One in ten physicians sought mental health or substance use care over a recent 19-year period, with demand rising sharply during the early years of the COVID-19 pandemic, new research showed.

The increase in mental health and substance use care among physicians during the pandemic outpaced the rise seen in the general population.

The greatest increases in visits involved care for anxiety disorders and adjustment reactions — patterns the researchers believe may reflect both heightened emotional burden and reduced stigma around seeking care during the pandemic.

The findings underscore a longstanding pattern of mental health strain among physicians that intensified under pandemic pressures, they noted.

The study was published online on November 17 in Annals of Internal Medicine.

Destabilizing Effect of COVID

Physicians have long faced high rates of mental health and substance use concerns, raising alarms about workforce sustainability and potential impacts on patient care. Although public and professional attention to physician mental health has grown — especially during the COVID-19 pandemic — robust population-level data tracking how these issues evolve over time have been scarce, the investigators led by Daniel T. Myran, MD, MPH, with The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

To address this gap, the researchers examined nearly 30,000 physicians over a 19-year period to map trends in mental health and substance use-related healthcare visits. The analyzed temporal patterns in healthcare visits related to mental health and substance use among 29,662 of early- and mid-career physicians (mean age, 33 years; 52% men) who registered with the College of Physicians and Surgeons of Ontario between 1990 and 2018.

The study population was composed primarily of family physicians (39%), followed by those in internal medicine (16%) and surgery (12%). Other specialties included psychiatry (5%), pediatrics (5%), anesthesia (4%), critical care/emergency medicine (4%), and radiology (3%).

Overall, 11% of physicians had at least one outpatient visit for mental health or substance use during the study period.

During the pre-pandemic years (2003-2019), the proportion of physicians seeking mental health or substance use care held steady at about 12% annually.

That changed with COVID-19: rates rose to 14.6% in 2020-2021 and 15.2% in 2021-2022, marking a substantial increase during the first two years of the pandemic.

Physician use of mental health and substance use care varied markedly by specialty. In 2018-2019, 28% of psychiatrists, 14% of family physicians, and about 10% of physicians in other specialties had at least one visit. During the pandemic, utilization increased across all specialties except psychiatry, where rates remained stable.

Before the pandemic, the leading reasons for mental health and substance use visits were anxiety and mood disorders. In 2018-2019, 8% of physicians had at least one visit for anxiety and 2% had a visit for a mood disorder.

Reasons for mental health and substance use-related visits were stable before the pandemic except for attention-deficit/hyperactivity disorder (ADHD), which was increasing.

During the pandemic, mental health and substance use visits increased for anxiety disorders, adjustment reactions, ADHD, and other concerns, while rates for mood and substance use disorders remained stable.

“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,” the authors wrote.

They reported that the wide variations seen in mental health care across specialties may reflect differences in healthcare needs or health-seeking behavior.

They suggested that hospitals and healthcare systems take “system-level” steps to support physician well-being, including targeted interventions for higher-risk physician groups.

This study had no commercial funding. Author disclosures are available with the original article.