COVID-19 Conversations From A Provider's Perspective: Practitioner Burnout

Practitioner Burnout

Three Virginia health system executives participated in a virtual discussion about COVID-19 from a provider’s perspective. The hour-long program was part of the 16th Annual Virginia Health Care Practitioners’ Roundtable sponsored by the Virginia Bar Association’s Health Law Section Oct. 22. Here is one summarized excerpt from that conversation.

Panelists:
   J. Corey Feist, CEO, University of Virginia Physicians Group
   Paul Neimeyer, Chief General Counsel, VCU Health System
   Lou Patalano, Chief Legal Officer, Sentara Healthcare
Moderator:
   Jonathan M. Joseph, Christian & Barton

[Jon Joseph] Lou, we talked earlier about the issue of burnout at some of the facilities. Has Sentara seen that much and is it something that has come across your desk at all?

[Lou Patalano] We have stressed to staff the importance of taking time off, and we haven't seen a lot of resignations. I will say that I've been pulled in to a couple of instances where our nurses have had to deal with disruptive patients, and in a couple of cases have been assaulted by patients. This just weighs on them even further in this time. And the biggest support that our legal team can offer is to tell staff we will be there to support you.

Now, from burnout in particular, I will address it from this standpoint: I'm about to take a couple of days off for my first “vacation” since the onset of the pandemic. I've encouraged my staff to remember in this crazy world we're living their first priority has got to be to take care of themselves. And so one of the things we were proud of, at least on my team, is we did not go through furloughs. I also encouraged my department to plan and calendar time off. I'm not going to hold them to it, but at least it made them try to map out some 2020 time off. At the end of the day, I need folks who are not burned out. And if we let the craziness of our roles and our jobs overtake us, it is a recipe for burnout. And that's a message I'd continue to give folks—think about taking care of yourself and your staff from a mental health perspective.

[Jon] I'm going to ask Corey to talk about burnout and he has a perspective here. I know your family's been directly impacted by physician burnout Corey and I'm very sorry about that. I know you've been actively involved in trying to address it. Can you tell us a little bit about that?

[Corey Feist] Absolutely. My family was struck by a significant tragedy in late April when my sister-in-law, who's an emergency room physician in New York City, contracted COVID and went back to the workforce and was overwhelmed by the volume of death and dying that she saw. We got her out of New York, and brought her to Charlottesville where she was admitted as an inpatient at the University of Virginia in the psychiatric unit. She was discharged, and on April 26, she took her own life. Her name was Dr. Lorna Breen. She was an accomplished physician. She ran the emergency room at the New York-Presbyterian Allen Hospital, which sees about the same number of emergency patients as the University of Virginia's hospital. Shortly after Lorna died, The New York Times ran an article about her death without our knowledge. In the wake of that tragedy my wife and I had a choice, which was, are we going to step into this conversation and really try to change the discussion at a national level? Or are we going to retreat into the shadows given the stigma of suicide?

My wife is also a lawyer and we chose to step into that conversation, though painful it has been. We have developed a non-profit called the Dr. Lorna Breen Heroes’ Foundation, and we have developed partnerships across the industry in really three primary areas. First is in the awareness area. We have spent a tremendous amount of time on radio and news for this issue, and we've reached over 65 million Americans with our message and a lot of that culminated on Sept. 17, National Physician Suicide Awareness Day. In addition, we've spent a tremendous amount of time in the legal regulatory realm. Virginia’s Sen. Tim Kaine sponsored legislation in the Senate called the Dr. Lorna Breen Health Care Provider Protection Act. It has a tremendous amount of support from across the industry as well as in both chambers of Congress.

Much of the burnout talk of physician utilization of mental health services stems from a fear of licensure reporting, or licensure or credentialing privileging. I'm part of a coalition working on an initiative called Humans Before Heroes. I skipped over an important part of this story, which is my sister-in-law had no prior history of mental illness. She came about her stress because of contracting COVID and then treating COVID patients in the heat of the pandemic. While we will probably never know exactly what happened, what we do know is very clear—as soon as she started back in her job and observed the fact that her colleagues saw that she couldn't keep up, she became fearful of the professional repercussions. She became very vocally concerned about fear for her license, and interestingly New York has one of the most favorable licensing laws in terms of reporting mental illness than any other state. We are working on an awareness campaign and certainly working within the regulatory space, to try to make a big difference. And then finally, we're using the money that we've raised to seed programs and fund research to reduce health care burnout and improve provider well-being.

We've published four different articles across the country, we've been noted in about 70 different publications and as we've said multiple times, we're just getting started. Folks can learn more about our work at drlornabreen.org. This is not something that impacts just doctors, it impacts nurses, and now all of us, frankly, because we need to treat our health care heroes as humans first. We need to recognize that if they are not healthy and of sound body and mind, they cannot treat patients.

We've seen some quality statistics that show that burnout leads to a 200% increase in medical errors. We also have seen statistics that show that 80% of the issues that contribute towards burnout come from institutional drivers. And so everyone here on the call who represents an institution needs to understand that they have a role in solving this issue and addressing this issue as an employer of physicians, or as an employer of a large workforce that is sprinting this marathon without a clear end in sight. So I want to thank Jon, Lou and Paul for giving me a little bit of space here. This was never about one doctor, this has always been about the institution and about protecting our health care.

[Jon] Thank you for sharing your story. Corey have there been some changes that you've put into place since this happened?

[Corey] Absolutely. What we're doing is we're reaching out to our health care providers and asking how we can help. I learned a long time ago that when you take care of your workforce, they take care of your customers. What we need to recognize, and what we have done much more proactively, is to reach out to our workforce and have an active conversation around cultural change. And we need to do that from within. It can't be lawyers, and many that are preaching it from the rooftops—such as the health care team members themselves—must meet each other through this conversation and we're helping to facilitate that in a significant way. So that's probably one of the biggest things that we've done as a health care institution—to rebrand it and make it a priority.

[Jon] Paul, have you seen new realities that have come from COVID and burnout?

[Paul Neimeyer] Yes, I think we have to a large degree. People in my department have to establish goals every year. So I've always had what I call a “stress goal,” because if you don't have something that puts you at your best you're not going to be the best lawyer that you can be. This is a soft goal that is not measured, but I think it sends the message that you really care about your employees. Examples may be daily meditation, a regular run, lunch with friends—it’s a moment where they think about themselves. And I think that's really important to demonstrate that you think about them more than just as an employee, you care about them as a person.

[Lou] I think making sure that we're checking in with folks as a human being is important. Not as a boss, not as a lawyer, but as a human being to make sure that we're there for each other in stressful times. Because you just don't know what folks are facing. One of the things I’ve done throughout the pandemic is schedule a meeting with my direct reports every two weeks and I have a team meeting every other week.

There is a show on Comedy Central called Impractical Jokers where four guys challenge each other to pranks. During COVID, they created virtual dinner parties with jokes and food. For every episode there was a meal, and at the end of each episode they name the next meal. The four guys would show up with their own take of that meal. So for our team meeting, I give them a meal. The next one is chicken. I'm not a good cook, but hopefully this will be a way to break the monotony, and be a way to let folks shine if they're a chef or if they want to be creative. And for people like me, it's just another excuse to eat. So that's my creative way to check in with the team—and it goes back to my message of checking in with each other as human beings.

[Jon] Corey, the Virginia statutes for the Board of Medicine require hospitals to report impaired providers, and there's immunity for reporting. Do you suggest a softer approach to address this?

[Corey] Thank you very much for that question. In 2020 the governor signed legislation introduced by the Medical Society of Virginia called the Safe Haven program. This program is intended to provide some immunity for our health care providers when they go through a counseling service that is provided through the Medical Society of Virginia. So I want to put a plug in for the MSV for starting this conversation. In early May, the Joint Commission issued a statement on removing barriers to mental health care for clinicians and health care staff. This is an important statement because it can serve as a model for other state licensure laws to follow, including Virginia.

Basically the statement noted the Commission supports the recommendation of the Federation of State Medical Boards and the American Medical Association to limit inquiries to conditions that currently impair the clinicians ability to perform their job. It's that “currently impair” language that I think has got to be the focus as opposed to individuals who five or 10 years ago went through a divorce and had mental health counseling. I think we've got to narrow that language. Some have proffered, including the law journal that is sponsored by the American Psychiatric Association, that about 30 state laws actually do not comply with the Americans with Disabilities Act on that subject.

And so there's a lot of work to be done here. As was noted previously on a separate town hall on this exact subject, HIPAA protects patients in terms of their protected health information. Why does that not extend to our health care workforce, particularly around mental health? It's a delicate balance, but we've got to do a better job. Physicians are the number one profession at risk for suicide. In fact, physicians and nurses die by suicide at two times the rate of the general population. Changes are needed to the laws and frankly, we've got to look at them in all 50 states.

Other conversations in this series:

  • "If we tried to do it alone, it was not going to work."
  • Moving Carefully When There's Pressure to Move Quickly
  • Personal Connections in a Remote Environment

This summary has been edited for clarity and length. It has been provided as an informational service and does not constitute legal counsel or advice, which can only be rendered in the context of specific factual situations. If a legal issue should arise, please contact an attorney listed or retain the assistance of other competent legal counsel. Case results depend on a variety of factors unique to each case and results do not guarantee or predict a similar result in any future case undertaken.

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