JESSICA SINGH, MD AND LORENZO NORRIS, MD PHYSICIAN APRIL 28, 2023
In the spring of 2020, as COVID-19 swept through hospitals in the tri-state area, Dr. Lorna Breen, a physician who served as the medical director of the emergency department at New York-Presbyterian Allen Hospital, contracted COVID while caring for patients. Shortly after returning to work under relentlessly overwhelming circumstances, she died by suicide.
Dr. Breen had no prior mental health conditions.
As her story made national headlines, Dr. Breen’s death became the symbol of the tragic burdens placed on health care workers, including the stigma of seeking mental health care. This deep-rooted cultural stigma that pervades the U.S. health care system is directly related to the numerous barriers faced by health care providers seeking mental health services: negative career implications, confidentiality concerns, lack of resources and support, and associated costs.
As a result, doctors and nurses often suffer the plight of “heroes”: publicly lauded for self-sacrifice while privately facing adversity in isolation. We should not be surprised that nurses and doctors in the U.S. have higher risks of dying by suicide.
From 2017 to 2018 alone, 729 nurses died by suicide. The prevalence of physician suicide has also been increasing, with over a third of physician deaths by suicide from 2003-2017 occurring between 2015-2017. A pre-COVID study published in Mayo Clinic Proceedings that analyzed responses from 5197 physicians found that “1 in 15 U.S. physicians had thoughts of taking their own life.”
A year after the pandemic began, the Physicians Foundation 2021 Survey of America’s Physicians, based on 2,504 responses, showed that “more than half (55%) of physicians know of a physician who has either considered, attempted, or died by suicide in their career.”
Another report published in Mayo Clinic Proceedings found that 30% of 2373 U.S. physician survey respondents in 2020 reported high levels of anxiety or depression.
We have both worked in health care settings where providers have died by suicide and experienced the devastating impact that results.
Time alone does not heal.
In addition to touching the lives of their friends, loved ones, and colleagues, physicians, and nurses care for thousands of patients throughout their careers.
The ripple effect of each loss is a grief we all must bear.
Dr. Breen’s life and death inspired her sister, Jennifer Feist, JD, and her brother-in-law, Corey Feist, JD, MBA, a health care executive, to form the Dr. Lorna Breen Heroes’ Foundation. A national movement followed, culminating in the enactment of the Dr. Lorna Breen Health Care Provider Protection Act (HR 1667) on March 18, 2022 to “address behavioral health and well-being among health care professionals.”
Funded by the U.S. Department of Health and Human Services, the Health Resources and Services Administration awarded $103 million over three years “to reduce burnout and promote mental health in the health workforce.”
One year after the passage of this landmark legislation, we interviewed Mr. Feist about its initial impact. He explains this law, which had bipartisan, bicameral support, “was designed as the first two or three steps of a full staircase of health policy.”
Though this legislation was monumental, he notes: “Only 45 [hospital] institutions out of 6000 in the country, which is less than 1%, were able to be funded. In this next grant process, we need to increase funding to include more organizations, especially rural and smaller organizations, and reach more health care providers.
We must also broaden the focus of the grants, not only to focus on individual resilience and mental health, but also to fund projects that are focused on operational improvement.”
The pandemic magnified the disparities in access and outcomes and the inefficiencies of the health care system, exacerbating health care provider burnout.
Despite mounting evidence demonstrating the implications of burnout on patients, providers, and the health care system, the status quo has been resistant to change, impacting health care access and delivery for everyone.
According to Medscape’s Physician Depression and Burnout Report 2023, which surveyed over 9100 physicians across more than 29 specialties, 53% of physicians said they were burned out. Remarkably, the top three factors that contribute most to physician burnout are the same as they were five years ago: too many bureaucratic tasks (61%), lack of respect from coworkers (38%), and too many work hours (37%).
Agency and organizational leadership, in addition to multi-dimensional involvement of local, state, and national leadership, are needed to effect systems change.
As Feist points out, the National Academy of Medicine’s National Plan for Health and Workforce Well-being, lays out a roadmap for systems change, and “it’s really a matter of putting the roadmap into place step-by-step.” The National Plan builds on a foundation of research and collaboration that “calls on multiple actors – including health care and public health care leaders, government, payers, industry to help drive policy and systems change.”
The Dr. Lorna Breen Heroes’ Foundation has been working to change the law at state levels and provides toolkits for health care providers and leaders to remove barriers to mental health access. Feist explains, “We must remove barriers to mental health access that apply uniquely to licensed health care workers: barriers in licensing applications, credentialing applications, and hospitals. We also need to make the confidential pathways to access mental health care abundantly clear for this workforce.”
Medical professionals can contact their state medical boards to advocate for change.
Like most physicians, Dr. Lorna Breen entered medicine to serve. Unfortunately, she paid the ultimate price as too many did. With the continued work of the foundation and legislation enacted in her name, Dr. Breen’s legacy has made her an advocate for all health care providers who have died by suicide and for those who currently struggle.
We must ensure that these initial steps not only endure but expand and prevail so that she – and all health care providers who have died by suicide – will live on not only through the many lives they have touched but also through necessary, systemic reform for the colleagues with whom they served.
Jessica Singh is an emergency physician. Lorenzo Norris is a psychiatrist.