Patterns in mental health- and substance use-related visits from 2003 to 2022 among registered Ontario physicians

Background — Physicians experience high levels of mental health and substance use (MHSU) concerns, with implications for workforce sustainability and patient care (1, 2). Although societal discussion over physician mental health has increased in recent years and accelerated during the COVID-19 pandemic (1, 3), to date, there has been limited population-based data on changes over time in physicians’ mental health.

Objective — To examine temporal patterns in MHSU-related health care visits among a group of nearly 30 000 physicians over a 19-year period.

Methods — We conducted a study of early (first 5 years of independent practice) and mid-career (sixth through 15th year of independent practice) physicians who registered with the College of Physicians and Surgeons of Ontario between 1990 and 2018. We used College of Physicians and Surgeons of Ontario registration data linked to health administrative data held at ICES (formerly known as the Institute for Clinical Evaluative Sciences) to identify physicians and capture all of their outpatient MHSU visits to a psychiatrist or family physician. We calculated the annual age–sex standardized proportion of physicians with 1 or more outpatient MHSU visits between 1 July 2003 and 30 June 2022 using direct standardization to the total physician population in 2022. We examined visits overall, by visit type (anxiety, mood, and substance use disorders; attention deficit–hyperactivity disorder; adjustment reactions; and other), and by specialty (family medicine, psychiatry, and all other specialties) as per prior methods (4).

This project was authorized by the privacy office at ICES. No informed consent was required because the study used deidentified health information.

Findings — Our study included 29 662 physicians in Ontario, of which 3274 (11.0%) had 1 or more outpatient MHSU visits. Mean age at study entry was 33.1 (SD, 4.5) years. A total of 15 506 (52.3%) were male, and the most common specialties were family medicine (11 448 [38.6%]), medicine (4643 [15.7%]), and surgery (3623 [12.2%]) (Table).