To support physicians' mental health, we need a systemic overhaul

To support physicians' mental health, we need a systemic overhaul
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When COVID-19 first arrived in New York City last spring, Dr. Lorna Breen found herself at the epicenter of the crisis. Like so many emergency room doctors, she faced enormous challenges in those early weeks of the pandemic: 12-hour shifts spent on her feet, a scarcity of PPE and other critical supplies, and what she described as an “onslaught” of patients — some of whom died in the ambulance or the hospital lobby before they could get help.

Yet, fearing professional repercussions and career setbacks if she spoke up, Breen never once complained. She didn’t ask for time off. Even after she contracted the virus herself, she went straight back to work as soon as she recovered. Day in and day out, she shouldered the heavy burdens of her work alone, until it ultimately proved too much. Last year, she died by suicide.

Dr. Breen’s tragic death has shone a light on another epidemic that has long been in the making: The enormous mental and emotional burden placed on America’s physicians. Doctors in the U.S. die by suicide at twice the rate of the general population, with one, on average, losing their life every day. And countless more are suffering in silence.

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In the throes of the pandemic, this issue has reached crisis proportions. On top of exhaustion brought on by long hours and overcrowded emergency rooms, our physicians have suffered the despair of losing patient after patient, the trauma of seeing colleagues get sick, and the fear of contracting the virus themselves — or bringing it home to their loved ones.

But even before the first COVID-19 cases presented at hospitals, more than three-quarters of U.S. physicians had already reported symptoms of burnout. It’s a condition that manifests in several ways: Among them, emotional exhaustion and the inability to recharge when off-duty, a chronically negative outlook on work, and a decreased feeling of personal efficacy and accomplishment.

And that can have significant consequences, not just for our physicians but for our entire health care system. Because it doesn’t just hurt doctors — it hurts the people they care for, too. More than half of physicians say burnout affects their work. They report snapping at patients, taking sloppy notes and making medical errors they wouldn’t normally make. This rate of “moral injury” — not being able to care for patients the way doctors feel they should be taken care of — will only continue to rise as the pandemic endures.

In response, many of these physicians cut back their hours. Some simply leave the field altogether. A recent Mayo Clinic study found that for every one-point increase in reported burnout, doctors were 30 to 40 percent more likely to leave the profession within the next two years. That’s the equivalent of losing the graduates of seven medical schools every year. And already, the Association of American Medical Colleges predicts a shortage of 37,800 to 124,000 physicians by 2034.

So how can we reverse this devastating trend?

For starters, the House of Representatives should immediately take up and pass the Dr. Lorna Breen Health Care Provider Protection Act, which unanimously cleared the Senate last month. The bill would establish grants to health systems and other care providers to help them improve their workforce's mental health. It allows for grants to medical schools to support the training of their students in proven strategies to strengthen mental health and resiliency. In addition to creating a national education and awareness initiative to encourage the use of mental health services by health care professionals, the bill would also establish a comprehensive study on physician mental health — including any barriers they may face in accessing the care they need. This is critical, as we cannot address what we do not measure. 

In the immediate, we also have to support our health workforce in prioritizing their own well-being, throughout this crisis and beyond. That is the aim of #FirstRespondersFirst, an initiative started by the Harvard T.H. Chan School of Public Health in partnership with Thrive Global and the CAA Foundation that provides frontline healthcare workers with additional resources — from PPE to mental health support.

There is work to be done on the state and local levels, too. Just as many state bars have revised their legal licensure applications in recent years, medical boards should follow Federation of State Medical Board guidelines and eliminate probing questions about mental health, which deter physicians from getting the help they need. As doctors know better than anyone, seeking treatment is not a sign of weakness or an inability to do one’s job. Just the opposite. 

What is most important is that the onus for physician mental well-being shifts from the personal to the systemic. Hospitals across the nation must implement more of the evidence-based interventions that we now know to be effective against burnout. That includes reducing the administrative tasks assigned to doctors and appointing dedicated wellness officers; removing mental health questions from malpractice applications, credentialing applications, state licensure applications, and the commercial insurance credentialing process; adapting the SafeHaven model regarding legal discovery during lawsuits; and allowing physicians to seek mental health outside their own healthcare systems. All these changes are urgently needed, since the alternative is a further decline in the resilience of the health system to respond to any future emergencies.

Fortunately, we are starting to see signs of change. We’re encouraged every day by how this pandemic has created newfound momentum to tackle deep-seated problems in public health. This crisis must be one of them. 

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When the history of this pandemic is written, doctors like Lorna Breen will be remembered as heroes for the way they met this moment with courage and compassion, often at significant personal cost. And they are.

But they’re also humans. And it’s time for the systems they work for to take care of them, too.   

Michelle A. Williams is Dean of the Faculty at Harvard T.H. Chan School of Public Health. Corey Feist is co-founder of the Dr. Lorna Breen Heroes’ Foundation and Chief Executive Officer of the University of Virginia Physicians Group. Shekhar Saxena is Professor of the Practice of Global Mental Health at Harvard T. H. Chan School of Public Health.