studies or strength tests to calculate.
The mental health perils of fellowship-trained sports medicine physicians (FTSMPs) have become more prominent with the dawn of the coronavirus disease 2019 (COVID-19) pandemic. These dangers include emotional anguish, sleeplessness, alcohol/drug abuse, indications of posttraumatic stress disorder (PTSD), hopelessness, apprehension, fatigue, antagonism, and higher perceived stress [1].
One recent study by Stavitz did specifically evaluate mental health issues and FTSMPs specifically in 35 physicians. Of the participants, 30 FTSMPs detailed that “mental health” was tough to label; however, based on personal understandings, most contributors professed that mental health is a facet of one’s natural life that affects one’s fitness to execute everyday responsibilities [2].
The results propose that the FTSMPs’ view of dealing with mental health encompasses a customized methodology with the impartialness of refining one’s total well-being and working life. Unambiguously, the contributors may have suffered mental health troubles due to the absence of management skills relative to their specific issues. Thus, the lack of coping skills may distress one’s decision-making and endanger their ability to treat their patients properly [2].
Image 1: General mental health theme and thoughts. Adopted from [2].
Physicians reported areas that cause stress and anxiety were patient care, busy schedules, family, and finances. Most participants were most strained about stabilizing their family’s schedule, work, individual schedule, and social life. Of the contributors, 22 felt pressures related to the high volume of their patient caseload. As FTSMPs, many participants were stressed by the conjecture that their patients relied on them to be mentally strong [2].
The participants faced extrinsic hindrances to looking for help for mental health. External barriers were their responsibilities to their communities, public view, insurance, other expenditures, and finding a mental health professional. Most participants communicated that, as FTSMPs, they were torn between their work and personal lives [2]. This can be a very difficult thing for physicians, especially if they live in the community that they work. Public view can be a strong deterrent for individuals to seek help for mental health issues. Despite spending numerous years in academia and preparing to become physicians, many participants noted the stigma of humiliation when seeking mental health care.
Figure 2. Barriers to mental health. Adopted from [2].
The American Medical Association estimates the cost of physician burnout in the United States at 4.6 billion dollars annually [3]. It was recently reported that a family physician seeing patients for 28 hours per week spends an additional 7.5 hours per week completing charts and other clerical patient care duties during evenings and on weekends [4]. This out of clinic time commitment takes away from the personal time required to maintain health and wellness and lends to burnout.
Shanafelt et al. reviewed Maslach survey results for 2011, 2014, and 2017 and found an overall rate of physician burnout of 51%, with family medicine ranking third among specialties at 55%. These surveys were widely distributed, and although the return was less than 20%, the results are assumed to reflect the state of physicians as a whole. It makes one think back and realize that at one point half of physicians reported burnout.
Among physicians, depression prevalence is similar to the general population (estimated at 12% for men and 19.5% for women). However, the suicide rate for physicians is 1.4 times greater for men and 2.3 times greater for women than the general population [6].
High doctor suicide rates have been reported since 1858 [6]. More than 160 years later the root causes of these suicides remain unaddressed. Physician suicide is a global public health crisis. More than one million Americans lose their doctors each year to suicide—just in the US [6]. One provider has made a registry of reported physician suicides with this number reaching more than 1,000 as of 2018. Of these 1,013 suicides, 888 are physicians and 125 are medical students. The majority (867) are in the USA and 146 are international. Surgeons have the greatest number of suicides on my registry, then anesthesiologists [6].
Figure 3. Physician suicides by specialty. Adopted form [6].
From Dr. Pamela Wible, MD: “Ignoring doctor suicides leads to more doctor suicides. Let’s not wait until the last few minutes of a doctor’s life when heroic interventions are required. Most physician suicides are multifactorial involving a cascade of events that unfold months to years prior. “
The previously mentioned study’s outcomes have strong inferences regarding how FTSMP employers can and must do more to support themselves, their families, and their patients. Failure to produce a maintainable work–life balance and offer appropriate access to mental health care may lead to enhanced FTSMP burnout. This consequence is very harmful not only to the provider themselves, but also to patients and medical institutions alike. However, the results of this study advocate that private practices and hospital systems can fundamentally and applicably ameliorate this issue through increased staffing and insurance plans that cover mental health services [2].
Summary
In summary, fall season is coming for sports medicine providers. This includes our entire teams with medical assistants, front office staff, athletic trainers, and colleagues. The fall season is typically the most busy and stressful for providers. Sometimes we need to be mindful of our situation and realize when rest or help is needed. Most providers are so used to stretching themselves thin for their patients and athletes that thinking about themselves and their current state does not occur. This can build for many years and affect personal lives significantly.
In memory of Dr. James Masterson, DO.
References
- Singh, G.P. Psychological impact of COVID-19 lockdown: An online survey from India. Indian J Psychiatry 2020, 62, 593.
- Stavitz J, Eckart A, Ghimire P. Exploring Individual Mental Health Issues: A Qualitative Study among Fellowship-Trained Sports Medicine Physicians. International Journal of Environmental Research and Public Health. 2023; 20(7):5303
- Roberts, William O. “Wellness and life balance for sports medicine physicians: Recognizing physician burnout.” Current sports medicine reports 19.2 (2020): 50-52.
- Reddy S, Rippey PC, Cuenca AE, et al. Seven habits for reducing work after clinic. Fam. Pract. Manag. 2019; 26:10–6.
- Shanafelt TD, West COP, Sinsky C, et al. Changes in burnout and satisfaction with work-life integration in physicians and the general U.S. working population between 2011 and 2017. Mayo Clin. Proc. 2019; 94:1681–94.
Wible, P., 2014. “When doctors commit suicide, it’s often hushed up.” Washington Post.
