By Deepti Govind
On Sept. 17, 2020, in recognition of National Physician Suicide Awareness Day, the Physicians Foundation published the alarming results of a new survey that found that nearly one in four physicians (22%) know another physician who has committed suicide, and that the majority (58%) express feelings of burnout. Even before the Covid-19 pandemic struck and led to massive overtime and exacerbated emotional stress of working in the healthcare industry, physician burnout rates were already at an all-time high. The Physicians Foundation 2018 Survey of America’s Physicians found that 40% of physicians often or always experienced feelings of burnout.
“Physician wellbeing was a public health crisis long before COVID-19. Now, we’re seeing the pandemic exacerbating this issue,” said Gary Price, MD, president of the Physicians Foundation. Per the 2020 survey, 50% of physicians reported experiencing inappropriate anger, tearfulness, or anxiety as a result of Covid-19’s effects on their practice or employment.
The latest survey also targeted coping mechanisms among physicians in the face of the pandemic-led prolonged uncertainty: 18% reported increasing their use of medications, alcohol, or illicit drugs, but only 13% of physicians said they sought medical attention for a mental health problem as a result of Covid-19’s effects on their practice or employment situation. This despite healthcare workers having to bear some of the worst of the pandemic, given they’ve been on the front lines of the war against the virus.
It’s this last statistic that lawmakers and advocates pushing for the passing of the Dr. Lorna Breen Health Care Provider Protection Act (S. 610) hope to change. Many physicians and healthcare workers don’t seek counselling or other behavioral health services, fearing it could jeopardize their medical license or impede their careers, says a Bloomberg Law article.
“There are two main reasons that so few physicians seek help – stigma and fearing a loss of their license. But just like anyone else, physicians are people and should feel comfortable seeking help without worry of being judged or losing their right to practice,” said Robert Seligson, CEO of the Physicians Foundation. And yet, it’s of critical importance not just to healthcare workers but everyone to address physician burnout and suicide.
S.610 — Dr. Lorna Breen Health Care Provider Protection Act
The bill in brief: It establishes grants and requires other activities to improve mental and behavioral health among health care providers. Specifically, the Department of Health and Human Services (HHS) must award grants to hospitals, medical professional associations, and other healthcare entities for programs to promote mental health and resiliency among health care providers. In addition, HHS may award grants for relevant mental and behavioral health training for health care students, residents, or professionals. It also requires HHS to conduct a campaign to encourage healthcare providers to seek support and treatment for mental and behavioral health concerns, and to disseminate best practices to prevent suicide and improve mental health and resiliency among healthcare providers. It would direct $140 million in American Rescue Plan funds to train current and future health professionals on how to prevent suicide, burnout, and substance abuse.
In addition, HHS has to study and develop policy recommendations on:
- improving mental and behavioral health among healthcare providers
- removing barriers to accessing care and treatment
- identifying strategies to promote resiliency
The bill was introduced in the Senate on March 3, and was passed/agreed to in the Senate with an amendment by Voice Vote on Aug. 6. Senators Bill Cassidy, M.D., and Tim Kaine issued a statement applauding Senate for the passage of the bipartisan piece of legislation. This measure was also introduced by Senators Todd Young and Jack Reed. The bill, which has 29 co-sponsors so far, now awaits action in the House where it’s been held at desk since Aug. 10. It has strong bipartisan support.
The long title of this act is “address behavioral health and well-being among health care professionals.”
Per Senators Cassidy and Kaine’s statement from August, the bill aims to:
- Establish grants for training healthcare professionals or trainees in strategies to address mental health and substance use disorders.
- Require identification and dissemination of best practices for preventing suicide and improving mental health and resiliency among health care professionals.
- Establish a national education and awareness initiative to encourage healthcare professionals to seek support and care for mental health and substance use concerns.
- Establish grants to healthcare entities (e.g., hospitals, community health centers, and rural health clinics) for healthcare provider education, the establishment of programs to prevent suicide and improve mental health among health care professionals, peer-support programming, and mental health treatment. Healthcare providers in health professional shortage areas or rural areas will be prioritized.
- Require a review related to improving healthcare professionals’ mental health and resiliency, including the impact of the COVID-19 pandemic on such professionals’ health and the barriers they face when seeking and accessing mental health care.
You can find the full text of the bill here.
Dr. Breen’s Story
The bill is named in honor of Dr. Breen, a physician from Charlottesville who died by suicide after fighting on the front lines of the coronavirus pandemic in New York. In 2019, Dr. Breen was one of four co-authors of a research article in the American Journal of Emergency Medicine that found emergency room providers could reduce the “alarming prevalence of clinician burnout” by working in “paired teams” of caregivers.
“Burnout is characterized by emotional exhaustion, physical fatigue, and cognitive weariness, which may lead to feelings of depersonalization and reduced accomplishment. The consequences of burnout are broad and has been shown to adversely influence both clinician well-being and patient care outcomes. Factors such as Emergency Department (ED) crowding, hallway care, and patient volume has been associated with increased perceived psychological distress and perceived communication quality among patients and providers in the ED setting,” the research article says.
The ED is a fast-paced setting, where teamwork is critical to efficient care. Would a novel ED team-based structure be associated with decreased levels of clinician burnout? That was the question Dr. Breen and her co-authors aimed to answer. Tragically, only ten months after that was published, in April 2020, Dr Breen committed suicide after “treating scores of dying Covid-19 patients, contracting the virus herself, and being consumed by feelings of helplessness and despair,” Bloomberg Law says.
She led the emergency department at New York-Presbyterian Allen Hospital in Manhattan, and became an early casualty of pandemic provider burnout — the very condition her research hoped to address, the Bloomberg Law article adds. To make matters more complicated, female doctors have higher suicide rates than men and, in general, doctors had the highest suicide rate of all professions.
Female doctors have even been known to risk miscarriages while on duty. The Bloomberg Law article cites the example of Dr. Mara Windsor, an emergency room physician in Phoenix, Arizona. Dr. Windsor said the pressure to persevere, to work when sick, to never take “mental health days” led her to continue making her hospital rounds as she began to miscarry early in her third pregnancy some nine years ago.
Dr. Windsor continued working despite severe abdominal pain, and sat down in the rooms when she was with patients because she was having a hard time bending over and walking, the article adds. She made it through her shift and went to see her OB/GYN only the next day, when an ultrasound confirmed the miscarriage and bleeding in her pelvis.
Stories of dealing with death, grief, frustration, and the stress of extreme uncertainty are echoed across various aspects of healthcare today, including nurses who are in “moral distress” after months of working under “crisis standards,” underscoring further the urgent need to address this public health crisis. Even today, i.e., Sept. 16, Senator Kaine urged lawmakers to pass the bill named after Dr. Breen.
“The level of burnout, moral distress, and repetitive trauma experienced by our health care workforce when we started this, is now magnified, 10-fold. We need to demonstrate to our healers that this is our recognition of their care for us, and we need to care right back for them,” Corey Feist, Dr. Breen’s brother-in-law who helped found the Dr. Lorna Breen Heroes Foundation said, per Senator Kaine’s statement.
Dr. Breen, for instance, had no prior mental health issues (known or suspected) and had no history of depression or anxiety, the Dr. Lorna Breen Heroes Foundation website says. “It was not until after her death that we learned that she had one significant risk factor – she was a physician,” it adds.