Physician compensation 2023: The good, the bad and the ugly
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As the physician shortage continues, the need for mental health treatment surges.[1] Adding the global COVID-19 pandemic alongside a rapid rate of physician burnout creates a recipe for a mental health crisis—not just for patients, but for physicians themselves.[2][3]
What happens when that demand begins to take its toll? Mental health professionals are assuredly feeling the burden, but how are they responding, and to whom are they turning?
To gain some important insight, MDLinx commissioned a survey through M3 Global Research to poll 50 practicing psychiatrists.
The goal was to assess the mental health of today’s practicing psychiatrists by evaluating their own personal challenges and additional lifestyle issues. Furthermore, this survey seeks to identify how psychiatrists are choosing to address their own mental health concerns, how such concerns subsequently affect their practice, and how the field of psychiatry is currently supporting their mental health as a whole.
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By examining the overall mental health of psychiatrists, we ultimately strive to identify potential areas of professional or personal concern that can be improved upon or addressed to ensure the optimal support for these physicians, essential to our environment of mental health crisis.
Demands on your mental health
As healthcare providers, we place the needs of those around us far before ourselves. Yet if we are struggling in our own mental health, those struggles can affect the care we give, whether we intend them to or not.
While there is a critical need to keep pushing through to provide care to as many as we can, the idea of ‘securing your own oxygen mask before helping those around you’ applies to our situation.
During the past year, psychiatrists reported many negative impacts on their own mental health.
Overall, 32% of respondents said that they had a general loss of interest and/or compassion fatigue.
These feelings were stronger in psychiatrists who practice mainly in an outpatient (38%) vs inpatient (20%) setting.
Excessive workload—particularly with respect to administrative tasks and insufficient time off—were the predominant forces driving psychiatrists’ own mental health challenges.
One psychiatrist in particular reported, “Institutions have often encouraged self-care to improve mental health and burnout while simultaneously requiring as many hours and as much productivity as ever.”
Unfortunately, this can often be found within healthcare organizations, as it is a tough dynamic to satisfy both mental health needs while simultaneously maintaining stability for providers themselves. Regardless, it is a dynamic that ought to be consistently monitored to ensure the balance remains intact, otherwise there becomes a crisis on either side whereby patients feel underwhelmed with care or providers feel overwhelmed with workload.
What psychiatrists had to say
- “Decreasing administrative hassles, like prior authorizations and [other] documentation, would be the most impactful.”
- "Psychiatrists with small practices—such as myself—either face increasing administrative burdens from payors or they get bought up by larger health systems at the cost of losing autonomy.”
- “The general decrease in civility over the past couple of years has added additional stress.”
- “It has worsened as patient demands increased and autonomy has decreased.”
- “I think that compensation plays a big role in terms of mental health. Many of us are realizing that other organizations pay higher compensation for ultimately fewer hours on the job, and so [they] offer a better sense of wellness and work-life balance. I think that the pandemic has really helped psychiatrists recognize their value.”
- “[An] emphasis on performance measures with an increase in number of patients and less time to properly diagnose and treat has put a tremendous burden on psychiatrists.”
Willingness to talk
Overall, psychiatrists tend to be comfortable talking about their own mental health.
More than three-quarters (76%) of respondents said they were either comfortable or very comfortable discussing their wellbeing, with only 4% saying they weren't. In addition, 72% said they have a good support system, such as their colleagues or others in the field, in place.
Though psychiatrists assure their patients that talking about their own mental health proves beneficial, how many of those same psychiatrists feel comfortable discussing their own mental health?
The results identify, in fact, that the overwhelming majority of psychiatrists feel either comfortable or very comfortable talking about their own mental health, with a comparable majority feeling somewhat or completely supported by their colleagues and others in the field.
This identifies a positive perspective of self-knowledge and solid support systems, which is critical when 50% of respondents agreed to some extent that their mental health had an impact on their ability to manage patients
What psychiatrists had to say
- “Less stigma and regular meetings with colleagues are helpful. Overall, things have improved.”
- “I think psychiatrists are becoming more comfortable talking about their own mental health. Supervision is encouraged, but it would be nice to have other professional support (ie, therapy) offered through employers.”
- “It has been mentally tough to deal with the pressure of COVID.”
- “I believe the environment has improved so that providers can discuss their own mental health, but it is still far less in comparison to fields outside of medicine.”
Working the problem
When confronted with recent mental health challenges, psychiatrists found respite in pursuing a variety of their own personal endeavors. Many focused more on exercise, diet and meditative practices, and more than half spent an increased amount of time with friends and family and/or found reprieve in working on personal hobbies.
All of this goes to show that with the current state of mental health need, it is crucial for psychiatrists to find individual sources of enjoyment and support outside of the work environment.
As psychiatrists, we are often our patients’ strongest advocates, but we should remember to take the time to be our own advocates on a daily basis as well.
Make time for yourself, for your hobbies and enjoyments—it can help ease the workload by balancing the scales.
As the mental health crisis continues unabated, psychiatrists seem keen to identify ways of easing the burden—but changing jobs doesn’t seem to be one of them.
Almost half (44%) of respondents increased telemedicine appointments, but only 8% of respondents opted for a change in their job or role to address mental health issues.
Furthermore, in response to the added workload, it appears that outpatient psychiatrists either felt more affected or found it easier to cut back job responsibilities than those in inpatient settings.
Instead of decreasing hours, almost half of respondents reported increasing telemedicine appointments.
While telepsychiatry has been steadily on the rise in recent years, the COVID-19 pandemic boosted this sector of psychiatry—it saw the highest utilization in telehealth compared to other fields of medicine.[4]
Finding the balance in whatever sector you choose is crucial, because maintaining that balance is what creates long-term stability in your career and in your life as a whole.
The way ahead
72% of respondents say that streamlining administrative tasks, such as EHRs, billing, and scheduling, would help to address issues affecting their mental health.
Overall, this survey confirms that psychiatrists have a strong sense of self-knowledge, support systems, and hobbies outside of work, which allow them to find a stable work-life balance.
But even then, overwhelming patient volume, a lack of time off, and burdensome administrative tasks add to the mounting pressure of psychiatrists in a persisting mental health crisis.
One respondent identified that the environment has improved with respect to psychiatrists being able to talk about their mental health, but says, “...[It] is still far less in comparison to fields outside of medicine.”
An overwhelming percentage identified that streamlining administrative tasks would help ease the workload burden. Other strategies psychiatrists detailed would help their mental health included decreased after-hours calls and increased time off, both notably at a 60% response rate. Furthermore, more than half of respondents felt lower patient volume and higher appointment lengths would also help improve their mental health balance.
It can be difficult to identify the ‘happy medium,’ whereby mental health needs are met without overburdening providers—especially when working amid a mental health crisis. Maintaining an open line of communication between administration and providers is essential in ensuring both sides of the dynamic are functioning optimally.
While there is a long road ahead to begin to solve the crisis on hand, the way forward needs to be paved with continued improvements—for the sake of ensuring psychiatrists are supported in their own mental health needs and for the sake of patient care.
In the interim, psychiatrists should continue to check in with themselves on the state of their own mental health and reach out as needed to available resources.
What psychiatrists had to say
- “There's a huge explosion now in mental health, and truthfully I feel there are not enough providers in mental health. So many of the therapists graduating from schools are training primarily in CBT, but…they often do not have a trauma focus.”
- “I believe that with the pandemic, there has been more awareness and focus on clinician wellness than ever before. That doesn't mean that there are easy solutions, but awareness is something.”
- “There has been more open dialogue and more acceptance, but actual support remains lacking.”
Sources and references
Kuehn BM. Clinician shortage exacerbates pandemic-fueled ‘mental health crisis.’ JAMA. 2022;327(22):2179-2181.
US Department of Health and Human Services. New Surgeon General Advisory sounds alarm on health worker burnout and resignation. Press release, May 23, 2022.
Whitehouse.gov. FACT SHEET: President Biden to Announce Strategy to Address Our National Mental Health Crisis, As Part of Unity Agenda in his First State of the Union. Press release, March 1, 2022.
US Department of Health and Human Services. New HHS study shows 63-fold increase in Medicare telehealth utilization during the pandemic. Press release, December 3, 2021.