COVID-19 is killing America’s physicians, and not just by making them sick.
Before the coronavirus struck, more than one doctor in the United States died every day by suicide, often driven by extreme professional burnout. With the onset of the pandemic in March, already overworked health care providers experienced a 60 percent increase in emotional exhaustion and high rates of post-traumatic stress disorder. The eventual toll this will take on the medical community is as yet unknown.
Dr. Lorna Breen was a casualty of this culture. The director of the emergency department at New York-Presbyterian Allen Hospital in Manhattan, she was on the front lines when COVID-19 peaked in New York City. Her heroism ultimately cost her life.
Over a period of weeks, Lorna treated COVID-19 patients in multiple emergency rooms, contracted the disease herself, and then rushed to return to work the moment she was able. She confronted countless challenges, from limited personal protective equipment and insufficient oxygen supplies to patients dying in the waiting room and hallways for lack of available help.
Lorna worked well beyond her 12-hour shifts and went back exhausted to the ER again and again until she could no longer stand. Lorna needed to take a break. Until the day she died by suicide, in April, she didn’t ask for help, she didn’t complain, she didn’t stop working. She needed mental health support to help her through this profoundly difficult time, but she feared it would end her career. Her story speaks volumes about a country that has not invested enough in public health and asks too much of individual physicians when crises strike.
Most Americans don’t realize that the majority of states require disclosure of a clinician’s complete mental health treatment history to licensing boards and health care institutions. Seeking basic behavioral health care can result in professional censure, loss of credentials, and even termination of employment.
The rules are one thing, but the health care community’s culture of stoicism is another. From medical school through residency and into practice, one message is communicated almost universally: Weakness is not acceptable.
On National Physician Suicide Awareness Day on Thursday, we are mobilizing in Lorna’s memory to break the silence surrounding physician mental health. Other clinicians need to hear that their burden of stress, overwork, anxiety, or depression is one that is frequently shared with their colleagues. And the health care community needs to realize that admitting fatigue, asking for help, or simply taking a break to cope with loss or prevent burnout is a courageous act. Doing so actively improves a doctor’s ability to care for patients and should be extolled not condemned.
What’s more, health care institutions need to recognize that the elevated suicide risk among their physicians — 40 percent higher for males and 130 percent higher for females — means they’re losing too many of their best and brightest. States must remove barriers to mental health care by updating disclosure requirements to ask only about current treatment, as the American Medical Association, the Federation of State Medical Boards, and the Joint Commission recommend.
Fortunately, there are signs of progress. The Dr. Lorna Breen Heroes' Foundation has attracted thousands of individuals, moved by Lorna’s story, to help promote the well-being of all health care providers. Congress has recently introduced the Dr. Lorna Breen Health Care Provider Protection Act to bring effective, evidence-based mental health resources to health care providers. The health care community is starting to have the conversation about how much is too much when it comes to our expectations of our health care providers and the expectations our providers have of each other and themselves.
Americans have cheered our health care heroes and have made joyful noise to acknowledge their sacrifices, but expressions of gratitude are not enough. Let’s get the health care providers who give so much of themselves the support they truly deserve — let’s encourage elected leaders to pass the Dr. Lorna Health Care Provider Protection Act now.
Michelle Williams is dean of the Harvard T.H. Chan School of Public Health. Jennifer Breen Feist and J. Corey Feist are the sister and brother-in-law of Dr. Lorna Breen and cofounders of the Dr. Lorna Breen Heroes' Foundation.