Dr. Lorna Breen’s lasting legacy [PODCAST]

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“We have a chance to take a meaningful step in fighting burnout and mental health issues in the health care profession. We have lost too many valued and vibrant health care professionals due to an illness that is treatable but stigmatized – including the devastating loss of Dr. Lorna Breen. The Dr. Lorna Breen Health Care Provider Protection Act will leave a lasting legacy for bettering our health care community, taking the first step in addressing this horrible crisis. Endorsement of the Lorna Breen Act is not limited to medical students, other health care workers, students, and hospitals have a stake.”

Corey Feist is co-founder, Dr. Lorna Breen Heroes Foundation.

He shares his story and discusses the KevinMD article, “A step forward: a way to advance the mental health of health care professionals.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: All right, welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Corey Feist. He is co-founder of the Dr. Lorna Breen Heroes Foundation, and he co-wrote the KevinMD article “A step forward: a way to advance the mental health of health care professionals.” Corey, welcome to the show.

Corey Feist: Thanks for having me, Kevin. Really appreciate it.

Kevin Pho: We’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Corey Feist: Sure. So, Kevin, I’ve been in health care a full career, 20-plus years, first as an attorney, then as an administrator, an executive. I spent the vast majority of that time at the University of Virginia Health System in Charlottesville, Virginia. The last five years, I’ve been the chief executive officer of the UVA Physicians Group. When I became the CEO of the medical group, I made it a priority to focus on an increasing issue that I’ve been hearing from the health care community, which is increasing burnout and decrease in job satisfaction. So we started working on things like electronic medical record optimization, and other ways that we’re preventing physicians from doing what they love, which is spending time with patients, and doing what they don’t love, which is spending days and nights and evenings on the electronic medical record. We also spent a lot of time redesigning processes in the clinical environment to try to make the workflows and things just more physician- and provider-focused.

In April of 2020, my personal and professional life came to a nexus point when my sister-in-law, Dr. Lorna Breen, an emergency medicine physician in Manhattan, died by suicide. Dr. Breen had a career in academic medicine, wanting her entire life nothing more than to practice emergency medicine in Manhattan, and she was fulfilling her dream. She was in an MBA program at Cornell University at the time. She was the medical director of the Allen Pavilion, the Allen Hospital medical center, which is a hospital owned and operated by NewYork-Presbyterian, and she was on faculty at Columbia.

Lorna’s story became national news because Lorna had no prior history of mental health issues at all. She was very smart, very bright, in great health. What happened to Dr. Breen is that she contracted COVID-19 treating patients on the forefront of the big tsunami of COVID patients that hit New York City in the March-April time frame of 2020. She went back into the workforce on very depleted resources, only having been without a fever for a day or so. She went right back in, had lost a bunch of weight, and was not fully able to really keep up later that week. From the very beginning of her time back, she was overwhelmed with the volume of death and dying that she was observing and experiencing, and had no ability to really help save lives like she was used to doing.

Later that week, she called my wife, Jennifer, her closest sibling, with 22 months separating the two of them, and she told Jennifer she couldn’t get out of her chair. So, with us being in Virginia and Lorna being in Manhattan, right in the middle of a pandemic, Jennifer contacted friends and got her out of New York while she drove as fast as she could up the East Coast to pick Lorna up on the side of the road in Baltimore, Maryland. Then she took her to the emergency room down in Charlottesville, Virginia, at the University of Virginia. Dr. Breen was admitted to the inpatient psychiatric unit, where she spent about 10 days. After being discharged only three days, Dr. Breen took her own life, tragically.

In the wake of her death and the publicity that surrounded that, Jennifer and I were overcome with just tons of feedback from the health care community that the issues Dr. Breen had experienced before her death, the stigma associated with getting mental health treatment, her fear of losing her medical license for getting mental treatment, her fear of the professional repercussions of taking a break and not being able to keep up, are significant issues that are pervasive across the health care industry. So in June of 2020, Jennifer and I co-founded the Dr. Lorna Breen Heroes Foundation. We now have federal legislation in Dr. Breen’s name trying to help the workforce, and we’re doing a lot of other things in this area to try to raise awareness, to advocate on behalf of health care professionals, and to educate institutions on how to support the well-being of the workforce. So that’s my abbreviated story and how we’re here coming to talk to you today.

Kevin Pho: Well, thank you so much for sharing that story, and I’m tremendously sorry for your loss.

Corey Feist: Thank you.

Kevin Pho: Over the past year plus since that tragic event, as you reflect on this, what are some of the things that you’ve learned from this experience?

Corey Feist: I’ve learned that there are at least six structural barriers that exist that prevent and inhibit physicians from getting mental health treatment. Medical licensure varies from state to state, and they can have questions about prior mental health issues. Credentialing questions in hospital applications to work at hospitals can have questions on mental health issues. Credentialing applications to be part of an insurance panel and get paid for your work as a doctor have those kinds of questions. Application questions for doctors to be covered by malpractice insurance often have those questions. Medical malpractice suits involving a physician as a defendant can ask for the mental health medical records of the treating physician; in only a few states are there prohibitions against doing that. Finally, the health plans that many physicians participate in as part of health systems often require them to get mental health services from the institution where they work. All of these six areas reinforce the stigma. So that’s one big lesson, which is we’ve got significant structural barriers that exist that apply to doctors and not really anyone else in this country.

We’ve also learned that this is a relatively new issue to the health care industry to try to attack at scale, and not just throw, as I would say, meditation apps at the problem. This is not about making the canary stronger, to borrow the analogy of a canary in a coal mine, but rather, we need to redesign the coal mine. Hospitals and health systems are ill-equipped in doing that, which is why we’ve launched the All In: WellBeing First for Health Care initiative with a number of national organizations to try to bring those tools to bear.

The final thing that I would say is that the conversation around these issues of mental health and burnout requires a degree of vulnerability. When you express that vulnerability, and you share something that is really an unspoken thing, what it does is it gives others permission to come out and share their stories and get help. Of all of the things that I just listed, having open, honest conversations about this and creating space to have these conversations is one thing that we need to do more of. It’s a huge lesson that I’ve learned, and a way to change the culture in medicine and the culture in the society to support those who are in need of help, whether a formal mental health diagnosis or something that’s short of that. So I would say those are three big lessons learned.

Kevin Pho: And you talk more about that in the KevinMD article that you co-wrote. It’s titled “A step forward: a way to advance the mental health of health care professionals.” So, Corey, talk about some of the unique challenges health care professionals face that may predispose them to mental health issues, because we have other professions that also experience burnout, especially during the pandemic. But what are some unique characteristics that afflict those in the health care profession?

Corey Feist: So it’s a great question, and I think that it’s important to separate burnout from trauma and PTSD. Trauma and PTSD and those symptoms, you know, those are formal mental health issues. Burnout, as you’ve explained, is a workplace condition, which can be solved by changing the dynamics of the workplace. It can make people more susceptible to mental health challenges through trauma, but in and of itself, burnout is not a formal mental health condition.

Irrespective of that, there are some unique things here. First of all, as you know as a physician, physicians go into the practice to help other people, not dissimilar to other professions that are helpers. They go into the practice to help other people, and they have a life of delayed gratification in doing that. So I think that, first and foremost, physicians have, you know, an ability to put others before themselves. When it comes to their own mental health needs, or their own recognition of them burning out, I think that they are often quicker to put their needs second, when they need to, in this case, put their needs first. That’s on the physicians.

I think that physicians also, right now, have gone in the last 15 to 20 years from being autonomous, very autonomous, really in charge of a lot of their work environment, to now, over 50 percent of the physicians in this country are employed by large health systems. So their day-to-day environment is no longer in their control, and I think that contributes to their frustration and their burnout in particular, because the resources that they need to take care of patients are often at someone else’s decision to make. So that’s a unique part about the mental health and burnout for physicians.

I just listed before those six barriers to stigma. We’ve actually just published an op-ed in U.S. News & World Report, co-authored by my wife, Jennifer, and me, on this issue, if individuals are interested in learning. So there are actual structural things out there that prevent doctors from getting, or significantly inhibit them from getting, mental health treatment.

The last thing I would say that I think is unique to physicians is that physicians are, well, maybe this isn’t unique to physicians, but I think that we have put our physicians in the position of having to think about the patient to the exclusion of themselves. I alluded to this before, but let me get it. In health care, for years, we have talked about the triple aim of health care, and that triple aim is high patient quality, easy access for patients, at the lowest cost for patients. What the entire industry has kind of skipped over is that the way you do that is you take care of the workforce, the physicians. You can’t do any of those three without thinking first about the workforce. I think that health care is kind of unique in that it really focuses on the customer, or in this case the patient, to the exclusion of the workforce, and I think the pandemic has just magnified that. We’ve ignored, to a large degree, physicians’ well-being, because we just assume they’re going to show up day after day after day and put their needs second to that of their institution or to the patient, and that is now, you know, increasingly detrimental to their own mental health. So those would be some of the big ones that I would identify.

Kevin Pho: You alluded to this earlier, that a lot of health care systems and hospitals suggest things like meditation apps and yoga to address behavioral health issues, but you also alluded to the fact that, instead of making a stronger canary, we need to change the coal mine. We need to have more structural changes. Now, from your perspective, also as a CEO of a physician group, those structural changes, unfortunately, are going to cost money, in terms of seeing fewer patients, lost revenue, more support. So there’s an inherent tension there in terms of the path forward. How do we resolve that tension?

Corey Feist: Yeah, that’s great. I think we resolve it by getting together and having these conversations. First of all, health care is a team sport. Let me be clear on the comments I made about the meditation apps and the yoga classes. We certainly need those things, but they’re not the solution, and that’s an easy way for people to say, “I’m addressing the solution,” but it’s really just touching the surface. In fact, one of the things that health care providers could really need now more than ever are peer support programs, so that they can talk to each other right now.

But I think that with regard to the structural issues, you know, some of them do cost money, but others are not so much monetary, but just attitude and approach. So I’ll give you an example. We’ve been working at the University of Virginia Health System for years to eliminate waste in our health system. We measure it. We measure the hours of waste, and we just kind of look at processes and we try to fix them. But what we rarely do, until this year, until I’ve been able to lead through it, is to say, “I’m going to eliminate the waste, first and foremost, that our doctors have in their day-to-day.” So I’m going to make a process that they’re involved in better for them. That doesn’t necessarily take more money. That just takes focus and prioritization, to say, “Kevin, in your specialty, you went into clinic, and you experienced these following barriers to get your patients through. Let’s go, and let’s put it on the whiteboard, and sit down together and try to make it a more efficient process.” In fact, it often will save money when you do those kinds of things.

So I think that’s maybe a false dichotomy, to think that you can’t have both of these things at the same time. In fact, I think that one begets the other. In fact, in speaking with physician leaders across the country who are really leading their health systems in ways that are more progressive on well-being, let’s just say, the first thing they say is, “We have created a culture of innovation where we give the physicians permission to help us craft solutions to the problems that they’re experiencing every day.” By and large, those are just processes where, you know, instead of going left, we go right here, to be obviously overly simplistic.

So I think that there is a lot that can be done that won’t cost money. Am I naive enough to think that some of it will cost money? Absolutely. But there is so much waste in health care. If we can make processes in the clinics and the ORs and the whole health care system more efficient, it’s going to free up resources to reinvest in some programs that will also help to redesign the coal mine, as we say. So I think starting with those processes that maybe save you some money, using those dollars and repurposing them, would be the way that I would approach the problem.

Kevin Pho: We’re talking to Corey Feist. He is co-founder of the Dr. Lorna Breen Heroes Foundation, and he co-wrote the KevinMD article “A step forward: a way to advance the mental health of health care professionals.” Corey, what has the response been from the various stakeholders for many of your initiatives? You talk a lot about the obstacles, for instance, the stigma surrounding mental health. Now, for your solutions to try to address these, have you encountered any obstacles or pushback?

Corey Feist: Very little. I don’t know a hospital executive in the country that’s not really worried and concerned for their workforce right now. On the nursing side, I don’t know a hospital in this country that’s fully staffed. There are hundreds of nursing vacancies in many hospitals across the country. So focusing on the workforce now more than ever is something that I know is top of mind to health care leadership.

I also think, and I’ve heard, that they don’t even necessarily know a starting point, which is one of the reasons why we started All In: WellBeing First for Health Care, because that initiative provides tools based on where you are in your journey of supporting well-being. So I don’t think there is really much resistance to it. It’s more of a “Show me what to do here, and I’ll do it,” because, you know, patients don’t come to hospitals for the bricks and mortar. They come to hospitals for the caregivers, the nurses, the doctors. If that workforce is not physically there, or not able to do the best that they can on a daily basis, you know, nobody wants that in their health system. So everyone is looking to provide top-quality care, and I think we’re helping to provide a road map for it, identifying some of these issues, and making the culture of health care a little easier on the health care providers themselves.

Kevin Pho: So give us some specific directions in terms of what we can do, because we do have a lot of clinicians and health care administrators who listen to this podcast. What are some specific ways that we can help move the needle?

Corey Feist: Absolutely. So first and foremost, the Dr. Lorna Breen Health Care Provider Protection Act has passed the United States Senate and is in the House of Representatives, waiting to be voted on by the Energy and Commerce Committee and then the full House. That is an absolute imperative. It is first-of-its-kind legislation. It has over a hundred million dollars of programmatic support, and much of that programmatic support is actually being funded right now in the form of HRSA grants. It is a really important piece of legislation, because it is almost over the goal line, and it is going to set a policy foundation for work to be done here. So your listeners can absolutely reach out to their members of Congress, ask them to co-sponsor the act, and ask them, if they’re on the Energy and Commerce Committee, to vote in the act. We need to get this over the goal line. So many on Capitol Hill have shared with me, once I’ve told the story and shared it, “It’s a no-brainer, and it’s what we need to do to support the workforce right now.”

The other thing that’s a very tangible thing that I would share with you is those six areas of stigma that I talked about a couple of times. If every hospital in this country separated fact versus fiction for their physicians on those six areas, to say, “What is the state law in our state? What are our credentialing questions?” and go down that list and publish that list for their own workforce, that would be a huge step forward, just in bringing current knowledge to our hospital, or to our physicians.

What I’ll tell you is, this is personal for me. Dr. Breen was convinced she was going to lose her medical license for getting mental health support, and in New York State, which is where she was licensed, there are no questions on the licensure application about mental health. So as I’ve spoken about this idea about publishing facts versus fiction, myths versus facts, or whatever you want to call it, I have found universal support that we need to do it, and in many, “Oh my gosh, I didn’t even know that our credentialing applications for our own hospital had these questions.” So it’s a big step forward, and it doesn’t cost any money to do. You know, we were talking about money before.

So: contacting members of Congress, asking them to vote for the Lorna Breen Act; doing this one piece of documentation, the facts versus myths; and then the last thing is, if organizations and individuals want help in this work, we are here to help. Contact us at www.AllInForHealthcare.org and join our initiative. It costs nothing to join our initiative. We are giving away tools for free if they want to know how to do this work, and if they want to participate on the national level, we are here for them. That is now my work moving forward with the Dr. Lorna Breen Heroes Foundation.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience? And perhaps you can end with: How do you want my audience to remember Dr. Breen?

Corey Feist: Oh, the take-home message is, when it comes to mental health, speaking about these issues and acting on these issues are a huge step that every single person can take. What I would say to you, having just spoken to the daughter of a physician who died by suicide just in the recent days, is that these issues can come up so quickly. So my message is, don’t wait. If you wait, your loved one or your colleague might not be there. So checking on each other, having these conversations, and taking care of each other would be our big issue.

Dr. Breen was a force. She was the crazy aunt to eight nieces and nephews, and drove a convertible Porsche in the middle of Manhattan when it made absolutely no sense to do so. She was a world traveler. She would study for her boards by herself on the side of a mountain somewhere. She took life by the seat of its pants, and she really was just this amazing woman. She was so caring for her patients and her colleagues. What I want you to know about Lorna is that she was more than just the suicide. She was a devout Christian, she was a latecomer to the arts and music, she was a salsa dancer, and she was my wife’s best friend. That was Dr. Breen.

Kevin Pho: Corey, thank you so much for sharing your story, time, and insight, and thanks again for being on the show.

Corey Feist: Thanks, Kevin.

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