Unpacking layers of stress among BIPOC health providers


Work. Family. Financial hardships. Remote learning. Fatal shootings. Hate crimes. Social justice protests. COVID-19. Grief. Personal and community trauma. Layers of stress.

Health care providers who identify as Black, Indigenous and People of Color, or BIPOC, often carry layers of stress on any regular day. Yet, they have shouldered several more layers over the past year from battling a pandemic while supporting the physical, emotional and mental health of their family, friends, patients, communities and somehow, themselves.

Together, the layers are forming a pressure cooker, observes Dr. Anissa Mattison, the assistant dean at the MSU College of Osteopathic Medicine’s Detroit Medical Center campus.

“If we don’t acknowledge that and plan for the future, we’re going to pay a price,” she says.

May is National Mental Health Awareness month, and while racial health disparities and vaccine rollout inequalities dominate the conversation, Mattison points to the dangerous burnout-accelerating environment surrounding BIPOC health workers—and the immediate need to alleviate the strain on these professionals through both individual and systems-level action.

As the director of the obstetrics and gynecology residency program at St. Joseph Mercy Oakland Hospital, Mattison observes physician burnout. Before the pandemic, physicians were already retiring early because of it. She’s experienced firsthand the roiling mix of emotions dealing with COVID-19 cases in a clinical setting.

“You could never really get away or turn it off,” she explains, citing fear of exposure; an exhausting responsibility to educate and advise patients, friends and family about the virus, variants and vaccines; balancing compassion with enforcing safety protocols; and supporting patients (especially marginalized and undocumented patients) who distrust the health system. In addition, physicians dealt with the discomfort that comes with uncertainty both at work and at home.

“Health care can be a lonely place,” Mattison reflects. “It’s one of those clubs where there’s so many things you can’t express or don’t want to burden family and friends with.”

“Then there’s the social justice work on top of all of that,” she goes on to say. “BIPOC who work in the health system have experienced firsthand or secondhand situations that were not equitable. In the past, they would compartmentalize those things in order to keep working. All the events of racial injustice ripped the band-aid off and let the wound bleed a little. We were forced to have these discussions.”

Mattison adds that another stressor BIPOC health providers struggle with is making daily calculations on whether to speak up despite fear of rocking the professional boat or staying silent and feeling like they contribute to a culture that condones the behavior.


Pushing for inclusive solutions

Mattison believes it will take an effort at every level to release the pressure within the health care environment.

“When you work in high-pressure health care situations, we’ve been trained to be very good at responding in the moment…and we’re still pushing through right now. The most dangerous time will be when we get back to some level of normalcy and think about where we have been,” she says.

Mattison predicts that the mental health recovery will require much more time, and she offers up a few ways to support health care professionals:

  • Provide mental health resources: Mental health support resources through hospitals and county systems should be normalized and be part of a routine outlet for physicians. Dr. Mattison calls for a collaboration with mental health providers to think outside the box.
  • Expand wellness tools and creativity: In addition to yoga and other wellness tools available to physicians that may benefit individual practitioners, Dr. Mattison advocates for sustainable, long-term changes to the system. “Can we give more leeway to physicians to bring the creativity back into medicine by prescribing more non-traditional recovery techniques—such as music therapy—even if it’s not covered by insurance, for example?” she asks.​​​​​​​
  • Listen and implement changes: “If there’s an issue you want to address, listen to the people affected by the issue: ‘What are you feeling? What are your past experiences? What do you expect?’ You have to talk things through and find the nuggets that can affect immediate change. Acknowledgment and finding that common ground goes a long way.”​​​​​​​
  • Become part of the solution: “Practicing physicians need to be part of the solution. It’s hard because we’re pulled in so many directions, but we need to be present in these governing bodies that are having a say [on policies].”​​​​​​​
  • Reach out: Reach out and do something kind for your friends and family in the medical field. Offer to have dinner delivered. Text them to check in. Don’t pressure them to respond or hang out, but reach out and make time to ask deeper, probing questions.

“We don’t expect systems change overnight but we don’t want lip service. Let’s substantially move forward, even if it’s just an inch (or centimeter) in the right direction. That’s powerful, motivating and it builds trust. We’ll keep moving with you,” Mattison says.

Her final reflection on supporting sustainable well-being is, “You need to find that joy and excitement you had when you applied to med school…find a way to sustain that for a long period of time.”

Read more about Dr. Mattison’s take on the need for more diversity and people of color in leadership positions in medicine, her plans to deepen the college’s community connections to foster trust and recruit diverse applicants in the years ahead, and how physicians can build trust with patients.