Experts discuss the mental health impact on female physicians, patients

Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.

In today’s COVID-19 update, AMA Chief Experience Officer Todd Unger discusses with experts the mental health impact of COVID-19 on female physicians and patients. This is the final episode in our special series in honor of the AMA's Women in Medicine Month.

Learn more at the AMA COVID-19 resource center.

Speakers

• Tiffani Bell, MD, child and adolescent psychiatrist
• Tracey Henry, MD, MPH, assistant health director, Primary Care Center, Grady Memorial Hospital
• Theresa Rohr-Kirchgraber, MD, professor, IU National Center for Excellence in Women's Health

Unger: Hello, this is the American Medical Association's COVID-19 Update. Today, we're discussing COVID-19's impact on the mental health of women physicians and patients. This is the final episode in our special series focused on women physicians and patients, in honor of the AMA's Women in Medicine Month. But the AMA will continue its important work to support and advocate for women physicians and patients all year round.

I'm joined today by Dr. Tiffani Bell, a child and adolescent psychiatrist in Winston-Salem, North Carolina, Dr. Tracey Henry, assistant health director in the Primary Care Center at Grady Memorial Hospital in Atlanta, and Dr. Theresa Rohr-Kirchgraber, professor of clinical medicine and pediatrics at the IU National Center of Excellence in Women's Health in Indianapolis. I'm Todd Unger, AMA's chief experience officer in Chicago.

Dr. Bell, we're going to start with you. We know the pandemic has taken a huge mental toll on physicians and even more so on women physicians. What's been your biggest challenge as a female physician during COVID-19?

Dr. Bell: Yes. Thank you for the welcome. My biggest challenge at this time has been, honestly, balancing home life with work. I have three young children under the age of four, and I'm currently expecting again. So it's been a lot to keep up with, doing all the things you need to do with keeping your house running and also just the daily work of being a physician. I find, because I'm home a lot of the time now, that I'm having to balance keeping the kids away and whether or not they can go to daycare, if COVID-19 is—if they have an outbreak. So those are some of the things that I'm challenged by right now.

Unger: Dr. Henry, does that sound familiar to you? What are your biggest challenges during COVID-19?

Dr. Henry: No, definitely. I had some of the same challenges as Dr. Bell, with the dual roles as being a physician and caregiver, both for our patients and also in the home. But there was also the additional challenge and worry of taking our work home and infecting our family members. And in fact, I had this decontamination routine to make sure that I wasn't infecting them. But really that consumes my already busy schedule. And then there was a lot of anxiety in the beginning, when we didn't know how to diagnose COVID-19, we didn't have treatment protocols. And there was also the threat of not having enough PPE.

Unger: Dr. Rohr?

Dr. Rohr-Kirchgraber: So we had a get together, kind of a virtual wellness meeting with some of the women physicians. And what came across from that is, not only all of those things that you're discussing, but also the guilt. The guilt that was associated with not being on the front lines. Many of us are researchers. We're seeing patients and outpatients or dermatology, things like that. And we felt a little bad about not being in the ICU or not being in the emergency room.

In some ways, though, it was very useful to get together. And we ended up writing an article about it that got posted online and got a lot of great feedback. I think just sharing our own guilt helped to make others understand that we're all in this together, and we all have similarities that need to be addressed. And just having that camaraderie was really useful.

Unger: So one of the key things you talked about, guilt. You're balancing many different roles, all three of you. And we know burnout was already a problem. And now we're seeing this being exacerbated by COVID-19. Dr. Henry, how do the structures and culture within medicine contribute to this kind of disproportionate impact on women physicians during the pandemic?

Dr. Henry: Yeah. And so, I think that were a problem before the pandemic, are still a problem during, and probably will be a problem after the pandemic. Women are often tasked with many of the service-oriented roles in medicine, in academics. For instance, we are in position to take responsibilities for others but not for ourselves. And then so, in those instances, we're unable to meet a lot of the benchmarks as fast as we want, in order to implement that. And so in fact, when need to teach women to learn how to say no and to be a little bit strategic about the different roles that we take on.

Unger: Dr. Henry, how do the structures and culture within medicine contribute to a disproportionate impact of burnout and stress that we're seeing on women physicians during the pandemic?

Dr. Henry: Yeah, so women, in general, are often tasked with many of the service sort of roles in academics and in our institutions. And those keep us really, really busy, but not productive in terms of benchmarks that we need for academic promotion. For instance, we may be less likely to be involved in research and other scholarship and less educational roles, because we're doing a lot of the things that will not lead us to benchmarks for promotion.

Unger: Dr. Rohr, what do you think?

Dr. Rohr-Kirchgraber: Well, we actually just wrote a paper that is in review about productivity for women during COVID. Because we've definitely seen, there's been a decrease, a marked decrease in the number of brands being submitted and the number of papers being submitted for publication, coming from our women physicians. And so in really looking at that, what we've figured out is, one, that we're going to have to have a different model when it comes to academic promotion. We're going to have to take into consideration those things that were done, that may not necessarily have had the same impact factor as before. For example, the article that we're writing on the change of establishing productivity criteria, could include the impact that you had on your local community, by acting as a resource for your community board or your school health system, by changing out the work that you were doing in the research lab to help out with the clinical side of things. All of that's going to have to be renegotiated, when it comes to promotion and tenure.

Unger: Well, let's turn to slightly different angle and talk about what you're seeing in terms of the impact on the female patient population. What are you seeing in your practice, and how are you identifying patients who are struggling with that, Dr. Bell?

Dr. Bell: So as a child and adolescent psychiatrist, often my patient is someone under 18. But I do have a lot of mothers who come with their children. And so, what they generally express to me is, the amount of overwhelming feelings they have about how they're going to continue to get their child the proper education, while they are taking care of their mental health needs, the anxiety that has increased. We we spoke about feeling guilty if you're not able to keep up with the things that you need to do. A lot of mothers are having to debate, is my nanny following the proper protocols when she's not around? And how can I enforce that, if she says she's wearing a mask, but you see her out at a party? It's hard to keep all that in line. And so, a lot of the female patients I have that are older, they just also are really in the guilt and the anxiety that they have about getting infected.

Unger: Dr. Rohr, what are you seeing with your female patients?

Dr. Bell: So one of our first concerns was about the ability to be able to get our patients and our colleagues and enough personal protective equipment. We recognize that almost 70% of health care workers are women. We're the first line. We're the ones that are getting more infected. But we don't have the proper equipment to help protect us. We did a small study looking at approximately 300 employees within our local health care system and looked at the fit of the mask. And we found that absolutely more women than men did not get proper protection from the use of the N95 masks. Our faces are designed differently. So now we have a big push out to...let's redesign those masks so that they can fit properly for your sex, or your face. And that way it would help protect us a bit more. And that goes for not only our health care workers, but also for our patients. We need to be able to have things and equipment that actually fits them. And not just keep assuming that all women are just little men.

Unger: Dr. Henry, any thoughts on that?

Dr. Bell: Yes, that is very true. We had, certainly an issue with having enough N95 masks of the smaller version. And even those did not fit in many of our faces, and we had to make special amendments to them to make sure that they fit. And so, I think that's part of the structural issue or making sure that our personal protective equipment work also women, even though they probably designed them for men.

Unger: Well, last question, Dr. Rohr, why don't you start? What message do you have or advice for other women physicians, especially those that might be struggling right now?

Dr. Bell: My advices is: we need to work together. We need to reach out to each other. Some of our situations are fairly similar and knowing how others have worked on things, knowing how others have come together. Whether we're using our Facebook group or our Women in Medicine group, or even our local church or community, neighborhoods can be very supportive. Think once when we pull together, instead of being divisive, it's so much more helpful. And I end every conversation with, mask on.

Unger: Great advice. Dr. Bell?

Dr. Bell: Yes. I'd like to remind everyone that your mental health is imperative. We must pay attention to it. Oftentimes, we're so busy that we put it to the back burner and just keep pushing through. And I think the pandemic has really made it quite obvious, that if you don't put yourself on the list of priorities, you won't have time. So make yourself important. Find some way to balance, even if it's a five minute YouTube meditation or yoga, whatever it is, a walk by yourself. Because we're all juggling a lot of balls, some of them you can afford to drop. And there's some that we just can't. So count the costs and figure out what you can let go for a little while. That's my advice.

Unger: Dr. Henry, your final piece of advice?

Dr. Henry: Sure. Do not let others define you and set your own path and agenda. And like Dr. Bell said, the same way you schedule time for everything else in your busy schedule, schedule time for yourself. Know your limits and set boundaries. And have language in place of learning how to say no, so that you're not picking up all of those busy things that leave you feeling like you're not productive.

Unger: Well, thank you so much. That's good advice. That's it for today's COVID 19 Update. I want to thank Dr. Bell, Dr. Henry, Dr. Rohr-Kirchgraber for being here today and sharing their perspectives. We hope you've enjoyed these segments, especially done for AMA's Women in Medicine Month. We'll be back soon with another COVID-19 update. In the meantime, for resources on COVID-19, visit ama-assn.org/covid-19. Thanks for joining us and please take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

With an increased number of people reporting worsening mental health in recent years, it is imperative that people are aware of the 988 Suicide & Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) telephone program.

People experiencing a suicidal, substance use, and/or mental health crisis, or any other kind of emotional distress can call, chat or text 988, and speak to trained crisis counselors. The national hotline is available 24 hours a day, 7 days a week.

The previous National Suicide Prevention Lifeline phone number (1-800-273-8255) will continue to be operational and route calls to 988 indefinitely.