Physicians face immense pressure from long hours, systemic healthcare challenges, and the necessity for tough choices in complex medical contexts, often leading to burnout and moral injury. There is an urgent need for systemic healthcare reforms, supportive interventions, and normalizing the idea of help-seeking and being engaged in peer support to promote physician well-being and prevent professional and personal crises.
The professional lives of physicians are marked by a particular aspect of being exposed to human suffering, a reality that is compounded by long and potentially labor-intensive hours, responding to medical challenges and crises, and making difficult decisions — all the while navigating patient’s and family’s emotions and maintaining composure and compassion. The demands of being present for other people almost constantly in addition to the rigors of engaging in medical training and high patient volume may not leave much space for physicians and medical residents to devote to their own health, by maintaining work–life balance, getting adequate sleep, and nurturing interpersonal relationships.
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There is a long-standing and cross-cultural expectation that despite such demanding roles, medical doctors should stay emotionally and physically healthy, simply because they are doctors. The proverb, “Physician, heal thyself”, or its variations, featured in classical Greek texts, the Bible, and the Judaic text Genesis Rabbah, has been a leitmotif of the core responsibility of healers: before attempting to help others, one must help themself. In modern terms, it is a call for healers to prioritize self-care and personal well-being.
However, the tension between internal and external responsibilities can take its toll and the calling to serve other people can transform into exhaustion, burnout, depression and sometimes harshness and insensitivity. Many clinicians also reject the term ‘burnout’, arguing that instead they are demoralized by the systemic healthcare problems that hinder them from helping patients and make them feel like abandoning one’s fundamental values. These systemic problems include profit-driven healthcare and an insurers environment, a divide between administrators and doctors, understaffing and budget shortages, altogether leading to physicians’ inability to deliver appropriate high-quality care. The resulting severe distress experienced by physicians is a form of ‘moral injury’ — a term that was first used in a different context. It was suggested by the Veterans Affairs’ psychiatrist Jonathan Shay and colleagues in the 1990s to describe the violation of feeling ‘what’s right’ in combat soldiers during wartime when they face challenging moral and ethical experiences that they are unable to justify and contextualize. In 2018, medical doctors Wendy Dean and Simon Talbot suggested that this concept also applies to physicians and can have a draining effect on their mental health, leading to hopelessness and suicidality.
Many physicians who are vulnerable may avoid seeking medical or psychological support, out of feelings of shame and ‘imposter syndrome’. For some physicians who are experiencing emotional or behavioral issues, self-diagnosis and self-medication with alcohol or illicit drugs preempts help-seeking. For these doctors who may be struggling with conditions such as alcohol or substance use disorders, there is a justifiable fear that disclosure and treatment could lead to suspension or loss of their license to practice.
A seminal report ‘The Sick Physician’ published in the Journal of the American Medical Association (JAMA) in 1973 had a crucial role in raising awareness about physician health, particularly mental health issues such as alcoholism and substance use1. It prompted the American Medical Association (AMA) to recommend that US state medical societies create programs that would address these issues and develop interventions. In 1991, the AMA, the Federation of State Medical Boards, State Medical Societies/Associations and individual state physician health programs initiatives led to the establishment of the Federation of State Physician Health Programs (FSPHP), a membership association of Physician Health Programs (PHPs) and Healthcare Professional Programs across the USA. Altogether, this brought a substantial transformation — physicians would receive support and treatment rather than being penalized if their mental health issues threaten their ability to safely practice.
Chris Bundy, the FSPHP chief medical officer, and Linda Bresnahan, the FSPHP executive director and chief executive officer, provide some insights into the FSPHP programs: “For nearly four decades, these programs have had a vital role in supporting the health and well-being of physicians and other healthcare professionals. They offer a range of interventions, including early identification, clinical evaluations, referral to treatment, long-term health monitoring, advocacy, and support for sustained recovery. Importantly, these programs operate independently from disciplinary systems, allowing healthcare professionals to seek help early without fear of license sanctions, thereby promoting a culture of safety, accountability, and wellness. Long-term outcome studies have found that physicians who complete PHP monitoring programs have recovery rates significantly higher than the general population, often exceeding five years of sustained recovery. Additionally, research indicates that physicians who have completed PHPs may have a lower risk of malpractice claims compared to their peers who have never been monitored — highlighting both clinical effectiveness and public safety benefits.”
As emphasized by Bundy and Bresnahan, confidentiality is crucial to promote help-seeking: “The FSPHP ‘Triad of Confidentiality’ identifies three critical areas. These are records protection, so that PHP records have special statutory protections from discovery in legal proceedings. Then, there is application protection, meaning that licensing and credentialing applications should be free of intrusive and stigmatizing language related to health status and should focus inquiry on current impairment. The third area is regulatory protection, so that physicians and other health professionals should be afforded the opportunity to participate in a PHP in lieu of disciplinary action when there has been no patient harm related to their health condition and board involvement.” Other efforts to reduce stigma around help-seeking include education and outreach to support licensure and credentialing reform, as well as reducing cost barriers to specialized mental health and substance use disorder services for safety-sensitive healthcare workers.
The July 2025 issue of Nature Mental Health features two pieces on physician mental health that advance the agenda on the effectiveness of mental health interventions and highlight suicidality rates and specific vulnerability time periods in the US medical residents. In their Analysis, Petrie et al. conduct a systematic review and meta-analysis of the effectiveness of interventions to reduce or prevent symptoms of common mental disorders and suicidality among physicians. The last analysis by these authors published in 20192 was limited by a small number of studies available at that time (8 studies were included in systematic review and 7 into meta-analysis). Since then, the COVID-19 outbreak stimulated the implementation of new initiatives to improve the mental health of healthcare workers owing to a sharp rise in psychological distress. In this new analysis, the authors synthesize the latest evidence on interventions by including 24 studies in the qualitative synthesis, of which 21 are included in the meta-analysis. The researchers find that a range of physician-directed interventions reduces symptomatology and that moderate effects are maintained over time. The preliminary evidence shows that skills-based approaches, such as mindfulness and mind–body-based programs, cognitive behavioral therapy, peer support and stress management are effective. They also find that face-to-face interventions might be more promising than digital interventions.
As noted by the authors, most randomized controlled trials on mental health interventions in physicians have been performed in high-income countries, such as the USA and Australia. However, the problem of physician mental health is certainly not limited to these countries, and it is imperative to have such trials conducted in lower- and middle-income countries, accounting for different cultural and clinical contexts, and to implement them in clinics and during medical training.
Our Research Highlight reports on work from Yaghmour et al.3 that examines the causes of death among US medical residents from 2015 to 2021, comparing these with 2000–2014 data from a previous study. They find that although death rates from neoplastic disease had reduced, suicide rates remained relatively unchanged, and that resident death by suicide tend to cluster around transition periods during medical training — from medical student to resident or from junior to senior resident — when stress levels might be at its highest, thus calling for fostering better learning environments and enhanced support during the crucial periods.
To see a tangible change in physician mental health, different drivers of stigma, such as societal stereotypes, language used in mandatory mental health declarations for licensure and other systemic practices that perpetuate stigma, should be eliminated. No less important is addressing self-stigmatization. The idea that it is fine to not always feel fine and to seek help and be engaged in peer support should become more normalized. In the end, physicians cannot completely heal themselves, and just like anyone else they need empathy, a trustworthy environment and help.
Finally, providing mental health support to physicians is not enough without transforming the healthcare environment. The troubling focus on profits above all must be challenged, and an emphasis on the original goal of truly serving people must be enshrined. Promoting collaboration and crosstalk among physicians, medical governance bodies and legislators may be one of the many necessary steps to address the problem of the disconnection between healthcare core values and clinical decisions. If physicians are to ‘heal themselves’, they must be valued and afforded the highest quality of care and resources within the systems they vitally support.
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