Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.
In today’s COVID-19 update, AMA Chief Experience Officer Todd Unger and AMA Immediate Past President Patrice Harris, MD, MA, in recognition of National Physician Suicide Awareness Day, talk with the family of Lorna Breen, MD, a physician who died by suicide during the COVID-19 pandemic. The family shares her story and the foundation and legislation that is working to normalize asking for help as a physician.
Learn more at the AMA COVID-19 resource center.
- Patrice Harris, MD, MA, psychiatrist and immediate past president, AMA
- Jennifer Breen Feist, JD, co-founder, Dr. Lorna Breen Heroes' Foundation
- J. Corey Feist, MBA, co-founder, Dr. Lorna Breen Heroes' Foundation
Unger: Hello, this is the American Medical Association's COVID-19 Update. Today we're discussing physician burnout and COVID-19, in recognition of National Physician Suicide Awareness Day. I'm joined today by Dr. Patrice Harris, AMA's immediate past president, as well as a psychiatrist and former public health director in Atlanta. And Jennifer and Cory Feist, whose sister and sister-in-law, Dr. Lorna Breen, an emergency medicine physician, died by suicide in April. And together they have co-founded the Dr. Lorna Breen Heroes Foundation, and are strong advocates for protecting the well being of physicians and other health care professionals. Mr. Feist is also CEO of the University of Virginia Physician's Group. They're calling in from Charlottesville, Virginia. I'm Todd Unger, AMA's chief experience officer, in Chicago. Dr. Harris today is National Physician Suicide Awareness Day, why is this day so important, particularly during COVID-19?
Dr. Harris: Well, thank you, Todd. And before we start to talk today, I would like to first offer my condolences to the Feists and the family of Dr. Breen. I want to offer those condolences personally, and on behalf of America's physicians. This is such an important topic for us to cover. We know that it's sometimes difficult to talk about, and to think about, particularly as physicians, as we are typically the helpers. But, as you say, on this third annual National Physician Suicide Awareness Day, we really have a wonderful opportunity to bring this conversation to the fore.
The theme this year is one of us and I have to share that I also have personal experience; a medical student that I mentored through medical school residency, and ultimately worked on my team died by suicide, and so this is an important topic, we have to talk about it. I want to also speak to the efforts of Vision Zero, it really calls on all of us, individuals, medical schools, residency programs, organizations, national groups, to make a commitment, to break down the stigma and to increase awareness. We really need to get to the vision to make the challenge to everyone to reach zero physician suicides.
Unger: Dr. Harris, burnout was already an epidemic problem before COVID, how are you seeing that impact further since the pandemic began?
Dr. Harris: Yes, pre-COVID-19 pandemic, we had significant issues around physician burnout. Issues around increased rates of depression, suicide, anxiety disorder, and COVID-19 has absolutely exacerbated this. Just the environment—it's been unrelenting. It's difficult, actually, for physicians not to know what to do, because that's what people count on us to do. And that's also a difficult position. And sometimes systems were not in place to help us know what to do with all these feelings of sometimes hopelessness and helplessness. So certainly, COVID-19 has exacerbated all of the issues surrounding physician burnout.
Unger: Mr. and Mrs. Feist, again, thank you so much for being here during what is, I know, a very, very difficult time. You've been deeply affected by this issue. Can you start just by telling us about Dr. Breen, what do you want people to know about her?
J. Feist: Todd, thank you for having us. Lorna Breen, Dr. Breen was my sister. She was very smart, very driven. She was extremely adventurous. She was a member of Redeemer Church, an active member in Manhattan. She was incredibly driven like so many in the profession and she had always wanted to be a doctor in New York City.
Unger: What did she tell you about the situation at her hospital at the height of the pandemic in New York?
J. Feist: Todd, my sister and I were extremely close and we spoke at least once a day, particularly during her time in the pandemic. And she described it as Armageddon. She said there wasn't enough oxygen, enough sources of oxygen for patients. Patients were dying in the waiting room. Patients were waiting hours to get out of the ambulance. There was no place to put patients who had died and it was relentless. And it went on for days and days. And now we know weeks and weeks, it was very difficult and it was the most difficult thing she had ever seen. I should add that my sister was an emergency room physician in Manhattan for 16 years. So it's not like she just got there. She wasn't new at this. And it was incredibly difficult. She described it as the most difficult part of her entire career.
Unger: And you said too, that as part of her role as an emergency physician on the front lines, in the early days of the pandemic, she actually got sick with COVID-19 as well. How did that affect her?
J. Feist: Yes. It's interesting, Cory and I have talked about it a lot in retrospect, and we were all together on vacation right before she went back to work. In fact, I think the day after we came home from vacation was the day they closed the borders to people coming from outside the country. And we all knew she would get sick. She knew she would get sick. And instead of saying, don't go, or instead of her saying, I'm not going, she went right after it. She got sick almost immediately. She was home for a total of, I believe, 10 days, which again, in retrospect seems ludicrous. She had fever, loss of sense of smell, extremely tired. And as soon as her fever was gone for three days, she called the hospital and said, put me back on the schedule. And they sure did.
Unger: Can you see at that point, do you know the kind of the toll accumulating between taking care of so many patients being a patient, what were you seeing?
J. Feist: In the beginning it just seemed like her job. She was doing her job. She had been sick, she got better, she went back. The entire time she was sick she was telling me the other doctors, PAs and nurses who were also sick. The other health care providers who were also staying at home. So in the beginning it just seemed like another day at the office, frankly. But when she went back after she got sick, she was really struggling. And I believed at the time and I continue to believe that COVID affected her brain. And then that combined with what she was facing in the emergency room, pretty much around the clock is what brought her down.
Unger: What could have finally happened when she realized that she needed help?
J. Feist: Well, she had been back at work for about a week and a half. And again, the amount of debt that she saw was unlike, I think what most people see in their entire careers. And she was seeing it in a matter of days and she kept working. She kept trying, she was covering two emergency rooms one day at the same time five miles apart from each other. And ultimately she called me on April 9th. She sounded confused. She told me she couldn't get out of her chair and she didn't know what to do. And it was then that I said, it's over and you're leaving and you need to come home. And we are now in September, this was back in early April. I didn't even know if I would be allowed to drive into New York state if I tried, but I was able to get friends of hers to help me get her further south. And then I got her in Maryland and brought her to Charlottesville.
Unger: Mr. Feist, I'd love if you could speak a little bit about, why did it take her so long and why does it take physicians so long to ask for help?
C. Feist: Like Lorna physicians and other health care providers they suffer from this particularly high degree of burnout and stress, but they do it under this code of silence, where they fear professional stigma from a licensure perspective and also just the cultural stigma. As Jennifer and I have reflected when Lorna went back into the emergency room and she was struggling, she knew her colleagues recognized it, or I should say she thought her colleagues recognized it, but she didn't have anyone stop her and say, it's time to take a break. It's time to sit down. You're still trying to recover from a pandemic that no one knows anything about.
And so that is not an atypical response from colleagues in health care, because you go to work after being in school for so long, you're among the best of the best the whole time. It's a highly competitive environment. It's a highly driven worker and work culture, but the culture in and of itself and all of the trappings that surround it from the regulatory environment to the environmental conditions within health systems are all built to reinforce this code of silence that all of our health care providers live under right now. And that's one of the things that we're trying so desperately to shine a light on, to bring visibility to this issue, to change this culture that is so desperately needed.
Unger: Yeah. That particular dynamic is documented. The data is there to support that and the numbers are pretty astounding. Can you speak to that research?
C. Feist: Prior to the pandemic 400 physicians in this country died by suicide each year. As we went into this pandemic, the public health crisis that was being called for by many in the health care community was burnout among health care providers, particularly physicians. That was supposed to be the issue of the year. What we've done now is we've layered a pandemic on an already burned out workforce. And we've asked that workforce to run a marathon without a clear ending. This year, now that the pandemic has begun, there have been surveys of burnout and how physicians and nurses are feeling now that they're running this marathon without the clear finish.
And the most recent data that I have shows that burnout among nurses is 62%, burnout among physicians is 42%. This workforce is working at an enormously fast pace and they're trying to sprint a marathon if you will, and it's just an untenable situation for our clinicians and ultimately for our patients. 200% is the percentage increase of medical errors when medical professionals experience burnout and are treating patients. So the error rate increases twofold if our clinicians are not of sound mind and body.
Unger: And despite that, I guess, also according to a 2019 survey of more than 15,000 physicians, 40% of physicians said they were wary of seeking formal mental health treatment. And 12% said, they'd consider it, but only in secret. Dr. Harris, how is AMA working to change this culture?
Dr. Harris: Well, Todd, I also want to first say, and you've heard me say this a lot that physicians don't run away from problems. We run towards them. And so do other health professionals. And Dr. Breen was certainly an example of that, but unfortunately that happens in an environment where we are not incentivized. In fact, sometimes disincentivized to seek care, or to even say we need help. I mean, I remember as a resident, the first time in psychiatry resident here in Atlanta, and the first time I had to answer the questionnaire to renew my license. And there was a question that said, have you ever been treated for a mental disorder? And probably I paid more attention to that question as a psychiatrist, but it immediately stuck out to me, boy, that question disincentivizes physicians from seeking care. It's not whether or not you've been treated.
I mean, these are diseases that are chronic, just like diabetes and hypertension. It would be a fair question to ask about impairing your ability to care. And so that question is just one example of the many issues around regulation and seeking care that again, disincentivizes physicians from getting the care that they need. But fortunately they AMA is working with other medical organizations, other entities to first of all, talk about this issue, talk about burnout, talk about mental health and mental illness and depression and anxiety, and really work to hopefully routinize, and I don't want to say normalize, but typicalise, that's a word I'm just using seeking care just as we would seek care for diabetes or high blood pressure. We've elevated burnout to its proper place in working with large health systems. You know that we have a lot of policy incentivizing our students and residents all along the career spectrum to get the help that they need.
And so we will continue on that journey, working with everyone at all levels to elevate this issue and make sure that we are incentivizing seeking care. And I have to say just recently on Twitter, I've seen a lot of medical students and residents and physicians saying, I am a physician, I have an anxiety disorder. I've been on medication and I'm in therapy. And I am so glad to see that. And we need to continue to see more of that. Again, raising the awareness, but also making sure that regulations and these questions that I talk about with the Federation of State Medical Boards that I know they've been on board. And we also want to make sure that we prioritize confidentiality and privacy where appropriate. Again, all in the service of making sure that physicians and other health professionals seek the care that they need.
Unger: Dr. Harris, the AMA has been focused for a number of years on physician burnout, even before the pandemic obviously. Can you talk a little bit about how we've adjusted the work there in terms of our surveying to account for the impact of COVID?
Dr. Harris: Absolutely. And I think the AMA and really others external to the physician community, the original response to this was almost physicians-heal ourselves. Get more sleep, exercise, and eat better and you will be okay. And what the AMA has been able to do actually through our survey work and our research work was really drill it down to say, you know what? This is a systemic problem. We should not be blaming individuals. Now look, all of us should do whatever we can to live healthy lifestyles. But when we really want to make a dent in this problem around burnout and other mental health issues, we have to address it from a systemic place. And so, one of the important things we did in definitely getting the research, giving organizations tools on how they can survey their own team members to see where they are. And also asking their own team members of a health system or a hospital or a practice what could be done to better meet their needs. So it's about addressing these issues systemically and not just from an individual perspective.
Unger: And that work has been extended with now with over 70 health systems deploying what we're calling the COVID Caring for Caregivers survey, and more than 40,000 responses have been collected to date for the team to look at. Mr. Feist, I want to talk to you a little bit about what you're working on. Can you give us some of the details around the bipartisan Dr. Lorna Breen Health Care Provider Protection Act?
C. Feist: Absolutely. Jennifer and I founded Dr. Lorna Breen Heroes Foundation, to address and reduce burnout of health care professionals and safeguard their well being. Senator Tim Kaine introduced the Dr. Lorna Breen Health care Provider Protection Act earlier this summer. He introduced it in the United States Senate, and it has bipartisan support. When he introduced it, it had bipartisan support and it now continues with vigor and strength to gain more and more support. Not just from Senator Kaine's peers in the Senate, but also now in the bipartisan companion bill that's been introduced in the House of Representatives again with tremendous support.
There's also at least 13 health care organizations, including the AMA who have extended their reach and supported this critical bill. For purposes of this audience what they need to know about the bill is that it covers four key areas. One is that it establishes grants when health professionals are in training so that they can learn evidence-informed strategies to reduce and prevent burnout, suicide, and other mental health conditions. Second, it helps to disseminate evidence-based best practices for reducing those same issues when they're in the workplace. Third, it establishes a national evidence-based education and awareness campaign targeted at existing health care professionals to encourage them to seek that support and the treatment for any mental or behavioral health concerns.
And finally, it establishes grants for employee education and peer support programs, which we know are so incredibly effective. And other mental health, behavioral treatments so that health systems across America can start to uniformly deploy the same type of systems to support our health care providers.
Unger: Well, final question. What message do you have for the profession and physicians, whether they're struggling or suspect that one of their colleagues is? Mrs. Feist, why don't you start.
J. Feist: Thank you. The message that I have is if you're struggling, you're not alone. And if you have a colleague or a coworker who you think is struggling, they probably are, and you should ask them how they're doing and ask them if they need help. And don't wait for somebody to invite the question just do it.
Unger: Mr. Feist?
C. Feist: Before you all received the incredible title of heroes, you were human. You continue to be human. We need to remember that you all are human and well before you received that hero label and you need to treat each other as humans. You need to be treated by your employers and health systems as humans as well.
Unger: Dr. Harris, any thoughts from you on what messaged you'd like to have for physicians?
Dr. Harris: Well, certainly the AMA is honored to support the legislation in honor of Dr. Breen. And I will say that as a profession, we will not ignore this issue and we will continue forward with the Feists, with anyone willing to partner with us to make sure we get to that Vision Zero goal.
Unger: Well, thank you so much, Dr. Harris. Mr. and Mrs. Feist, we so much appreciate you for being here and sharing your incredibly important story of Dr. Lorna Breen. It's really helped to bring attention to the critical issue of protecting physician well being. That's it for today's COVID-19 update. We'll be back soon with another segment, stay safe and be well. If you need anything in terms of resources on COVID-19 visit the AMA site, ama-assn.org/covid-19. Mr. Feist, is there a URL that you'd like to let the audience know about in regard to your work?
C. Feist: Thank you, Todd. drlornabreen.org is the URL that I would direct everyone to for more information about our foundation and ways that they can lend to a hand and support.
Unger: Thanks so much for being with us today.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.