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Psychiatrist, internist, and addiction medicine specialist Muhamad Aly Rifai discusses his article “It’s time to operationalize physician wellness.” Muhamad explains why wellness cannot remain a slogan or a poster in the breakroom but must be embedded into the structure of health care systems. He outlines practical steps such as protecting confidentiality, revising credentialing practices, investing in real peer support, and creating opt-out touchpoints to normalize help-seeking. He also emphasizes the difference between burnout and mental illness, highlighting the need for targeted interventions. Listeners will gain a blueprint for how leaders and organizations can reduce stigma, prevent suicide, and build a culture where physicians are supported as human beings and patients ultimately benefit.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Muhamad Aly Rifai, a psychiatrist, internist, and addiction medicine specialist. Today’s KevinMD article is “It’s time to operationalize physician wellness.” Muhamad, welcome back to the show.

Muhamad Aly Rifai: Thank you for having me to talk about this timely and important topic on physician wellness and how we can make help for our colleague physicians more practical and operationalize that process for health care systems as well as practices around the country.

Kevin Pho: All right, so tell us what this article’s about.

Muhamad Aly Rifai: In the article, I write as a physician who has been involved for as many as 20 years with my state’s physician health program, which caters to physicians who are impaired, whether with psychiatric illness or with drug and alcohol substance use issues. In that experience, I’ve been blessed to have helped a lot of colleague physicians, but I’ve also seen a lot of colleague physicians who have just flickered away, succumbing to their psychiatric illness or their drug and alcohol issues, leaving the field of medicine.

We’re seeing that there is a significant amount of burnout, and physicians are leaving medicine in droves. You have posts after post on your blog showing that that’s a significant problem. We’ve also written about how physicians are overrepresented with depression, anxiety, and post-traumatic stress disorder, and how suicide in physicians is also significant. We lose almost one medical school class every year to suicide. September is suicide prevention month and depression prevention month, so I think it is time for us to talk about how we take practical steps. We’re just talking about this as a phenomenon and not offering any solutions.

I try to present some practical solutions where we can talk about that and give a message to health systems, hospitals, and clinics about how to operationalize physician wellness in a way where we could ensure that physicians show up to work clear. They’re feeling that they’re able to help their patients. They’re not feeling burdened with electronic medical records, paperwork, or patient issues. They’re able to listen to their patients and not go home and find out that they have an additional two or three hours of work and develop depression, anxiety, post-traumatic stress disorder, leave medicine, and, God forbid, have suicidal thoughts. I think some practical steps are very important, and I offer some of those practical steps in the article.

Kevin Pho: Before talking about some of these solutions, we’ve been talking about burnout, like you said, for many years now. Do you feel that hospitals and medical institutions are taking it seriously, and are they making progress in terms of operationalizing physician wellness? How far have we come?

Muhamad Aly Rifai: I talk in the article about some organizations that have taken it seriously and have taken some of that playbook and started understanding what’s going on with their physician workforce. They try to deploy some of these strategies that I recommend. These organizations that have been moving have been able to retain clinicians, have better outcomes for their patients, have better satisfaction scores from their physicians and providers, have been able to reduce errors, and have been able to build a reputation that they are a place that honors that concept of trying to reduce burnout in physicians and providers, and that they’re able to exert excellence and show humanity when they’re dealing with their fellow physicians and their employees. These things are non-negotiable; they really need to hone in on that.

But there have been organizations that are not heeding those warnings and continue to bleed talent and trust. We are seeing that some organizations are really honoring this, and there’s now a distinction. You can see which organization is valuing physician wellness and some organizations that are not valuing that, and they’re bleeding talent and trust.

Kevin Pho: Let’s talk about some of the solutions that you mentioned in the article. Where do we start?

Muhamad Aly Rifai: You start at the top. I don’t think it’s a solution that starts from the bottom. You need to start at the top. The leadership needs to be involved and sign on to that, and they need to be a role model for that. They need to show humility. They need to understand that showing humanity, whether a person has burnout or has issues, requires modeling vulnerability.

For example, we talked in the past about even in government agencies that are related to health, like the Secretary of Health and Human Services, who talks openly about his depression and history of drug use issues and how he was able to work through that and how he continues to struggle with that. Leaders who tell the truth and show vulnerability will serve as role models to their fellow physicians and the people they supervise, showing that they mean changes and are presenting this visibility. They’re able to provide that example to other fellow physicians that it’s OK to seek help, you’re not going to be penalized if you seek help, and that that is an avenue to reducing errors, better patient safety, better productivity, and mostly, the organization would be more profitable if their physicians are happy, patients are listened to, there’s a reduction in error, and there’s improvement in productivity.

Kevin Pho: There are some steps in your article: structured, trained peer support programs, changes in credentialing and licensing. Go on in terms of next steps after that person on the top understands the burnout plight.

Muhamad Aly Rifai: I talked about the fact that there needs to be wellness committees, and those have been evidence-based and shown to work. If the leadership involves the second-tier, third-tier, and even the fourth-tier physician colleagues in wellness groups that focus on and provide suggestions to the leadership about what can be done to improve the lives of physicians, improve their productivity, reduce errors, and reduce depression and anxiety, that shows significant input and feedback from the common physicians to the leadership.

I also talk specifically about the issue of confidentiality and credentialing, and how on every medical staff application, there are questions like, “Have you ever suffered from depression, anxiety, mental illness, or drug and alcohol issues?” The questions use the word “ever.” If somebody had ever had an episode of depression or grief many years ago, they still have to declare it, they would have to be questioned, and they may have to be referred to a psychiatrist who would clear them to ensure that they’re not experiencing any current issues.

Reviewing those credentialing applications, legitimizing that it’s OK if somebody has issues and seeks help, as well as protecting time for individuals to seek help and be protected, is crucial. State medical boards continue, I know my state medical board and the state medical board next door to me, they continue to ask about drug and alcohol use and depression impairment. In states where medical marijuana is legalized, physicians have to have the option to invoke their Fifth Amendment right if asked if they’ve ever used marijuana. They have to invoke the Fifth Amendment to get away from the question, even though it’s legalized in their state.

Confidentiality and understanding individuals’ issues with depression and anxiety continue to be a problem, and the leadership, I think, can work on that and can manage that significant change.

Kevin Pho: If we know that when state medical boards and credentialing committees keep asking about behavioral health issues, that creates stigma surrounding behavioral health in physicians, why can’t they just take that off the forms? What’s the argument on their behalf?

Muhamad Aly Rifai: It’s an incremental change. They argue their default position is patient safety: “We don’t want somebody who has depression to be managing patients.” But there’s really no clear evidence to suggest that if somebody has depression or anxiety, they’re going to be a physician or a provider with poorer outcomes or with errors. In fact, there is significant evidence that if you have those conditions, you may be a more compassionate physician, your outcomes may be better, and you are probably less prone to errors because you put yourself in a patient’s shoes and understand what they’re going through.

It’s stigma that is prevailing and persistent, and it’s going to take more and more time. Hospital credentialing applications take a long time to change. State medical boards are the same thing. Once these things seep into these applications, they’re very hard to take away. That’s where these entrenched positions about not catering to physician wellness come from. Only those hospitals that will tend to these issues will show more credibility, be able to retain more talent, and show that they have a more human atmosphere for the practice of medicine in their institution.

Kevin Pho: To your knowledge, are you aware of any hospitals or state medical boards that have removed those questions?

Muhamad Aly Rifai: Yes. There are hospitals that are removing those questions. I’ve consulted with a couple of hospitals that actually removed these questions from their credentialing applications. They just default to the best judgment of the physician regarding anything to declare in terms of their health issues. They frame it in general health terms: “Is there anything in your health history that you would wish to declare to us on a voluntary basis?” Actually, some physicians may declare things if they feel they need special allowance for specific times or appointments. It becomes more of a voluntary rather than a mandatory disclosure, and the physician feels less stigmatized. They feel able to disclose that to their workplace because the workplace will gain a better understanding of the things they struggle with and could be more compassionate, and the person could be more productive in terms of their patient care.

Kevin Pho: You mentioned that there are hospital systems that take burnout seriously, and that leads to better morale, better retention, and even increased revenues. Can you share a particular story where a medical institution has changed its stance towards the better and it made that appreciable difference in the physician workforce? Just tell us a story so we can visualize what that would look like.

Muhamad Aly Rifai: Sure. Absolutely. A large hospital system that had about thirteen or fourteen hospitals experienced several incidents where there was physician suicide, completed suicide by physicians. That rang the five-alarm fire in the leadership to understand what had happened and to do a root cause analysis, and I was involved with that. One of the findings was that the medical staff application was involved and that some of these physicians who unfortunately committed suicide did not disclose that information.

The decision was to remove those items and make them voluntary, not mandatory. Over the next two or three years, people saw that physicians sought more help. They also established, and I talk about this in my article, an outside counseling firm with psychiatrists that are not in-house. Physicians, when they seek help in-house and are referred to an in-house psychiatrist, fear that their medical records are going to be open and people are going to see they are seeking help for depression and anxiety.

Seeking help outside the system (I am the psychiatrist for that health system; they refer their physicians and employees for me to see) shows they value providing their employees and physicians with outside help. They feel much more appreciated. They feel that their privacy is protected and that the health system is invested in their wellness and improvement, and that there’s no prejudice and no stigma about them seeking psychiatric help because it’s completely confidential. They’ve had increased outcomes, reduction in error, and increased profitability. It can be done, and it has to come from the leadership.

Kevin Pho: We’re talking to Muhamad Aly Rifai, psychiatrist, internist, and addiction medicine specialist. Today’s KevinMD article is “It’s time to operationalize physician wellness.” Muhamad, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Muhamad Aly Rifai: Sure. I believe in medicine that we can focus on the human that is inside the white coat. A physician who is cared for will show up with a clearer mindset. They will listen deeper to their patients. They will think more precisely, and patients will feel it. Safety data will reflect it, and retention curves will confirm it. This is the future. If we have physicians who are struggling, we’re not going to have good outcomes. If you are a physician leader, you need to operationalize this change. If you are a physician, you need to ask your people to follow, and patients will benefit. The culture will transform, and we can build a profession where it’s safe to talk about your own vulnerability and your own illness. That will make you a better physician and a better provider for your patients.

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

Muhamad Aly Rifai: My pleasure.