Already at high risk of suffering from burnout and PTSD, emergency physicians are straining to care for patients with COVID-19. However, recent evidence suggests many of these providers are reluctant to seek the mental healthcare they need, creating adverse circumstances for themselves, their colleagues, and maybe even their patients.

A poll conducted in October by the American College of Emergency Physicians (ACEP) and Morning Consult revealed 87% of 862 emergency physicians are more stressed since the start of the pandemic, with 72% reporting they are experiencing more symptoms of burnout.1 Despite the availability of mental health services, the data show nearly half of emergency physicians are uncomfortable seeking mental health treatment. Seventy-three percent of respondents cited stigma in the workplace, and 57% cited a fear of professional reprisal as the top barriers to seeking mental healthcare. Also, 27% said they avoided seeking mental healthcare out of a concern for their job.

Advocate for Change

In an Oct. 26 media briefing, ACEP President Mark Rosenberg, DO, MBA, FACEP, said the results underscore what his group has been hearing from members. “We take care of patients instead of ourselves ... as a result, there is a higher rate of career burnout and PTSD than in any other specialty.”

Rosenberg stressed the poll results add urgency to the need for emergency physicians, policymakers, and clinical leaders to work together to change the approach to mental health.

In April 2020, after exhaustively caring for patients with COVID-19 in New York City before contracting the virus herself, emergency physician Lorna Breen, MD, took her own life. Family members attended the Oct. 26 media briefing.

“For the first 49 years and six months of her life, [Lorna] showed no signs of depression or anxiety. That changed after she got COVID-19 and was an emergency provider in Manhattan,” noted Jennifer Breen Feist, JD, Breen’s sister and co-founder of the Dr. Lorna Breen Heroes’ Foundation.2

While Dr. Breen did seek mental health treatment, she was worried about the possible negative consequences for her career.

“She was so concerned about the stigma of seeking help and so concerned about how she would be perceived by her peers that it was her main focus. We believe it ultimately was her downfall,” Feist said.

Tackle the Barriers

As poll statistics suggest, thousands of frontline providers are suffering in silence, observed Corey Feist, JD, MBA, co-founder of the Breen foundation.

“Given the scale of suffering that we are seeing in our hospitals across the country, it is no surprise that many of our emergency physicians feel that they’ve got to be superhuman at work. We simply need to give them the reassurance as well as the support they need to take care of themselves first and foremost before they take care of patients,” he said.

Feist noted that as he and his wife have delved deeper into the topic, they have learned about the adverse consequences of stress and burnout, not just on providers but patients, too. “There is a 200% chance of an increase in patient errors when healthcare providers are burned out. If our healthcare heroes in the ED aren’t going to [get help] for themselves, they need to do it for their patients who they were sworn to protect,” Corey Feist said. “Physicians across the country are reluctant to reach out for mental health. Jennifer and I strongly believe that this status quo must change.”

Feist noted one of the big barriers to culture change in this area concerns the sometimes-invasive questioning of physicians regarding mental healthcare treatment they may have received before. Such questions are part of some state licensing and hospital credentialing processes.

Nurture Peer Support

Rosenberg pledged that ACEP is moving on several fronts to reduce the stigma attached to mental healthcare, including assuaging fears about losing a job.

“We need to have the opportunity to share [these concerns] and maybe get professional help without being afraid of what is going to happen,” he said. ACEP offers a wellness resource program for the group’s 40,000 members that includes peer support, crisis support, and physician advocacy and wellness resources.3

Corey Feist said one of the most effective tools for physicians under stress is talking to colleagues. “Peer support networks are critical to addressing the solution. Even if you don’t think you have the skills, you do by virtue of the MD behind your name,” he said. “Particularly right now, it just takes hearing each other. Give yourselves permission to talk and listen. It is critical now more than ever.”

Feist also encouraged clinicians to advocate for resources in their own healthcare settings. “Recognize that you play a key role in helping to change the culture and in taking care of each other,” he said. “Speaking to each other about this stigma and ... your needs is going to lift an incredible weight off of everyone’s shoulders so that [people] don’t have to hide in the shadows anymore.”

REFERENCES

  1. American College of Emergency Physicians. Mental Health Among Emergency Physicians. October 2020.
  2. Dr. Lorna Breen Heroes' Foundation.
  3. American College of Emergency Physicians. COVID-19 physician wellness.