Overwhelmed by the COVID-19 pandemic but fearing the stigma of seeking mental healthcare, emergency room physicians are at risk of burnout, moral injury, and suicide.

A new survey by the American College of Emergency Physicians (ACEP), conducted in October, revealed that 87% of emergency physicians say they are more stressed since the start of the COVID-19 pandemic. In addition, 72% report experiencing more professional burnout. (More information is available at: https://www.emergencyphysicians.org/press-releases/2020/10-26-20-as-stress-during-the-pandemic-grows-nearly-half-of-nations-emergency-physicians-uncomfortable-seeking-mental-health-care.)

ACEP reported the results of a national sample of 862 emergency physicians at a recent press conference. The general results were framed by the story of Lorna Breen, MD, an emergency physician at NewYork-Presbyterian Allen Hospital in Manhattan, who died by suicide after contracting COVID-19. Breen contracted the pandemic virus treating patients as New York City was overwhelmed by the virus last spring. She stayed home while sick but returned to help her colleagues during a time when personal protective equipment (PPE) was in short supply and patients were in beds lining the hallways. Her sister, Jennifer Breen Feist, JD, told the following story, which has been edited for length and clarity, at the Oct. 26 ACEP press conference.

“Today is the sixth-month anniversary of my sister’s death. My sister died on April 26, 2020. My sister, Dr. Lorna Breen, treated patients with COVID-19 in New York until she got the virus herself. Lorna was always tough and smart, and very active. She always wanted to be an emergency physician in Manhattan. For the first 49 years and six months of her life she showed no signs of depression or anxiety. That changed after she got COVID.

“In the time between when my sister got sick and her death — about five weeks — all she could think about was getting back to work. When she was home, she was on the phone all the time on attending, leading virtually, trying to find PPE, checking on her colleagues and other healthcare workers who were sick. [We] kept telling her about the airplane analogy of putting your oxygen mask over your own mouth before you take care of others, but my sister was just too focused on saving as many people as she could.

“With patients overflowing in the hallways, not enough PPE at the time, and minimal supplies — compared to the number of sick and dying patients — my sister rose to meet the challenges of COVID-19. We believe this ultimately cost her her life. We know that when she finally did seek mental health treatment, she was so concerned about that stigma of seeking mental health — so concerned about how she would be perceived by her peers. That was her main focus, and we believe, ultimately, it was her downfall.”

Written comments by respondents to the ACEP survey expressed similar concerns about the stigma of seeking mental healthcare:

  • “I felt concerned that my job would be in jeopardy or others would question my ability to do my job.”
  • “There are questions on medical license applications about if you’ve ever been treated for mental health. I don’t want to be perceived as unfit for duty.”
  • “I do not want to get diagnosed with a mental health condition, then have to report it on job applications or medical licensing applications/renewals. I am afraid I would potentially lose my job, future job opportunities, license, and eligibility for disability insurance.”
  • “In medical school, I avoided treatment as I believed it would affect residency applications, licensing eligibility, etc.”
  • “I am concerned about reporting to state licensing boards and retaliatory actions taken by these boards.”
  • “[I] would have to declare on reappointment, explain and risk potential limits on practice.”
  • “I thought that if I sought treatment for ADHD/anxiety that it would make me a lesser candidate for emergency medicine positions.”

Bipartisan Bill in Congress

Feist is co-founder of the Dr. Lorna Breen Heroes’ Foundation, which is trying to raise awareness of this critical problem and pass federal legislation to address specific remedies. (More information is available at: https://drlornabreen.org/about-the-foundation/.) ACEP is one of the sponsors of the bipartisan bill, titled “The Dr. Lorna Breen Health Care Provider Protection Act (S. 4249; HR 8094).” The bill calls for several actions, including:

  • Establishing grants to train students, residents, or healthcare professionals (HCPs) in evidence-based techniques to reduce and prevent burnout, mental health conditions, suicide, and substance use disorders. These grants also would go toward improving well-being and job satisfaction.
  • Identifying best practices to reduce and prevent burnout and suicide among HCPs, educating HCPs on these practices, and promoting mental and behavioral health and job satisfaction.
  • Creating a national, evidence-based campaign to encourage HCPs to seek support and treatment for mental and behavioral health concerns.
  • Creating grants for employee education, peer support, and mental and behavioral health treatment, prioritizing HCPs in current or former COVID-19 hot spots.
  • Conducting a comprehensive study on HCP mental and behavioral health and burnout, including the effects of the COVID-19 pandemic.

ACEP Survey Findings

The results of the survey revealed that four in five emergency physicians cite concerns about family, friends, and personal health, while three in five cite job or financial security concerns and lack of PPE.

“Despite the availability of services, nearly half (45%) of emergency physicians are not comfortable seeking mental health treatment,” ACEP reported. “The poll shows that stigma in the workplace (73%) and fear of professional reprisal (57%) are the primary barriers preventing emergency physicians from getting the mental healthcare they need. As a result, more than a quarter (27%) of emergency physicians have avoided seeking mental health treatment out of concern for their job. … Only 5% reported there is ‘no stigma at all’ in their workplace.”

Female, older, and rural emergency physicians report the highest level of stigma in their workplace.