More than 1 in 10 Ontario physicians sought mental health or substance use care annually between 2003 and 2022, with rates remaining stable for 15 years prior to increasing substantially during the COVID-19 pandemic, according to research published in Annals of Internal Medicine.
The population-based cohort study examined 29,662 early- and mid-career physicians registered with the College of Physicians and Surgeons of Ontario between 1990 and 2018. Investigators calculated age-sex standardized annual proportions of physicians with at least one outpatient mental health and substance use (MHSU) visit to a psychiatrist or family physician.
During the prepandemic period, the standardized proportion of physicians with MHSU visits per year remained generally stable, measuring 12.5% from 2003 to 2004 and 12.1% from 2018 to 2019. The proportion increased during the COVID-19 pandemic to 14.6% from 2020 to 2021 and 15.2% from 2021 to 2022 before declining slightly to 14.4% from 2022 to 2023.
Anxiety disorders represented the most common reason for MHSU visits prepandemic, with 8.4% of physicians having at least one visit from 2018 to 2019, followed by mood disorders at 2.4%. During the pandemic, MHSU visits increased for anxiety disorders, adjustment reactions, attention deficit-hyperactivity disorder, and other reasons, while remaining stable for mood and substance use disorders.
MHSU care utilization varied considerably by specialty prior to the pandemic. From 2018 to 2019, psychiatrists demonstrated the highest utilization at 28% compared with 14.2% of family physicians and 9.7% of all other specialty physicians, including 8.0% of medicine physicians and 7.8% of surgeons. During the pandemic, mental health care among physicians increased for all specialties except psychiatry, which remained stable.
Overall, 11% (n = 3,274) of the physicians had one or more outpatient MHSU visits during the study period. The cohort's mean age at study entry was 33.1 years, 52.3% (n = 15,506) of whom were male. Family medicine represented the most common specialty at 38.6% (n = 11,448), followed by medicine at 15.7% (n = 4,643) and surgery at 12.2% (n = 3,623).
Reasons for MHSU visits remained stable prior to the COVID-19 pandemic, except for attention deficit–hyperactivity disorder, which demonstrated an increasing trend.
"Our findings suggest that current concerns over a physician mental health crisis may not reflect a new crisis but rather highlight a longstanding pattern of adverse physician mental health that was exacerbated during the pandemic," wrote lead study author Maya A. Gibb, MPH, of the Ottawa Hospital Research Institute, and colleagues.
The investigators used College of Physicians and Surgeons of Ontario registration data linked to health administrative data held at ICES (formerly the Institute for Clinical Evaluative Sciences) to identify physicians and capture outpatient MHSU visits. They included early-career physicians in their first 5 years of independent practice and mid-career physicians in their sixth through 15th year of independent practice.
The investigators noted that observed increases in MHSU care during the COVID-19 pandemic among physicians exceeded changes seen in the general Ontario population. They acknowledged study limitations, including inability to distinguish between time and birth cohort trends, lack of accounting for correlation across years from physicians appearing in multiple years, examination of only treatment prevalence rather than symptoms, and exclusion of visits to other health care providers such as psychologists.
The study was supported by ICES, funded through an annual grant from the Ontario Ministry of Health and Ministry of Long-Term Care, and by a Physician Services Incorporated Grant (25-03). Dr. Myran received salary support from a Tier 2 Canada Research Chair in Social Accountability. Disclosure forms are available with the article online.
Source: Annals of Internal Medicine
