No single thing drives a physician to feel unwell.
Now three years since the start of the pandemic, any health care worker can point to public distrust, isolation, personal protective equipment, high patient mortality rates, burdensome insurance regulations, a changing health care landscape, and more as reasons behind burnout – and new obstacles seem to appear at every turn.
Physicians in several Texas counties can find assistance in their county medical society’s counseling services: Bexar, Dallas, Harris, McLennan, and Travis county societies all have independent programs for mental health assistance, ranging from courses to confidential talks with psychiatrists.
But physicians in smaller or rural counties may have nowhere to turn when burdens become too heavy. In light of that discrepancy, and freshly recommitted to its “Wellness First” mission since last fall, the Texas Medical Association’s Committee on Physician Health and Wellness took to the task.
“[Resources are] not equitable across the state. So, TMA is filling in the gaps, especially helping to support our physician colleagues that are practicing in more rural areas or in counties that aren’t as resource-rich, so they also have the support they need, as those colleagues oftentimes are practicing in more isolation,” said Michelle Owens, DO, a member of TMA’s Council on Health Service Organizations, and co-chair of the Travis County Medical Society’s Physician Wellness Program. “Being able to extend that olive branch so that they can feel supported and remembered and valued is really important.”
By taking the initiative to destigmatize mental health care and provide access to it, Dr. Owens says TMA can be a role model to other organizations, which will reinforce the fight against burnout.
“TMA is an organization that’s very well respected and trusted. By them saying, ‘Hey, listen, we think this is important’ – hopefully that helps other Texas health care organizations see that.”
With an eye to physician burnout, TMA learned of a program equipped for the job: Anticipate Joy, a Texas-based service led by two clinical psychologists, Karla Evans, PhD, and Veronica Tetterton, PhD.
In January, powered by a grant from The Physicians Foundation, TMA’s contract with Anticipate Joy began.
Anticipate Joy offers 30-minute counseling sessions, available by phone, video, or text, to physicians and nonphysician family members, regardless of TMA membership status. TMA’s collaboration with the program is a loud and proud way to support mental health, something TMA leaders say is particularly needed in medicine.
For decades, physicians in Texas have held concerns about seeking mental health care. At the height of the pandemic, especially, when physicians needed help most, the pressure to present a strong front kept them from care, says E. Linda Villarreal, MD, an internist in Edinburg and TMA president from 2021 to 2022.
Physicians were “fearful that if we got depressed and acknowledged it, it would be a kink in our personality or character,” she said.
Such fear may in part be due to Texas licensure rules. For many years, when applying for or renewing a medical license, physicians would be asked if they’d ever sought care for mental illness.
“There were concerns of retribution, or even potential denial of being able to practice in this state, if you had said yes, you had sought treatment,” said Dr. Owens, a hospice and palliative medicine physician in Austin.
Since her initial licensure, the Texas Medical Board’s verbiage has changed, now asking: “Are you currently suffering from any condition for which you are not being appropriately treated that impairs your judgment, or that would otherwise adversely affect your ability to practice medicine in a competent, ethical, and professional manner?”
But the fear of punishment lingers.
Dr. Owens says Travis County Medical Society’s Physician Wellness Program provides its members access to its Safe Harbor Counseling Program – something she’s both proud of and recognizes as a privilege.
“We’re incredibly fortunate to have the robust program that we have, and that continues to grow,” she said. “But I do think not all county medical societies are created equal, and not per any fault of their own.”
Physicians in counties with fewer resources also may face additional challenges simply based on geography, Dr. Owens adds.
TMA chose Anticipate Joy because of its unique ability to cater to physicians’ needs. The program says it stands apart from other counseling services and employee assistance programs (EAPs). For one, clients are not limited to a set number of sessions, meaning they can build a long-term working relationship with their counselor.
Another key difference from EAPs is in privacy. Anticipate Joy uses a self-referral model, so members access the service through a URL distributed by TMA. The URL can be found on TMA’s Wellness First webpage (www.texmed.org/Wellness), and TMA also has disseminated a QR code that leads directly to the service. Supervisors and TMA are not made aware when a physician requests mental health services. Anticipate Joy’s sessions are HIPAA-compliant; its counselors and program will never communicate to supervisors or TMA about appointments, participation, or treatment recommendations.
After scanning the QR code or accessing Anticipate Joy through the TMA webpage, physicians must create an account, which includes completing a brief intake form. Then, they can purchase a session at a discounted rate of $25 and select a therapist. To find the best fit for each case, users can filter Anticipate Joy’s therapist network by clinical specialty, gender, and race.
“By connecting with a counselor who shares a background with them, physicians build a foundation for their mental health care to be impactful,” Dr. Owens said.
This is especially pressing as existing literature on burnout reflects higher rates among certain demographics – namely, women early in their careers.
“We know that female physicians who are earlier in their career and have young families are the ones who oftentimes … are affected by burnout [at higher rates] than their male colleagues at the same age, higher than their female colleagues of an older age,” Dr. Owens said. Connecting with a counselor who understands the trials of motherhood could be crucial to such a physician.
Anticipate Joy’s network includes licensed marriage and family therapists, licensed professional counselors, licensed clinical social workers, and licensed clinical psychologists. More than 75% of the network has more than 10 years of experience. Once the chosen therapist has approved the request, the client can then select a suitable time. Anticipate Joy says in the vast majority of cases, clients will have their initial appointment within days of their request.
While counseling itself will make a difference in physicians’ lives, Dr. Owens sees TMA’s work with Anticipate Joy as part of a much larger picture.
“It’s not the end-all, be-all, but it’s definitely a good step in the right direction,” she said. “It’s important that our big organizations, that are there to really support physicians and to be advocates for us – which TMA always has – that they’re really putting their money where their mouth is and modeling this.
“[Health care] organizations are the ones who have to take responsibility and ownership into: ‘How do we create a culture and a place where our physicians can be well?’”
That’s crucial, Dr. Owens adds, because burnout stems from multiple factors, not just one. “You have to get to the root of it.”
At least now, they aren’t facing the challenge alone, says Dr. Villarreal.
“The personality of all human beings is [to believe] you’re the only one that’s suffering, you’re the only one that’s going through this,” she said. “Until you hear someone else mention it. Then, you’ll realize you’re not unique in that you’re not alone. And there are people out there that are willing to help.”