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FSMB Shines Light on Physician Burnout and Wellness

Analysis  |  By Christopher Cheney  
   August 10, 2018

The journal of the Federation of State Medical Boards has published a special issue with a range of perspectives on burnout and wellness, including physician mental health and help-seeking behavior.

Physician burnout has reached crisis proportions and medical regulators need to step up efforts to address the problem, a special issue of the Journal of Medical Regulation says.

"The time has come to help the healers heal themselves—and return to productivity and career fulfillment. As medical regulators, we need to protect the public—the millions of patients whose physicians are impacted by burnout each year," JMR Editor in Chief Heidi Koenig, MD, wrote in the special issue.

The special issue, which was published by the Federation of State Medical Boards, features four articles about physician mental health, FSMB wellness and burnout initiatives, assessment and referral, and help-seeking behavior.

1. Physician mental health

Fear is a primary barrier to care for physicians with mental health conditions, the first article says.

"Most mental health problems can be effectively managed, but real and perceived barriers—such as confidentiality concerns and fear of negative ramifications on one’s reputation, licensure, or hospital privileging—keep many physicians from addressing their mental health needs."

The article includes three recommendations to address physician burnout and wellness:

  • Community response: Education programs should encourage peers and mentors to help distressed colleagues get care. Active involvement of peers and mentors also promotes normalizing the seeking of help.
  • Stigma reduction: Policies must make it safe for staff members to seek support or treatment, as early as possible after onset of distress.
  • Licensing: Mental health questions in state licensing documents have the unintended effect of driving distressed clinicians underground. These questions should focus on competence rather than illness. Mental health questions should be phrased the same as physical health questions.

2. FSMB initiatives

The FSMB plans to be in the vanguard of efforts to address physician burnout and wellness.

About two years ago, the regulatory association formed a workgroup of state medical board members and stakeholders to study burnout and wellness.

"This was a timely decision for the FSMB as it positioned the organization alongside several others at the forefront of working to identify and address what has become an epidemic," the second article says.

Burnout and wellness recommendations that the FSMB workgroup adopted in April are included in the JMR special issue.

In addition to the workgroup, FSMB is participating in a collaborative effort to find solutions to burnout led by the National Academy of Medicine.

Individual state medical boards also have been launching burnout and wellness initiatives. Licensing changes allow physicians to not report a potential impairment as long as they are receiving treatment, the article says.  

3. HEAR program

The third article in the special issue focuses on the University of California San Diego Healer Education Assessment and Referral (HEAR) program.

UC San Diego launched HEAR in 2009. Over the previous decade, there had been one medical student or physician suicide every year.  

Hundreds of medical professionals have received help through the program, the article says.

"Through June 2017, 1,537 UC San Diego healthcare personnel have been screened, 320 individuals have dialogued with a counselor either in person, by phone or electronically, and more than 300 have been referred confidentially for evaluation and treatment by a mental health professional."

The HEAR program has two essential elements:

  • Education and outreach: Lifting stigma and supporting help-seeking behavior
  • Proactive approach: Identifying at-risk clinicians for support and care referrals

HEAR appears to have impacted suicides at UC San Diego, the article says.

"There have been two suicides among UC San Diego medical and pharmacy students, residents, fellow and physician faculty since 2009, and none in nurses or other professional health care staff since they were added to the HEAR umbrella."

The figures are small but significant, the article says.

"Although the numbers are too small to perform statistical analysis, based on the rate of suicide in the UC San Diego academic and clinical community before 2009, we have observed six fewer suicides than in the same timespan previously."

4. Help-seeking behavior

The fourth article examines the effectiveness of the Interactive Screening Program (ISP) developed by the American Foundation for Suicide Prevention.

To evaluate ISP, researchers gathered data from six medical schools from 2007 to 2013. The ISP online questionnaire was completed by 1,449 medical students, residents, and faculty physicians, with 97.5% reporting some degree of stress but only 5.3% receiving care.

ISP is designed to identify people at risk of suicide by offering anonymous online screening. A counselor reviews the screening information, then posts a confidential response to the ISP website. After the screening assessment, ISP participants can exchange confidential messages online or get a referral for care.

Researchers found participant engagement with the ISP service was robust—81.2% returned to the ISP website to see the counselor's screening response.

Out of the 1,449 ISP participants in the study, 131 either asked to speak with a counselor in person or requested a mental health referral.

ISP, which is a key component of HEAR, is a viable option for suicide prevention for healthcare professionals, the article says.

"The core components of ISP—participant anonymity, allowing participants to feel more comfortable addressing their concerns, and personalized interactive engagement with experienced counselors—offer an innovative method of overcoming barriers to help-seeking."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


To reduce stigma, healthcare organization policies must make it safe for staff members to seek treatment.

Education programs should encourage peers and mentors to help identify and support distressed colleagues.

A UC San Diego program is having an impact on clinician suicide.

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