Psychological well-being is shaped by many things at once: personal history and circumstances, relationships, the work itself, the culture of the places we train and practice, and the policies that govern them. Mental health is part of health, and what physicians face can’t be reduced to a question of individual coping skills.
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My interest here reaches beyond what usually goes under the heading of physician wellness. I want to understand how medicine responds to psychological suffering, in patients and in colleagues; how institutions contribute to it; and how professional culture and policy can obstruct, delay, or outright block physicians’ access to mental health care.
Supporting people who are suffering and changing the conditions that contribute to their suffering are related responsibilities. They are not the same responsibility.
Clinical work carries real psychological weight: serious illness and death, error and uncertainty, responsibility for outcomes we can’t fully control. Training and practice add pressures of their own, from hierarchy and long hours to evaluation that can feel inseparable from identity. None of that makes distress inevitable, and not all of it is harmful. But the environment matters, and so does the way a profession talks about the people struggling inside it.
Exhaustion, detachment, and a diminished sense of effectiveness tied to work conditions. The World Health Organization classifies it as an occupational phenomenon, not a medical condition.
Knowing the right thing to do for a patient and being prevented from doing it by the system around you, and the deeper wound when that happens again and again. Wendy Dean and Simon Talbot have argued that much of what gets called burnout is better understood this way.
Depression, anxiety, post-traumatic stress, substance use disorders, and other conditions. They may be related to work, unrelated to it, or both, and they are treatable.
Not simply the far end of burnout. It reflects many interacting factors, among them mental illness, life events, isolation, and barriers to care, and treating it as a burnout problem misreads it.
Keeping these apart matters. Not all occupational distress is psychiatric illness. Not all psychological suffering originates in the workplace. And changing institutions does not remove the need for individual care: a healthier workplace and good treatment are different things, and some people need both.
Being encouraged to seek care is not the same as being safe to seek it.
Physicians should be able to get appropriate mental health care without fearing unnecessary professional consequences. For years, many licensing and credentialing applications asked about any past diagnosis or treatment. In a national survey of nearly 6,000 physicians conducted in 2014, about 40 percent said they would be reluctant to seek formal care for a mental health condition because of concerns about their medical license, and reluctance was higher in states whose applications asked broadly about mental health history (Dyrbye et al., Mayo Clinic Proceedings, 2017).
Having a mental health condition, now or in the past. Common, and on its own says nothing about whether someone can practice safely.
Therapy, medication, a leave of absence. Getting care is what we want people to do.
Whether any health condition, physical or mental, currently impairs the ability to practice safely. This is the question that bears on patient safety.
A history of treatment is not evidence of current impairment. Patient-safety oversight matters, and it shouldn’t depend on indiscriminate disclosure of mental health histories. The American Medical Association’s position is that inquiries should focus on whether a current impairment exists, not on past diagnoses or treatment.
In her 2023 presidential address to the Association for Academic Surgery, Dr. Carrie Cunningham, then the association’s president and a surgeon at Massachusetts General Hospital, spoke openly about her own depression, anxiety, and substance use disorder. A surgical leader saying that from the podium was huge, and it mattered. The people these application questions deter are our colleagues, and sometimes our leaders.
Watch the address on the AAS website. A later survey of the academic surgery community, with Dr. Cunningham as senior author, found that nearly 1 in 7 respondents had experienced suicidal thoughts in the past year (Annals of Surgery, 2024).
The Dr. Lorna Breen Foundation is named for an emergency physician who died by suicide in April 2020. It leads ALL IN: Wellbeing First for Healthcare, a coalition of national organizations founded in 2021, which helps licensing boards, hospitals, and other care organizations audit and revise their applications, verifies that intrusive mental health questions are gone, and encourages them to tell health workers that seeking care is safe. Its September 30, 2026 announcement reported, as of September 25, 2026:
For comparison, 29 medical boards were verified in 2024 and 40 in September 2025 (AMA Advocacy Update, October 2, 2026). Figures are the Foundation’s; check the current list on its Wellbeing First Champion Challenge page.
That is real, measurable change, and it came from sustained, collective work across many organizations. It is also incomplete. Not every board or hospital has been verified. Changing an application doesn’t, on its own, change how a credentialing committee responds when a physician discloses treatment, how a residency program handles a request for leave, or whether physicians believe the change is real. As the Foundation’s CEO, Corey Feist, put it, “Changing the paperwork is only the beginning.”
Licensing boards are one door. Hospitals ask similar questions when they credential and recredential physicians, and employers and training programs have forms and cultures of their own. Changing what an application asks is concrete and checkable, which is part of why it matters. It also sends a signal. An institution that urges physicians to seek care while asking them to disclose every past treatment is sending two messages, and people tend to believe the second one.
The organizations below lead this work. I support it, and I want more surgeons to know it exists and how to take part.
We train for years to respond to a cardiac arrest: a protocol, a team, practiced repetition, and the expectation that anyone in the room can start. Many of us receive far less preparation for recognizing that a colleague may be thinking about suicide, asking about it directly, and helping them reach care.
Notice warning signs, ask directly, stay with the person, and help them connect to care. These are skills. They can be taught, and they can be practiced.
Reduce the preventable contributors to psychological harm, remove barriers to treatment, and make confidential care easy to reach.
These approaches are complementary, not interchangeable. Preparing colleagues to respond doesn’t excuse an institution from changing the conditions it controls, and better conditions don’t replace the people who notice and act.
A large recent review, a 2024 meta-analysis in The BMJ of studies from 20 countries, found that suicide rates among women physicians were higher than in the general population. Among men physicians, rates were not higher than in the general population overall, though they were higher than in other professions of similar socioeconomic status. Over time the gap with the general population narrowed for both, but it persisted for women. The authors caution that suicide deaths may be underreported, possibly more so among physicians, and that most of the data come from Europe, the United States, and Australasia.
Suicide has many interacting causes. No single workplace, policy, or event explains any one person’s death, which is also why prevention has to work on several fronts at once.
The 988 Lifeline’s #BeThe1To campaign offers five steps, with the evidence behind each one.
The American College of Surgeons collects six actions for surgeons, along with peer-support programs and confidential professional resources.
My own writing on suicide prevention will be collected here as it’s published.
Trauma-informed care is not a branch of mental health treatment. It is a way of practicing, and of running institutions, that recognizes how common trauma is, how it shapes people’s encounters with healthcare, and how care itself can reproduce harm. It belongs in the trauma bay and the clinic, in palliative care conversations, in teaching, and in how leaders respond when someone reports harm, whether that person is a patient or a colleague.
These overlap with the six principles in SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach (2014).
This is connected to my longest-running work: survivor advocacy and violence prevention, including emergency department advocacy and crisis-line work. That history is on the Advocacy page, and it isn’t repeated here. For what surgical care can look like when it is centered on the person receiving it, see Surgery & Palliative Care and the path for patients and families.
Little of my published writing is about mental health directly yet. These pieces sit close to it: the culture physicians train in, and the conditions they work under.
On harassment and inequity in medicine, and why residents, with the longest careers ahead of them, belong at the center of efforts to change its culture.
Written during the 2024 resident strike in Buffalo: on the conditions residents train under, and why physicians’ families deserve access to healthcare in their own right.
More of my essays are on the Writing page. To hear when new ones are published, subscribe on Substack.
Mary Brandt is a pediatric surgeon and Distinguished Emeritus Professor of Surgery, Pediatrics, and Medical Ethics at Baylor College of Medicine. She received the 2023 Ladd Medal, the highest honor in American pediatric surgery, and she also holds a Master of Divinity. For nearly twenty years she has been teaching surgeons about compassion fatigue, burnout, and what it takes to sustain a life in surgery.
Her work keeps two things in view at once: what an individual surgeon can do to stay whole, and what the culture and business of medicine are doing to the people inside it. Self-care alone isn’t enough, she argues, and she calls for a new approach she names Well-Being 3.0.
A selection. Dr. Brandt has published more than 245 papers, most of them in pediatric surgery; her CV also lists two decades of lectures on compassion fatigue, burnout, and the ethics of self-care, including the University at Buffalo’s Butsch Memorial Lecture in 2018, “Why are Surgeons Leaving Surgery – And What Can We Do About it?”
If someone is in immediate danger, call 911. Details last checked October 15, 2026.
Paths through this site for residents, premeds and medical students, physicians, advocates, and patients and families, and the full Resources collection.
If you’re working on licensing or credentialing reform, peer support, suicide prevention training, or trauma-informed practice at your institution, I’d like to hear what you’re doing and what you’re running into.
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Why is it still so hard for physicians to seek the very care we are trained to provide?