It has been a long year, and many of us have wounds our colleagues have no idea about. SGIM members experienced COVID-19 and worked on the front lines, and some of us lost loved ones prematurely from COVID-19 or other illnesses inevitably impacted by the pandemic. We have members who questioned their roles in academic general internal medicine, not to mention their roles as partner, child, parent, activist, and health professional. We may not have been aware of the baseline stress already experienced by many of our members, but undoubtedly the pandemic worsened the strain.

I wonder at times what structural supports are in place for our members to react individually or as a group when faced with bereavement, burnout, and other crises? What are the resources offered to clinicians seeking support for their mental health? What are effective macro-level interventions?

As mentioned in this month’s CEO Q&A, Mark Linzer and colleagues recognized the need to address systematic structures leading to burnout long before this current crisis. To that end, ACLGIM leadership partnered with Dr. Linzer’s group to understand physician burnout in GIM.¹ That work led to the development of the WELL Program.²

Regarding mental health, many of our members have several options as they seek assistance through their personal storms. Many may have turned to colleagues in local affinity groups, such as spiritual homes, social justice, and sororal or professional organizations. Within SGIM, members may have found solace in community with like-minded individuals in one of the approximately 60 interest groups at our 2021 SGIM Annual Meeting. This may be an ideal time to reach out and check in on someone and, more importantly, let them know you are there and it is okay to take a needed break.

Members may be sustained at the regional level or find that their support networks are more local. To highlight two of our regional locations, those calling Emory University their professional home have the largest cohort of SGIM members in the Southern Region. Emory-based SGIM members can seek out or encourage friends, trainees, and colleagues to seek support from institutional resources, such as those found on the Emory + YOU: Your Wellness.³ The site offers employees online mental health screening tools, counseling resources, and financial wellness programming. In the Mountain West Region, where the largest cohort of our members can be found affiliated with the University of Colorado, UCHealth set up a crisis support hotline for staff and providers.⁴ I hope highlighting these two specific resources will inspire us to remind our friends of these resources at local institutions. Employee assistance programs are only one avenue of support for our members, staff, and trainees. More work is needed at all our institutions to ensure that these programs and their staff represent and provide services that are culturally appropriate and sensitive to the diverse needs of those seeking assistance.

For our members who do not feel comfortable seeking sources of help at their place of employment or if there is an ongoing clinical need, we must strive to dispel the stigma related to seeking mental health services. Our collective energy should be focused on the continued advocacy needed at the state medical board level to further evaluate the necessity of probing questions regarding mental health on state licensing applications, and if they are there to ensure there is a differentiation between current illness and impairment.⁵

As we encourage the use of mental health services, we must also be aware of their potential financial and emotional cost. The Health Policy Committee has long advocated for improving access to integrated behavioral and physical care options as well as ensuring effective implementation of mental health parity. This work over the decades has ensured that most of us we can access mental health services as part of our employer/practice-based health insurance plans. Insurance parity is only one part of access. Many find it difficult to find a mental health professional who takes insurance. The Clinical Practice Committee and our Veteran Affairs partners have long advocated for (and many our members have been successful in implementing) behavioral health services embedded within primary care. More work is needed to fully integrate behavioral health into all sites of primary care. There is also a growing recognition that immediate access to mental health services on inpatient wards for patients is needed, as complementary support of the physical and emotional care provided by our academic hospitalists.

“Put on your oxygen mask first before helping others…” The historical relevance of this statement has changed over the past several decades. It started as a statement of fact. This is how to address an extreme airplane emergency when you have seconds to act and taking care of oneself first will allow you to better assist someone else. I remember this statement being useful for mothers, many of whom worked outside the home. It was seen as a reminder to care for oneself in order to be a better mother. Healthcare professionals are now facing an urgent burnout and mental health crisis. On behalf of all of us, I call for fundamental systematic structural changes similar to those noted in the CEO’s Q&A that are needed in our workplaces to prevent harm—including aggressive attention to overwork, impossible electronic medical record burdens, lack of ancillary support—and allow meaningful protected time for self-care and access to mental health services.