Could COVID-19 Pandemic Increase Physician Burnout, Suicide?

— "This entire culture has to change," said Jennifer Feist, sister of Lorna Breen, MD, who died by suicide

by Shannon Firth, Washington Correspondent, �鶹��ý September 17, 2020

On September 17, �鶹��ý, recognizes National Physician Suicide Awareness Day.

If you or someone you know is considering suicide, call the National Suicide Prevention Hotline at 1-800-273-8255.

Physicians have one of the highest rates of suicide among all other professions. Approximately experience burnout during their careers and have met the criteria for burnout.

Research also suggests that thought about taking their own lives in 2018, with nearly 400 attempting suicide.

The COVID-19 pandemic has undoubtedly put more stress on physicians, nurses, and other healthcare workers, and is likely to exacerbate these problems, noted physicians and advocates who participated in a , hosted by U.S. News and World Report, on Tuesday.

Clinicians, advocates, as well as many hospital and health system leaders are pressing for change.

"On April 9, my sister called me because she couldn't get out of her chair," said Jennifer Feist, JD, a lawyer in Charlottesville, Virginia, whose sister, Lorna Breen, MD, the medical director of the emergency department at NewYork-Presbyterian Allen Hospital, on April 26. Feist spoke out about her sister's death and the need to address mental health stigma.

Breen had had her first "COVID-19 shift" on March 14, and saw right away how unprepared hospitals were for the pandemic, Feist said.

Over a period of roughly 3 weeks, Breen treated patients with COVID-19, became ill with the virus, recovered, and began working again. Once she'd been fever-free for 3 days, Breen called the hospital and said she was ready to go back to work, Feist recalled.

Breen and her colleagues worked hard and faced huge stressors from limited personal protective equipment to even a shortage of beds, Feist remembered. "She told me patients were dying in the waiting rooms and hallways."

Often Breen and her colleagues would continue working for 18 hours at a time, "to try to help as many people as they could," Feist said.

But, she said of her sister, "the work didn't stop and it didn't slow down, and she kept going back, day after day, for her 12-hour shifts, until she could literally no longer stand."

Feist brought her sister back from New York City to Charlottesville, Virginia, where she was eventually hospitalized at the University of Virginia.

Breen had no prior history of "known or suspected" mental health issues, and Feist said she also believes that the . (There have been multiple studies about the neurological impacts of COVID-19.)

Whatever the cause of the mental problems, Feist said Breen feared asking for help.

She worried about losing her medical license or being ostracized by her colleagues. Breen, who co-authored a study in 2019 on , was aware of the phenomenon but did not want her own colleagues to know she was suffering from burnout, Feist said.

Corey Feist, MD, Jennifer's husband, who also spoke during the webcast, noted that more than one physician dies from suicide each day.

He said he knows his sister-in law was one of many clinicians suffering from these challenges and worries that others will continue to "suffer in silence" and not get the help they need, because of professional stigma and fearing judgment from their family and friends.

Jennifer Feist said that what she learned from her sister's death is that stigma is "learned" in medical school, "reinforced" in residency, and "solidified" through the types of questions that physicians are asked in licensure and credentialing forms.

"We believe this entire culture needs to change," she said.

"Our expectation that the healthcare providers be superhuman with no needs, no fears, no family, and no need for rest has to change as well. These are humans before heroes," Feist said.

Victor Dzau, MD, president of the National Academy of Medicine, who also participated in the webcast, echoed these feelings.

Dzau recently co-authored an editorial in the that highlighted key steps for what he calls preventing a "parallel pandemic."

In the editorial, Dzau and two colleagues called for establishing anonymous reporting systems at the facility level to ensure clinicians' "psychological safety" by enabling them to reach out with concerns for themselves or others without fear of punishment, maintaining and growing well-being programs, and integrating chief wellness officers or leaders or clinician well-being programs into the "COVID-19 command center" or other decision-making bodies for as long as the pandemic lasts.

Dzau also suggested earmarking federal funds to create a "national epidemiologic tracking program" that would assess clinician well-being and report the results of interventions meant to address the problem.

He also called for allocating funding to help treat clinicians who suffer mentally or physically as a result of their work during the COVID-19 pandemic.

He likened such a fund to .

In July, Sen. Tim Kaine (D-Va.) introduced the " which would establish funds to help educate students, residents, or other healthcare providers in "evidence-informed strategies to reduce and prevent suicide, burnout, mental health conditions, and substance use disorders."

The bill would also include grants for peer support programs, mental and behavioral health treatment, evidence-based awareness campaigns, and a comprehensive study of healthcare professionals mental and behavioral health, and burnout, including the impact of COVID-19 on all aspects of their health.

Shannon Firth has been reporting on health policy as �鶹��ý's Washington correspondent since 2014. She is also a member of the site's Enterprise & Investigative Reporting team.