Tennessee health professionals are continuing to feel the strain of the pandemic and resulting health system impact, and their mental health is suffering. That is the recurrent story told in anonymous comments left by physicians and other healthcare providers who have accessed the Tennessee Professional Screening Questionnaire (TN-PSQ) over the past three years.

From February 3, 2020, through February 3, 2023, 648 health professionals used the anonymous mental health screening tool; more than half of users scored in the high/severe risk category, including 20 percent at risk for suicide. Eighty-three percent of users were not already receiving therapy or treatment for their stated problem.

“Overall utilization and the high number of those not already getting help are big indicators to us that this tool is sorely needed, and that we are reaching our target population,” said TMF Executive Director Jennifer Rainwater.

“The large number reaching out for the first time is a solid indicator that stigma, shame, and fears of career implications or censure for a mental health condition are still huge barriers in the medical profession,” added TMF Medical Director Dr. Michael Baron.

Top Concerns

User comments describe the pressure they are feeling to perform in workplaces dealing with a lack of help and resources for the existing patient load – even as they personally struggle with the impact of the pandemic, the economy, and what seems to be the “new normal” in health care.

“Job too stressful,” cited one health professional. “Patient panel is too large and administration is trying to keep me seeing more new patients. Late workdays mean not seeing my kids when I get home … Nighttime charting/documentation on the EMR means little to no quality time with my spouse. It seems like there is no good way to fix the work situation and that it will worsen.”

“Job-related stress of too many patients and not having enough staff to help, having to do most of the work myself is never ending, insurances not paying enough for the work being done,” echoed another.

Multiple newly employed providers reported feeling overwhelmed and inadequate.

A user identifying themselves as a recent PA program graduate wrote, “It has been extremely overwhelming trying to switch from ‘student’ mode to ‘provider’ mode, especially when I am expected to see roughly 30-40 patients a day, and I suffer from imposter syndrome daily.”

Results

From February 3, 2020, through February 3, 2023, a total of 648 health professionals utilized the TN-PSQ screening tool:

• 132 (20%) were Tier 1A (high/severe distress including suicidal thoughts)
• 217 (33%) were Tier 1B (high/severe distress with no suicidal thoughts)
• 270 (42%) were Tier 2 (moderate distress)
• 29 (5%) were Tier 3 (low to no distress)
• 648 (100%) received initial response from site MHP
• 443 (68%) reviewed the counselor’s response
• Of reviewers, 141 (32%) dialogued with MHP a total of 243 times
• Of dialoguers, 97 (66%) requested an appointment or referral
• 83% were not already receiving treatment or therapy for their mental health problem

The Fear Factor

The reason for both the existence and high utilization of the TN-PSQ by health professionals is fear, said Dr. Baron – fear of discovery and disappointing self and others; fear of being perceived as weak and incapable; fear of lost opportunities, punitive action, or other career implications. Cost and time are also barriers to seeking care for most health providers, especially early in their careers.

“We are the absolute worst about asking for help and following our own good health advice, and the hardest on each other when we do reach out. We have much work to do in this area,” he said.

Rather than focusing on fixing the “canary in the coal mine,” as previous health and wellness efforts have done, Dr. Baron said systemic changes are needed. As current President-elect of the Federation of State Physician Health Programs (FSPHP), he is hopeful about changes happening through movements like the Vital Signs campaign by The Physicians Foundation and the ALL IN: Wellbeing First for Healthcare effort by the Dr. Lorna Breen Heroes’ Foundation and First Responders First, as well as coordinated work by the FSPHP, the Federation of State Medical Boards, the American Medical Association, the American Council of Graduate Medical Education, and other health professional entities.

In the meantime, the TMF and other organizations focused on health professional health are seeking more effective ways to address what is being called the “parallel pandemic” among healthcare workers. For this reason, the TN-PSQ will continue to exist and serve as an early intervention tool for mental and behavioral health conditions among health professionals in Tennessee.

About the TN-PSQ

The TN‐PSQ is a free, voluntary, confidential, interactive online mental health screening tool incorporating the PHQ‐9 — a widely‐accepted vehicle for self‐assessment of depression; it offers a response from and optional anonymous interaction with a licensed mental health professional for further assistance and connection to nearby mental health resources. The TN-PSQ is operated and staffed separately, and users are not known to the TMF unless they contact the Foundation and reveal they have taken the screening.

Its target audience is health professionals who might not ever contact the TMF Physician’s Health Program on their own; the goal is to provide them with help before a mental health condition is serious enough to affect patient safety and/or lead to a referral to the TMF or action by an employer or state health licensing board.

The TN-PSQ uses a platform called the Interactive Screening Program, developed in 2001 by the American Foundation for Suicide Prevention. Cited as an evidence-based best practice in suicide prevention by the U.S. Surgeon General and other entities, the ISP is used by over 160 institutions and organizations across the country, more than 50 of those serving health providers or those in training.

The TMF was the first Physician Health Program in the nation to utilize the ISP; its results have led PHPs in Arkansas, Ohio, and Wyoming to adopt the platform with several others exploring it for use with their health professional populations.

About the TMF

The Tennessee Medical Foundation is a 501(c)3 organization operating the state’s Physician Health Program (PHP), offering expert assistance to physicians and other health professionals struggling with addiction, mental, emotional, and behavioral health disorders. Its mission includes providing impairment and health resources and education to health professionals, healthcare workplaces, medical schools, and training programs. Visit e-tmf.org for more information.

Learn More

Access the TN-PSQ at tn.providerwellness.org. For more information, including frequently asked questions about the screening tool, visit e-tmf.org/tnpsq. To learn more about the AFSP’s Interactive Screening Program, visit afsp.org/interactive-screening-program.