Depression, Burnout & Wellness: Lasting Pandemic Lessons for a Rural Physician

Throughout the COVID-19 pandemic, mental health issues cropped up with physicians, nurses, and other healthcare workers who found themselves confused, strapped for resources and many times, unappreciated for the risks they were taking. In addition, many were afraid of bringing the disease home to their loved ones, adding to the toll of their mental stress. A survey of 20,947 physicians and other healthcare workers found that 61% of those surveyed were extremely concerned that they would be exposed to the virus and/or they would expose their loved ones. Approximately 38% self-reported experiencing anxiety or depression; 43% suffered from work overload, and 49% had burnout.

As the sole pulmonologist at The Bellevue Hospital in Bellevue, Ohio, a hamlet of just over 8,000 people, ACOI member, Nathan P. Samsa, DO, FACOI, felt overwhelmed by pressures and expectations brought on by the pandemic that neither his community, nor the U.S. as a whole, could have foreseen. He was the only physician at his hospital who was managing the patients on ventilators and oxygen in the COVID ward. He acutely felt the health emergency as did many rural communities where approximately 6.6 million COVID-19 cases and more than 175,00 COVID-19 related deaths (as of June, 2022) have been recorded according to the USA Facts and Centers for Disease Central and Prevention.

Overwhelming Demand and Physician Burnout

Dr. Samsa was under immense pressure because he simply had no other place to send patients or to find additional help. All the hospitals in nearby communities were closed to new patients. While the cumulative death rates for COVID-related deaths per 100,000 population initially was higher in metropolitan areas at the beginning of the pandemic, that changed in December of 2020.

For under-resourced rural communities, the problem became much broader than just the physical resources of PPE, ventilators, and other equipment. The mental toll overwhelmed many providers, who like Dr. Samsa were desperate for credible, up to date COVID information. He relied peer-reviewed journals and local health department trends to source information on the virus instead of the CDC.

The stress for Dr. Samsa was compounded by the lack of downtime and inability to enjoy his family. Additionally, the variety of unknown situations that cropped up regularly thrust him into even more challenging situations, adding to his stress. He was too often being confronted with treating patients and performing procedures he normally would have sought outside help with. Dr. Samsa recalls spending 16-18 hours at the hospital daily. That toll was also felt by his 7- and 11-year-old children who resorted to writing letters to him telling him how much they loved and missed him.

Exerting further pressure on Dr. Samsa and The Bellevue Hospital were requests from other overwhelmed facilities, even Michigan hospitals, located across the northern border from Ohio, that ran out of beds and desperately tried to find places for their patients. While they tried to accommodate as best they could, it quickly became too much. The high demand, long hours, time away from family, and confusion over what information to rely on added to the mental health stress.

When Dr. Samsa recognized that he was headed to a “dark place,” feeling burnt out and depressed, he gave himself the permission to slow down, a tactic less than 30% of physicians take to alleviate their burnout. The perception for many physicians is that they are not allowed to stop and take a break and step away. The duty of obligation casts a long shadow over them and the notion that they must live up to a superhero status that they either self-assign or that society affixes onto them. As a result, they are rendered fearful of disappointing their employers, their patients, their family members and many times, their profession when they begin to feel overwhelmed, depressed, and burnt out.

One study found that doctors who stepped away from work dealing with their own mental health issues felt guilty and shamed. Along with a sense of fear and failure, doctors often sink into feelings of inadequacy. The researchers found that physicians suffering from mental health conditions felt overwhelmingly stigmatized by friends, family, and peers. Feeling isolated and distressed, some of the doctors kept their struggles to themselves choosing to pretend they were fine and continuing to go to work each day rather than admit to their mental health challenges.

The study also revealed that doctors experienced lack of support from colleagues, leading to their own internal stigma they took on from what they perceived as the negative judgment of their colleagues. Stigma was also a key feature of another survey of almost 2000 doctors essentially leading to the conclusion by the study’s lead researchers that “fewer professions stigmatize mental health disorders more prominently than medicine.”

What Can be Done to Reduce Physician Burnout?

According to the Physician Burnout & Depression Report 2022, physicians reported that the following would help them reduce their burnout:

• Having a more manageable work schedule – 39%
• Increased compensation to avoid financial stress – 38%
• Greater respect from administrators/employers, colleagues, or staff – 36%
• Increased control/autonomy – 36%
• Lighter patient loads – 33%
• More support staff—33%
• Fewer government regulations – 26%

Dr. Samsa set his own boundaries and came to peace with the knowledge that he could only do what he could do. In short, he halted the superhero expectations that he had previously placed on himself. He recommends others feeling the way he did do the same and come to terms with accepting their own limits. He adds that asking for help and getting counseling is a sign of strength, not weakness.

He also believes that physicians need to accept that they are susceptible to burnout and that they may need help. Yet nearly half of all physicians believe they can deal with their burnout or depression without the need for professional assistance. Sadly, 43% are afraid to risk disclosure to their medical board; 32% are concerned about it being on their insurance record; 25% are concerned about colleagues finding out, and 22% are afraid that the medical profession will shun them.

Resources for Physician Burnout

Physician Support Line: A free, confidential psychiatrist-staffed support line for doctors and medical students. 1 (888) 409-0141.

National Suicide Prevention Lifeline: Open 24/7 and offering free, confidential support for all—doctors included—and their loved ones. 1 (800) 273-8255.

American Foundation for Suicide Prevention (AFSP): AFSP offers support for those having thoughts of suicide, people who have lost someone to suicide, those who have concerns about someone’s mental health, and people who have survived suicide attempts. 1 (800) 273-8255 or text TALK to 741741.

PeerRxMed: A free support service that partners doctors with peers to help navigate physician burnout, resignation, isolation, and distress.

MeaningfulDoc | Promoting Physician Well-Being: This app was launched by ACOI member, Britton Jewell, DO, FACOI in August, 2020. Developed to be a proactive resource, Dr. Jewell wanted to provide an additional resource addressing physician burnout that provided regular inspiration and support for his colleagues.