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Clinical psychologist Annia Raja discusses her article “Why more physicians are quietly starting therapy.” Annia explains how growing numbers of physicians are turning to therapy—not because they are failing, but because they are recognizing they cannot carry the weight of medicine alone. She outlines cultural shifts that are breaking down the “invincible doctor” myth, from generational openness to the impact of the pandemic, and highlights what doctors are really seeking in therapy: depth, safety, and understanding. Annia also emphasizes why quiet participation still matters, how therapy can be an investment in career longevity, and how these changes benefit both physicians and patients. Listeners will take away insights into how therapy is reshaping medical culture and why healing the healers is essential for the future of care.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Annia Raja. She’s a clinical psychologist. Today’s KevinMD article is “Why more physicians are quietly starting therapy.” Annia, welcome to the show.

Annia Raja: Thank you so much for having me, Kevin. I appreciate it.

Kevin Pho: Let’s start by briefly sharing your story and journey.

Annia Raja: I’m a clinical psychologist in private practice, and I specialize in providing therapy to physicians. The long and short of it is my spouse is a physician. He and I have been together since pre-med. When I went into private practice, both organically as well as eventually me making it explicit, I eventually made a specialty of working with physicians providing in-depth therapy. I am very passionate about serving this population and speaking about intersections of physician mental health, wellness, and doctor burnout, etc.

Kevin Pho: And how long have your clientele primarily been physicians?

Annia Raja: I would say it has been at least five years or so, starting right at the helm of COVID-19 especially. Even before then, it was an implicit attraction that some physicians had to my practice, and right around COVID-19, I saw that there was a very clear need, and I made that very explicit in my practice.

Kevin Pho: I would love to hear more about your observations and insights. This is a clear topic that’s on the minds and in the forefront of many physicians. Your article on KevinMD is “Why more physicians are quietly starting therapy.” For those who didn’t get a chance to read your article, tell us what it’s about.

Annia Raja: It’s really just giving a narrative from what I’ve seen from the vantage point of my practice of how, thankfully, more and more physicians are reaching out to get therapy, whether it’s by reaching out to me or other clinicians in my practice directly or just me hearing from other colleagues in the space. There are a few trends that I’ve noticed as far as why and how this is happening.

One, there are more frank conversations happening around physician burnout. That is a huge contributor, and I think thankfully, physicians are starting to take that phenomenon much more seriously for themselves as well as systemically across their colleagues and across health care in general.

Two, referring back to the pandemic, that really just opened the floodgates for not only doctors to start to acknowledge the strains the pandemic was putting on them personally and professionally, but also for more of a social awareness of this too, of just how much American society takes advantage of physicians and expects them to be strong and to use that term, “resilient.” We’re seeing more and more that there are cracks, and of course there are cracks. We’re all human. Humanizing doctors in that COVID-19 intersection has been huge.

I think there are generational shifts, too, as I spoke to in the article. Gen Z and millennials are much more apt to have frank and open conversations about mental health. As we get into the intersections of how American health care really beats down doctors across so many factors and the impact that that has on their wellbeing, I think all of these things are contributing to people taking their wellness much more seriously and acknowledging that they need help too.

Kevin Pho: When you entered that word, resilient, you put it in quotes. Why did you do that?

Annia Raja: It was a slight nod to one of the other articles I’ve written for KevinMD where I essentially say we need to stop telling doctors to be resilient. Briefly, I think resilience and that word, which I see used so often, especially in physician wellness spaces and wellness programs that are institutionalized in hospital settings or big systems, really misses the mark because it individualizes what are deeply systemic things.

Telling doctors to be more resilient when these are already deeply resilient people is not only missing the mark, I think it’s harmful. When we are internalizing these messages of “I just have to try harder, I have to be better,” etc., those very things are the factors that are contributing to how burnt out, overwhelmed, and exhausted doctors already are. To implicitly and explicitly have these messages beat into doctors all the more, it’s not only not helpful, it tends to make the problem worse.

Kevin Pho: There are a lot of professions, of course, where burnout is prevalent. You work specifically with physicians, so what is unique about medicine that makes burnout among physicians different from burnout in other professions?

Annia Raja: This is where my depth lens really comes in. A lot of what I do with my physician clients is, rather than trying to focus on these quick fixes of, “Oh, you just need to cope better, try some grounding techniques, try breathing techniques,” etc., we deliberately put that to the side and get really deep into their histories.

What I notice a lot with doctors in particular is that there are a lot of personality and family-of-origin dynamics around being the helper, being the savior, being the martyr, and even being very self-sacrificial. These internalized schemas of always being available for other people, often to the expense of oneself. These factors I think are particularly unique for physicians, intersecting with how doctors are taught throughout their training to identify a problem, get the diagnosis right, and come up with a clear treatment plan. I hear a lot from physicians that so much of what they have to contend with is the gray in medicine and how sometimes there isn’t always a clear answer, but that doesn’t always translate for people with being able to have a sense of gray in their personal lives and their whole sense of self as well.

I think those particulars of medicine being viewed socially as well as internally as a noble profession, as a profession that’s supposed to be a calling that you’re supposed to give your full self to, can make burnout even more entrenched. Such that even when we name those systemic factors, we still have a lot of personal work to do to process and make meaning around these internalized schemas of identity and how they see themselves. That’s just a short list; there’s so much more there.

Kevin Pho: Give us a success story. You obviously don’t have to give personal information, but an amalgamation of cases where a physician went to you, you made a difference in their lives, and maybe a little bit of a before and after, just so we can see some of these techniques in action.

Annia Raja: I think a broad arc that I see is there’s a particular pattern I’ve noticed of attendings that are three to five years out from training. They’ve finished residency, they’ve finished fellowship, they’re in attending life. Maybe they’re in their first job, or maybe they did their first job for a year or so, it didn’t work out, and they’re in their second job, but around that three- to five-year mark post-training, they hit a wall. They hit a wall for a variety of reasons that I’ve seen. Doctors can often have this fantasy of being in the rat race, like, “If I just get through this next step, relief is just behind this next milestone. Just on the horizon.” They have to cope that way; it’s understandable. “If I just get through med school, if I just get through residency, things will be better. If I just get through fellowship, relief is just around the corner.”

What I often tell my clients is, “Wherever you go, there you are.” The external is real, of course. It’s material. However, when there isn’t space to work on yourself, you’re going to still find yourself struggling with similar things, even when your external circumstances seemingly get better. A broad arc that I see with clients in terms of before and after with treatment is they’ll come to me three to five years out and they’re just like, “I have either replicated the circumstances in my current job and in my current life that I was struggling with, even when I was younger in training,” like a job that is working them to the bone. They’re picking up call shifts constantly. There’s a deeper sense of emptiness; they don’t even know what to do with themselves when they have free time off, etc. Now there’s some awareness of, “I can’t blame training, I can’t blame medical school, I can’t blame residency. This is my life now.”

They’ll come to me with this arc, and what we’ll do over the course of therapy is process how and why they’ve gotten to the point that they have. That usually requires a lot of emotional processing around grief of milestones or younger years that they’ve missed out on in training or a lot of the narratives that they may have told themselves of, “Things outside of me have to get better, but I don’t have to work on myself,” or there aren’t things that I have to hold myself to account for. Or the opposite too; that “both/and” is a lot of what I contend with, with my clients of, things are situational as well. I also have an arc of doctors where they’re constantly self-blaming, so we have to do a lot of work to help them see the bigger picture.

Over the course of therapy, we process all of those things, we make meaning around them with a deliberate focus of not trying to problem-solve stuff. Over the course of time, there are various success stories. They might leave an oppressive job. They might go look for something where they might make a little bit less money, but they have much more time. It may look like them working on assertiveness where they may be asserting themselves with hospital administration a bit more to ask for more time off or to build that into their contracts. It has also looked like us building a sense of self outside of their physician role. A lot of doctors I’ll see have either lost touch with or they don’t even have hobbies. So even just that sense of having a personal life outside of work and actually cultivating that over time. So, those are just broad strokes.

Kevin Pho: What kind of question should physicians ask themselves to determine whether therapy is right for them?

Annia Raja: Good question. I think one thing to ask yourself is, “Am I ready for introspection?” That can be a tough one for folks. There can be this knee-jerk impulse that I think is broadly gratified in society, looking for instant gratification as opposed to asking, “Am I ready to do deeper work, and am I ready for change?” And it’s OK if the answer to that is no, or not right now. I’ll often have conversations with potential new clients where they’re really frustrated with their life and their circumstances, but they just don’t feel like there’s enough room and space for them to really feel like they can make changes right now. And that’s OK.

Are you ready for introspection? Are you looking for quick fixes versus are you looking to make more meaningful changes in your life? I think that can be a helpful question. Are you looking for more coping versus that deeper type of work? For coping, there’s great therapy out there that’s more structured and more solutions-focused, so that can help people determine the type of approach that’s going to be helpful for them.

I think another one too is, “Am I getting feedback from other people in my life that there’s stuff for me to work on?” A lot of times people will reach out, not so much because they feel like they want to or need to, but there’s just some sense of, “My wife or husband or spouse is telling me, ‘Look, you’ve got to work on yourself.'” Or they’re getting feedback from friends, sometimes even colleagues when things are really bad, where they might be noticing cracks showing. So, are you getting feedback from important people in your life that it’s time for you to attend to yourself a bit more?

Kevin Pho: We’re talking to Annia Raja. She’s a clinical psychologist, and today’s KevinMD article is “Why more physicians are quietly starting therapy.” Annia, let’s end with some take-home messages you want to leave with the KevinMD audience.

Annia Raja: Yes. I would just love to impart to people to take your sense of self and your mental wellness seriously. It’s important. We need our healers to be whole for us to be able to help and provide healing to others. I would say also to really allow ourselves to collectively dismantle whatever stigmas might be there for doctors to reach out for help. There’s a strong sense of identity that doctors understandably have of, “I have to be the strong one. I have to be the one that’s holding everything together.” Just as you advise your patients that it’s OK to reach out for help, I’m encouraging people to bring that message back home towards yourselves. There’s a lot of stigma, unfortunately, for doctors in even reaching out to get care.

You also don’t have to be struggling or in acute distress to reach out. I really encourage people to think about wellness, including something like therapy, as more akin to how we would think about other wellness exercises like lifestyle, diet, going to the gym, etc. You don’t just go to the gym when you have an injury. It’s an ongoing practice of maintenance for the sake of your health. I invite your audience to cultivate a mindset more akin to that when it comes to attending to mental wellness.

Kevin Pho: Annia, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.

Annia Raja: Absolutely. Thanks for having me.