September 17, 2020
An Opinion piece by ACEP President, Dr. William Jaquis and co-authored by Jennifer Feist and Corey Feist
The pandemic is shining a light on the courage and dedication of our front-line health care workers, but beneath the surface our heroes are suffering. Emergency physicians are struggling to manage their mental health.
Even before the pandemic, nearly two-thirds of emergency physicians said they experienced burnout on the job, according to research published in the Annals of Emergency Medicine. Research indicates that in the U.S. alone, about 6,000 emergency physicians contemplated suicide in 2018, with nearly 400 attempting to take their life. Circumstances have become more dire as the fight against COVID-19 continues.
Each life lost was someone’s friend, colleague or family member. One hero among many was Dr. Lorna Breen, an emergency physician who tragically died by suicide in April.
Breen was treating patients with COVID-19 in New York until she contracted the virus. She hurried back to work as soon as she could to lead her emergency department, which was then at the epicenter of the virus.
With patients overflowing into the hallways, not enough personal protective equipment and dwindling supplies, she rose to meet an incredible challenge, and it cost her. Breen was magnetic, a force of nature. She was tough as nails, active and vibrant, and she showed no signs depression or anxiety before the pandemic. We will never know whether mental health treatment at any point during her career could have saved her life.
There are thousands of emergency physicians like Breen giving everything they have to protect their communities against COVID-19. But there are real barriers that prevent physicians and other health care workers on the front lines from getting the mental health treatment they need.
These challenges, such as potentially losing their medical licenses or facing other professional setbacks, persist in part due to a pervasive culture that sees asking for help as a sign of weakness, and antiquated institutional red tape that precludes health care workers from seeking treatment from a professional.
Some state licensing boards continue to ask questions about physicians' mental health histories or past treatment that appear to violate the intent of the Americans with Disabilities Act, which prohibits discrimination against people with psychiatric disorders. Practicing physicians with histories of psychiatric disorders or mental health counseling have also faced discrimination with respect to receiving hospital credentials and privileges.
It defies explanation that doctors on the front lines could lose professional opportunities for seeing a marriage counselor, talking to an expert about depression or getting professional help to navigate any of life’s common struggles. Now factor in the strain of the pandemic, and it is clear that discouraging doctors from prioritizing their mental health has real consequences for all of us.
We need to change our approach to physicians' mental health care in this country, and fast. The American College of Emergency Physicians is working with doctors and hospitals to create programs that more meaningfully address burnout. ACEP has also partnered with the Dr. Lorna Breen Heroes' Foundation to advocate for legislation such as the Dr. Lorna Breen Health Care Provider Protection Act and other efforts to dismantle barriers for physicians seeking mental health treatment. And, emergency physicians stand with more than 40 organizations that support immediate changes to licensing and credentialing requirements across the country.
Experts are still learning about this virus, but we know that health professionals are forever altered by this experience. We have a moment to use this tragedy to effect change for those on the front lines and ensure that no one is forced to choose between mental health and career.
Jennifer Feist and Corey Feist are the sister and brother-in-law of Dr. Lorna Breen and co-founders of the Dr. Lorna Breen Heroes' Foundation.
Dr. William Jaquis is president of the American College of Emergency Physicians.
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