In the noble pursuit of healing others, doctors often find themselves battling an invisible adversary: their own mental health challenges. However, a daunting obstacle stands in the way of seeking help—the fear that reaching out for support will jeopardize their professional careers. An experienced doctor and activist for healthcare workers, Dr. Anne Louise Phelan passionately advocates for a better system—one that prioritizes support and understanding.
The medical field has traditionally been associated with a culture of resilience and self-sacrifice due to its demanding workload and high-stakes responsibilities. When it comes to their patients’ lives and health, doctors are counted on to be pillars of strength and competence. But underneath this anchored exterior, a growing number of medical professionals are struggling in silence with their own mental health.
The unique challenges of medical practice, such as long working hours, emotional intensity, and exposure to traumatic experiences, can exact an incapacitating toll. Burnout, anxiety, depression, and even suicidal thoughts are alarmingly common within this profession.
Despite the evident need for mental health support, a disheartening obstacle stands in the way for doctors—a fear that seeking care may result in a report to medical boards or their associated physician health services, potentially leading to the loss of a medical license. This trade-off has created a dangerous dilemma for physicians, caught between their personal wellness and the potential adverse consequences of seeking help.
During her many years of practice, Dr. Anne Louise Phelan, a brilliant and compassionate physician, commanded respect and admiration within the medical community. With a reputation for providing exceptional care to her patients, she was seen as a beacon of hope for those in need. However, her life took a devastating turn when an unjust decision by a medical board shattered her career and left her feeling powerless.
She is now a tireless advocate for regulatory reform, which will allow doctors to seek care without fear of reprisal by their colleagues or medical boards, to benefit doctors and patients alike. By removing obstacles to medical professionals seeking treatment, we as a society can truly acknowledge their hardships and humanity.
After receiving a bachelor’s degree in psychology from The College of William and Mary and studying bioscience at the postgraduate level at Virginia Polytechnic Institute, Dr. Phelan graduated from the University of Virginia School of Medicine in 1981 and finished her residency training in family practice in 1984. Over a span of 35 years, she worked in correctional medicine, family practice, emergency and urgent care, occupational health, community health and public healthcare institutions.
In all those years, she was never the subject of a malpractice suit, a formal complaint or a disciplinary action by any medical organization.
During her career as a physician, Dr. Phelan cherished the ability to make a tangible difference in people’s lives, healing them through direct care. She quickly discovered, however, that working in medicine presented its own tribulations.
Medicine is a complex field that demands a disciplined mind and a compassionate soul. These two can sometimes be at odds during a difficult event, leading to moral injury, a state similar to post-traumatic stress disorder (PTSD).
PTSD is the re-living of a traumatic event that threatened one’s life or physical integrity. It can arise from various traumatic experiences such as combat, accidents, or natural disasters. The disorder is both a psychological and physiological phenomenon.
After experiencing a triggering event, a person may go into a “fight or flight mode,” where he or she experiences intense fear and panic. Simultaneously, muscles may tense up, and heart and respiratory rates may increase.
In contrast, Dr. Phelan explains, moral injury stems from the violation of deeply held moral beliefs or the failure to live up to one’s own moral standards, often leading to intense feelings of guilt, shame, or moral anguish.
Dr. Phelan adds, “For instance, in medicine, it’s really drilled into us that in order to be good at what you’re doing and to help your patients, you have to do everything you’ve been trained to do to save a person’s life or to resolve the problem.”
In a perfect world, medical professionals would always have this ability. However, sometimes doctors cannot administer necessary care due to factors beyond their control.
“Moral injury occurs when the external situation is such that you cannot do what you’re taught or feel obligated to do—what you’re compelled to do by your training. As a result, you feel shame that you’ve let people down and that you have betrayed your own values. It is a deep, deep injury to your soul.”
We witnessed moral injury on a massive scale during the COVID-19 pandemic. Hospitals were overwhelmed by the inundation of patients, and healthcare professionals were put under immense performance pressure.
Doctors faced difficult ethical decisions and moral distress; the scarcity of resources, such as ventilators or ICU beds, forced them to make challenging decisions about allocating limited resources and prioritizing patients. These decisions, often made under tremendous duress, had long-lasting emotional impacts, leaving them feeling conflicted, guilty, and burdened by their weight.
“There was an extremely heavy burden placed upon them to perform admirably, but they lacked sufficient resources. Throughout the pandemic, there was a scarcity of beds, ventilators, personal protective equipment and support staff.”
One of the main emotional challenges doctors faced during the height of the pandemic was the constant fear and anxiety of contracting the virus themselves. They worked in high-risk environments, were directly exposed to infected patients and faced shortages of medical-grade masks and other equipment, which put their own lives in jeopardy.
This fear extended beyond their professional lives, as many doctors worried about unknowingly transmitting the virus to their families and loved ones.
The demanding and overwhelming work environment also led to increased levels of burnout among healthcare professionals at all levels. They had to work without adequate breaks and faced the strain of providing care in a rapidly changing situation. Additionally, they witnessed an overwhelming amount of illness, suffering, and death.
Dr. Phelan says that, despite the exponential increase in seriously ill patients, hospitals did not adequately address the issues of emotional and physical fatigue in staff.
The pandemic also isolated doctors from their support systems. Social distancing measures and the need to limit contact with others meant that doctors had to bear the emotional burden of the pandemic themselves. This sense of isolation and the inability to seek solace exacerbated mental health issues.
As an added hurdle, the tools available to slow the spread, such as masks and vaccines, became politicized by the media and the public, which resulted in confusion and unnecessary illness and death.
“There were all these recommendations like vaccines, masking and social distancing which could protect individuals from severe COVID disease and decrease its transmission to others. At the same time, there was a message coming out from the White House that the pandemic wasn’t a serious problem. You have to wear a shirt and shoes in order to get service at a grocery store, and no one thought twice about that. Suddenly if you have to wear a mask as well, your human rights are being violated.”
In the United States, the COVID-19 pandemic came in four distinct waves: Alpha, Beta, Delta and Omicron. Dr. Phelan characterizes the trauma and moral injury specifically affecting medical personnel who had reached their physical and mental breaking point as the pandemic’s fifth wave.
“There was a wave of medical professionals who had burned out physically and emotionally or who had gotten COVID-19 but could no longer function adequately because they weren’t recovering as they had hoped. The added moral injury contributed to the resulting anxiety, depression, and suicidality. Ultimately, some physicians and nurses started quitting medicine altogether.”
While the number of COVID-19 patients flooding hospitals has decreased, there has been a reported resurgence of moral injury since the Supreme Court overturned Roe v. Wade.
“Physicians, nurses and allied health professionals are trained to provide the best care possible for their patients, including obstetrical and gynecologic care. Suddenly in states where abortions are banned or severely restricted, physicians and nurses are again in this situation where they know what the patient needs but are unable to provide it.”
She uses the scenario of a pregnant woman who developed a dangerous uterus infection due to delayed treatment to illustrate her point.
“There was a situation early on where the fetus was unable to survive outside the womb, but physicians had to wait until either the fetus died or the woman became septic, at near death, before they could intervene and terminate that pregnancy.”
Healthcare professionals in these states feel helpless, knowing how they should treat their patients but being unable to do so. Instead, they must watch them suffer and risk permanent injury or death since intervening too early has become a perilous legal issue. Doctors are left in an impossible position.
“In a couple of states, if the physician performs an abortion that the state now declares is against the law, they get reported to their medical board, and the medical board can take away their license. And then, of course, there’s the worry of being sued by the patient or family or being charged criminally by their state.”
In addition to the already tricky emotional demands of working in a profession where patients completely put their trust in them, doctors have no true outlet for dealing with their daily stresses. If doctors themselves seek care, they risk being investigated by medical boards to see if they are fit to do their jobs.
“In many states, you have to divulge past personal history of mental illness or substance abuse to the medical boards, not just your current state of well-being, but also of issues that have resolved or are being properly managed. This is a violation of the Americans with Disabilities Act.”
Dr. Phelan shares that, along with herself, a number of her colleagues have lost their licenses for doing what is ethically required of them—seeking care for mental health issues. With such implicit punitive measures, the other option doctors are left with is to try to handle the situation themselves so that the board does not find out that they are struggling.
“What we’ve discovered is that not only do physicians have about twice the rate of suicide as those of other professions, but also at least a third of the physicians who commit suicide are not getting any kind of treatment whatsoever. And we do know that not just depression itself, but depression that is left untreated, is a major contributor to suicide.”
She also asserts that the board’s current approach to investigating cases violates doctors’ due process and civil rights and inflicts further moral injury by harshly judging and publicly shaming them.
“Medical board investigations are considered administrative proceedings instead of civil proceedings. Because one of their primary missions is to protect the public from those whom they consider dangerous doctors, they have an uncontested right to omit protections that physicians would have in a civil matter. For example, they can suspend a physician’s license on an emergency basis even when there’s no evidence that that physician has performed in a substandard manner. Medical boards also violate physicians’ HIPAA privacy rights by publishing their findings on their public websites, including very personal medical information about the physician. In my opinion, they may also be violating their 14th Amendment rights. The 14th Amendment says all individuals, regardless of religious beliefs, ethnic background, gender or profession, have the same right to equal treatment under the law. Physicians, nurses, psychologists, and therapists are not given this right when being evaluated, investigated or disciplined by their boards.”
Dr. Phelan believes it is important to note that a medical license is considered a form of property.
“If the state is going to take away your property, it has to follow a specific procedure known as ‘due process.’ They also have to compensate you for the loss of your property. When medical licensing boards revoke a person’s license, they are taking away the property that gives them the ability to make a living.”
According to Dr. Phelan, boards may have a perverse incentive to pursue cases more aggressively than is appropriate. Their actions veer away from simply being protective of the public to enhancing their reputation as protectors of patient safety by systematically increasing the number of physicians they discipline each year.
“They’re more inclined to take radical disciplinary actions like license suspensions, revocations and limitations rather than, for example, saying to the doctor, ‘OK, you’ve got this issue, you really need to see a psychiatrist, and we need to monitor you.’”
Dr. Phelan’s loss of licensure directly resulted from the board’s current policies and procedures. Motivated to point out the current system’s flaws, she began sharing her story online; her first article was titled “They Fell Like Dominos.”
“A third of the comments were from people who said, ‘This happened to me,’ and a third were from people who said, ‘I had no idea it was happening to doctors.’ And we’re realizing that this is probably worse than getting sued because if you get sued, you have civil rights. You get legal representation from your malpractice carrier, and a burden of proof must be achieved before you’re found guilty of malpractice.”
Nonetheless, another third suggested that the board ruled correctly and that she was just a disgruntled doctor with a drinking problem. Dr. Phelan says she was prepared for the backlash she would receive after sharing her story, but she felt compelled to do so because of how callously medical boards were treating doctors.
“It’s a lot more common than one might think because people feel shame and don’t want others to know what they’ve been accused of. It is a personal failure that’s associated with failure as a physician or a professional in general.”
Physician health programs (PHPs) were created to address some of the struggles doctors face. She describes the programs as initially informal groups of people helping their colleagues through difficult times. The small circles were a place of understanding, but Dr. Phelan says that some have devolved into state-sanctioned centers of coerced medical treatment.
She further explains that PHPs were intended to be monitoring programs that ensured physicians got the care they needed while ensuring that their patients were also well cared for. Over the last 20 years, PHPs have become a power onto themselves that can demand exactly what the physician’s treatment will be. As they’ve become more closely aligned with the medical boards, any deviation from the PHP’s “recommendations” can result in suspension or even revocation of the physician’s license.
After a devastating event in her life, Dr. Phelan experienced the system’s failure firsthand. Like other doctors, Dr. Phelan carried a heavy burden behind the polished exterior and the white coat—an invisible battle with her mental health. Long hours and the relentless demands of the medical profession contributed to an overwhelming sense of exhaustion, only adding to the personal despair she battled.
Dr. Phelan understood the importance of seeking help for her mental well-being, recognizing that it was crucial not only for her own sake but also for the sake of her patients. Yet, she found herself trapped in a grim predicament. Deeply aware of the stigma surrounding mental health issues in the medical field, she feared the repercussions of seeking care. After stepping away from work for an extended period, she returned only to learn the board was investigating her.
The medical board told her that in order to keep her license, she would have to stay in inpatient drug rehab for up to 90 days.
“I was a mess, and I knew that I was a mess, so I took time off to get better. And it wasn’t until three months after I returned to work that they started investigating me. When given a choice to get inpatient treatment or permanently lose their license, if a doctor says, ‘OK, I’ll do it,’ they may or may not, at the end of the 90 days, get their license back. Also, they’re almost always put into a five-year monitoring contract which can be very onerous and expensive. If, on the other hand, the physician says they can’t do it because they can’t afford it or don’t have the physical capacity to endure it, the board lets the world know that they are not compliant. Then they revoke the physician’s medical license.”
It was in this oppressive climate that Dr. Phelan’s fate was sealed. A decision by the medical board, driven by outdated policies and a lack of understanding, stripped her of her license without due consideration for the years of dedication she had poured into her craft.
Betrayed by the system she had trusted, she was left to grapple with the devastating consequences of a profession that failed to prioritize the mental well-being of its healers. Dr. Phelan states that this is where financial incentives usually come into play.
“The inpatient substance abuse treatment facilities that PHPs refer physicians to benefit financially. Insurance doesn’t cover such prolonged stays even for serious addiction problems because they’re not considered medically necessary. As a result, the physician must pay for the stay in cash, and the facility receives two to three times more reimbursement than it would get from insured patients.”
Crucially, in her case, the physician who decided that she needed inpatient treatment was also the acting medical director of the facility he was recommending she be admitted to.
“In some states, the PHPs are funded through a medical society or a private entity that gives them additional funding for each physician in a contract with them. So, the more physicians they have under contract and the longer they’re under contract, the more money the PHP stands to get.”
These rigid regulations only reinforce doctors’ bias against seeking mental health care, even among colleagues. Dr. Phelan says that physicians learn to be intolerant of perceived weaknesses or failures as early as the third year of medical school.
“And now I’m seeing this disturbing trend. It used to be that the responsibility was on the attending physician to be sure that the work medical students and residents do for the patient was being done properly. Now it has shifted to blaming the residents and medical students themselves.”
She describes a story where a medical student was fired along with an attending physician when the student complained about the physician’s lack of compliance with established protocols. Behaving in an ethically appropriate way, whether seeking care for oneself or reporting observations of doctors violating medical standards (i.e., being a whistle-blower), has become a professionally precarious endeavor under the board’s oversight.
As pressure grows for doctors and medical students, Dr. Phelan believes this system is unsustainable. In order to properly rectify these issues, the public and medical professionals must recognize that the boards are created by state legislatures and the members are chosen by their respective governors. This relationship effectively makes them extensions of state government that should be required to respect their licensees’ civil rights.
“The first step is to convince legislators that there is a problem—that physicians’ rights under the ADA and HIPAA are being violated and good doctors are being lost to society. This is an issue that they need to heed. The second step is general awareness by the public and the profession.”
She reasons that if every physician who was suffering was able to seek treatment without fear of reprisal, the stigma might diminish. And ultimately, people could get the medical care they needed.
Dr. Phelan also argues that it is crucial to consider how, despite appearances, a solution to concerns about patient safety that rests on absolute intolerance of mental health disorders can cause more harm than good and may even perpetuate and aggravate the problems it was initially meant to resolve.
While the goal may have been to make sure doctors that directly interact with patients are competent, the fear of punishment and loss of livelihood robs doctors of an avenue to care for themselves. This ultimately not only hurts doctors, but it also potentially harms patients who unknowingly are putting their trust in the hands of a doctor who may not be dealing with their own issues due to a fear of license discipline.
“The medical profession has to recognize that there’s a problem. They have to understand the dire consequences that can happen should a colleague have untreated mental health and substance use disorders. It requires a certain percentage of people pushing back on something before a change is even considered.”
As with all legislative changes, doctors who have been personally affected by the unforgiving policies of the board need to come together and advocate for a policy that allows doctors to seek appropriate and ethical care while also protecting the public’s welfare. It is possible to do both.
“At the legislative level, there needs to be a critical mass of people who are agitating for a cause before legislatures will respond. They need to say, OK, we need to seriously discuss this. We need to consider legislation. We need to consider changing the standards by which our medical boards and their PHPs operate. We need to change the financial incentives that are driving physicians into these expensive drug rehab centers.”
According to her, these changes can start with amending questions like “Have you ever been treated for a mental health issue?” or “Have you ever had a substance abuse issue?” asked by licensing boards.
“One of the major things that keep doctors from seeking treatment is that they know that if they seek treatment, they’re going to risk losing their license or they’re going to have to lie on their license applications. And that has to change. It should be, ‘Do you have any issues that might currently impair your ability to practice medicine, and if so, how are you addressing them?’”
The time to act is now. If doctors continue to try and self-medicate their issues or just “grin and bear it,” Dr. Phelan says we will continue to have tragedies such as suicides on our hands.
This pervasive issue haunts the corridors of hospitals and the hearts of physicians nationwide. An unspoken rule seems to loom over the medical profession, silently warning doctors to conceal their pain and suffering lest they risk everything they had worked so hard to achieve. The system meant to protect both patients and doctors is now instilling fear and discouraging those in need from seeking the care they deserve.
“If we are not careful, these physicians and nurses who have been traumatized may realize that they need professional support but may not be getting it because, if the employer or medical board finds out, that could jeopardize their careers. And if they don’t get it, they may be at risk for self-harm. And we know that the consequences of that are pretty dire also.”
Dr. Phelan continues passionately writing about the cause, hoping to see a more just and compassionate regulatory agency someday. She wishes healthcare professionals would be granted the same empathy and respect they extend to their patients and institutions. Nowadays, she is working on a collaborative memoir and anthology called The Disrupted Physician.
“I not only share my own story, but I include the stories of several others who have witnessed things firsthand. And the end of the book will be devoted to what you should do if you’re called before your board or PHP. It will also include links to various support groups people can go to.”
It took exceptional courage to put her story out into the world, speaking truth to power, despite expecting deeply personal criticism. But, as Dr. Phelan points out, “If you have nothing to fear, then there’s no need for courage.”
Moumita Basuroychowdhury is a Contributing Reporter at The National Digest. After earning an economics degree at Cornell University, she moved to NYC to pursue her MFA in creative writing. She enjoys reporting on science, business and culture news. You can reach her at email@example.com.