By Hassan Khokhar
Doctors constitute an essential profession and are necessary for the provision of healthcare to communities across the United States. However, over 80 percent have experienced mental health issues as a result of the burdens of their profession. Barriers and stigma have continually impeded receiving mental health outreach. We see this in the very own professionals who prescribe a referral to their patients for mental healthcare. We primarily observe this phenomenon concentrated in the 30-49-year-old female age group (Vanhaecht 2021). In response to Dr. Breen’s suicide in the early months of the pandemic, in April 2020, the introduction of the Lorna Breen Health Care Provider Protection Act was imposed. Dr. Breen was the chair of the Department of Emergency Medicine in upper Manhattan, New York (Feist et al. 2020). The chaos that spread amidst the pandemic had left her feeling helpless; Regardless of being infected with COVID-19 herself, she felt shame for not being able to care for others. Despite taking the necessary precautions of checking into a psychiatric ward twice, Dr. Lorna Breen had unfortunately taken her life once she had started to rehabilitate.
Medical health professionals, especially physicians, are essential workers. Some may classify this profession among the pillars of society. Society relies on healers to nurse you back to health and prevent the mass spread of disease. Arguably, human lives are considerably contingent on the proponent of health. Little in this world remains to matter if health, mental or physical, is an impediment to living. When 80% of doctors have experienced mental health issues, a burden is inflicted on the healthcare system (Gerada 2018). Suicide rates are double the general population, one physician dies from suicide alone every day (Matheson 2018). Failing to take action to curb this mental health crisis among our healthcare workers may create severe issues in the effectiveness of the healthcare system to sustainably meet community needs. (Pereira-Lima 2019).
Stigma has significantly affected the ability of healthcare workers to seek out care for their mental health (H.R.1667, Section 764(d)(3)(B)). This stigma increases among physicians with greater responsibilities. The role entails you to behave within specific standards and maintain associated perceptions. As a care provider, it is of utmost importance to excel in communicating interpersonally. However, the constant makeup of a convivial facade, especially in the case of fabricated emotions, can ultimately produce detrimental effects. Not only can this be draining to the individual, but this can also mask their current state and hinder them from receiving the necessary intervention.
Stigma manifests in various forms. With just 13% reaching out for help, the low willingness to combat the issue despite high rates of mental health issues can be traced to some roots (Weiner 2020). Hospitals require the disclosure of a past history of mental health conditions or treatment for credentialing purposes, creating a sense of distrust (Feist et al. 2020). Physicians find that disclosing their current mental health status would result in their confidentiality rights not being protected. In the case of Dr. Breen, she was sure that her career would terminate, a career that took a lifetime to build up. This widespread culture of silence has been reinforced through the negative repercussions shown to be imposed: censure by licensing boards, termination of employment, and widespread negative professional impact (Galbraith et al. 2020).
Social ostracization is another form of stigma observed within the medical community. Chatterjee et al. 2020 indicated that 1 in 5 doctors have been ostracized, which has been cross-examined with physicians that have depression, anxiety, and high-stress levels. Physicians who open up about mental illness are often assumed to not be fit for the rigorous roles and responsibilities within the medical community.
Mental health stigmatization, either in the form of licensure concerns or social ostracism raises notable issues that need addressing. National-evidence-based education programs indicate efficacy in reducing mental health. In one study by the CDC 2015, 23% of interns with suicidal ideations decreased by nearly 50% from the utilization of web-based cognitive behavior therapy (four sessions). Greater awareness ultimately leads to a decrease in mental illness, more outreach in times of dire need, and reduced associated stigma.
Psychiatric morbidities can also be exacerbated by the high-stress environment and burnout rates. 74% of physicians reported experiencing burnout (Kalmoe et al. 2019). This vastly spread issue harms the provider-patient experience, leading to lower levels of care. The burnout can eventually also bleed into physicians’ personal lives, where familial relationships begin to strain. Work-family conflicts can lead to disputes at home, creating a domino effect and chaos all around in physicians’ lives. Specifically among female physicians, greater divorce prevalence is observed (Daily 2019). With the COVID-19 pandemic burdening healthcare providers, the issues have merely magnified. 8 in 10 physicians have been affected: Reduced income, staff, and increased rates of burnout (Physicians Foundation 2021). The overloaded hospitals implicate physicians’ psychological well-being, creating a pandemic within a pandemic.
COVID-19 has further been attributed to the physician shortage within the country. According to AAMC 2021, it is estimated between 37,800 and 124,000 shortage in physicians will be drawn by 2034. This shortage in providers has always been an issue, only exacerbated by the pandemic. The financial impact and emotional burden faced by providers amidst COVID-19 have deterred new physicians from the field. It is estimated that 16,000 practices (8%) have been shut down, with another 4% planned to shutter within the next year (Physicians Foundation 2020). A once highly respected job is seen through the lens of undesirable, due to the conditions that have been heightened.
Allocating resources in this area often initiates debate since the healthcare system is still functioning at the end of the day. Not only have new doctors been dissuaded from the field and unexpectedly been quitting, but early retirement from older physicians has also contributed to the physician shortage. 33% of medical practices had a physician retire early or leave due to burnout (MGMA 2021). At this rate, major shortages can partially collapse the healthcare system if intervention is not placed within the appropriate time period.
The proposed budgetary spending of the Lorna Breen Health Care Provider Protection Act may be another imposed limitation. Currently, $4.6 billion in costs related to physician turnover and reduced clinical hours is attributable to burnout each year, the equivalent to $7600 per employed provider (Han et al. 2019). Not only will the crisis be addressed, but improved outcomes in healthcare will additionally be observed. Since physicians cater to the entire population, more efficient health outcomes will provide the opportunity for economic growth across the country, all whilst having a robust healthcare force and population. The overall economic benefits attained far outweigh the costs imposed by physician burnout and mental illness.
To counteract the issue, the need for a policy such as the Lorna Breen Act will address the prevention of suicide, burnout, mental/behavioral health conditions, and substance use disorders among health care professionals. Additionally, the bill will work towards improving mental health and resiliency, addressing the stigma to seek services for mental health and substance use disorder, and identifying risk factors and informed tactics to respond to suicide and mental health conditions. We need the implementation of policy wherever physicians face burdens in the healthcare system: hospitals, community health centers, rural health clinics, and medical professional associations.
The bill has contingencies to create a long-term solution. Currently, no system has been established to counteract the issue, despite the higher rates of burnout and suicide in physicians. The initiation of a national-evidence-based education program utilizing factors such as web-based cognitive behavior therapy would ultimately be able to create change within the healthcare system. Large-scale implementation of the program would aid physicians by providing them with the adequate tools to counteract burnout and receive assistance in times of mental health crises.
Physicians experience a difficult transition from the role of a provider to patient. The very own workers who specialize in the recognition and treatment of mental health are being inflicted by this issue at greater rates. Physicians are unable to detect symptoms in themselves, despite being trained investigators of mental health issues: an ironic phenomenon. In the face of the pandemic, stigma and burnout have deepened into the system. With the increased implementation of national-evidence-based education programs in healthcare facilities, the crisis of mental health and substance use disorder can be tackled.
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