Over almost two decades of follow‑up, about 1 in 10 early‑ and mid‑career physicians had at least one outpatient visit coded for mental health or substance use concerns. Before COVID‑19, the share of physicians with at least one such visit in a given year was relatively stable, at around 12% annually.
With the onset of the pandemic, that changed: mental health/substance use visit rates increased to roughly 14.6% in 2020–2021 and 15.2% in 2021–2022, outpacing trends observed in the general population. These shifts align with broader data showing that physician mental health challenges have been climbing by roughly 0.5% per year and are tightly linked to workload, moral distress, and system pressures.
What Are Physicians Presenting With?
The diagnostic mix tells an important story. In the pre‑pandemic period, anxiety and mood disorders dominated mental health visits, with attention‑deficit/hyperactivity disorder (ADHD) gradually increasing in prominence. During COVID‑19, visits for anxiety disorders, adjustment reactions, ADHD, and related concerns rose markedly, while rates for mood disorders and substance use disorders remained comparatively stable.
This pattern suggests two parallel phenomena: a genuine surge in stress‑related conditions driven by rapidly changing clinical demands, and a modest but meaningful reduction in stigma around seeking care for anxiety, stress, and adjustment problems. Physicians are still less likely to seek formal help for severe depression or addiction, a gap reflected in suicide data showing that many physicians who die by suicide never accessed mental health care in the preceding year.
Substance Use: Hidden but Common
Substance use among physicians remains a critical, often hidden, dimension of this picture. Reviews estimate that 6–8% of physicians meet criteria for a substance use disorder at any given time, and 8–15% will experience a substance use disorder at some point during their career. Alcohol is the most frequently misused substance, with studies suggesting hazardous or high‑risk alcohol use in roughly 15–36% of physicians, depending on setting and methodology.
Misuse of prescription drugs—particularly opioids, sedatives, and anxiolytics—is also more common in medical professionals than the general population, driven by easy access, self‑treatment of pain, and use of medications as a maladaptive coping strategy. Importantly, mental health distress, burnout, and long work hours significantly increase the likelihood of turning to alcohol or drugs as a coping mechanism, compounding risks for medical errors and impaired judgment.
Differences by Specialty and Career Stage
The new longitudinal analysis highlights marked differences between specialties in how often physicians access mental health or substance use care. In the pre‑pandemic period, roughly 28% of psychiatrists, 14% of family physicians, and about 10% of physicians in other specialties had at least one mental health/substance use visit in a given year.
During the first two pandemic years, use increased across almost all specialties except psychiatry, where rates remained stable, possibly reflecting higher baseline utilization and greater comfort with mental health services among psychiatrists. Other work indicates that surgeons, internists, and some high‑intensity specialties may have elevated rates of substance use, even when they do not seek formal treatment, suggesting that administrative data likely underestimate true prevalence.
Why Many Physicians Still Avoid Care
Despite rising visit rates, many physicians with significant symptoms still avoid treatment. Common barriers include:
- Stigma and culture of perfectionism – Fear of being seen as “weak,” “unreliable,” or less competent by colleagues or leaders.
- Licensure and credentialing concerns – Worries that disclosure of treatment will jeopardize licensure, hospital privileges, or malpractice coverage.
- Time and access constraints – Long work hours, limited appointment flexibility, and lack of truly confidential pathways to care.
These factors help explain why physicians have some of the highest suicide rates of any profession, even though administrative visit data suggest only a minority receive formal mental health care before a crisis.
System‑Level Priorities for Healthcare Leaders
The new findings argue strongly for shifting from individual‑level “resilience” messaging to structural change. Evidence‑informed priorities include:
- Confidential, low‑barrier access to care
- Create or contract truly confidential mental health and addiction services for clinicians, with clear firewalls from HR, licensing bodies, and credentialing committees where legally feasible.
- Offer rapid access (e.g., within days) for acute anxiety, suicidality, or suspected substance use disorder, with clear referral pathways from peer, occupational health, and leadership channels.
- Address workload and moral injury
- Use staffing, scheduling, and documentation redesign to reduce chronic overwork and administrative burden, which are tightly linked to distress and hazardous coping.
- Involve frontline clinicians in decisions about workflow and resource allocation to mitigate feelings of powerlessness and moral injury.
- Normalize help‑seeking and protect careers
- Revise licensure and credentialing questions to focus on current impairment rather than historical treatment, aligning with emerging best‑practice recommendations.
- Encourage senior clinicians and respected leaders to share de‑identified or personal stories of seeking support, reframing treatment as a marker of professionalism rather than failure.
- Targeted support for high‑risk groups
- Focus enhanced screening and support on early‑career physicians, high‑intensity specialties, and those with known exposure to trauma, litigation, or repeated adverse events.
- Embed proactive outreach during key transition points, such as residency, early attending years, and after critical incidents.
Practical Takeaways for Healthcare Professionals
For clinicians reading this as peers rather than patients, several practical lessons emerge from these new data:
- Experiencing anxiety, stress, or even escalating substance use in today’s clinical environment is common, not a personal anomaly—and help‑seeking is increasingly the norm among colleagues.
- Early intervention for anxiety, adjustment problems, and burnout is far more effective than waiting for severe depression, addiction, or crises that jeopardize licensure and patient safety.
- Engagement with confidential services, peer support programs, and system‑level advocacy is a professional act that protects both clinicians and patients, rather than a sign of weakness.
As health systems and physician leaders digest these findings, the opportunity is to move beyond viewing mental illness and substance abuse as individual failings and toward treating them as predictable, preventable occupational hazards that demand structural solutions.
