As emergency medicine physicians in Washington, D.C., we have been called health care heroes. However, at the start of the pandemic, many of us were terrified of this virus. We worried about our patients, our colleagues and about transmitting the virus to family and friends. Before there were vaccines, before there were antibodies, all we had was fear. And with that fear came stress, burnout and fatigue.
We were not alone. Many of us endured this plight. All amidst a challenging political environment in which there were endless debates about the utility of vaccines and masks. While others debated, we continued to work as we always have.
Almost two years ago, an emergency medicine colleague, Dr. Lorna Breen, died by suicide after recovering from COVID-19 and being overburdened by a stressful work environment in New York City. In reports on her life and death, it was noted that she never struggled with depression or mental health concerns before the pandemic. We never met Breen, but from what we understand, our field lost an amazing member of our ranks when she died.
On March 18, President Biden signed into law an act in her name, the Dr. Lorna Breen Health Care Provider Protection Act, designed to support the mental health of health care providers. It includes funding in support of burnout prevention in this population.
Since Breen’s death, some things have changed while much has stayed the same. Now, over 140 million Americans have tested positive for COVID-19 and almost 1 million have died from the disease. But we also have vaccines, and over 65 percent of the population is fully vaccinated. Mask mandates have come and gone.
People are starting to feel things are getting back to normal. Hospitals have had some reprieve. Still, our health care workforce is suffering.
Globally, the World Health Organization estimates that 180, 000 health care workers died during the pandemic. The survivors have suffered an enduring emotional toll. In 2020, illness and injury increased by 40 percent in health care and social assistance sectors, higher than any other private industry sector and led by the nursing professions. Almost one in five health care workers have quit their practice while many more have considered leaving. America is now facing a nursing shortage, long present but pushed to the brink by the pandemic.
Some of this is due to the burnout from the pandemic and the resultant mental health effects. Health care workers are facing depression, anxiety and post-traumatic stress. Others are experiencing moral injury, the sense that they cannot fulfill their moral obligation to provide high quality care due to various limitations such as administrative barriers or shortage of adequate resources. At a time when so many were already struggling, layoffs eliminated the livelihoods of 12 percent of health care workers, and those that remain are pressed to work harder, to do more with less support.
It’s hard to know what to do when you experience these challenges. In our medical training, we aren’t programmed for self-care. Work-life balance is tossed aside early in our careers. Medical students spend long hours in classes and cramming for exams. Residents work 80-hour work weeks. When training ends, the long hours have already become a way of life, and we continue to prioritize work, forgoing time with family and friends. These stressors and tensions were exacerbated with COVID-19.
While the long hours are shared by many other professions, in the clinical arena, burnout and staffing shortages have clear victims — patients. As we ask health care workers to push themselves harder , everyone suffers — workers and patients alike. More patients will die preventable deaths, and the cycle of burnout and moral injury will continue.
Something needs to change.
There is no silver bullet to addressing health care provider mental health. Provider wellness must be addressed at multiple levels and calls to build individual resiliency, as in the Dr. Lorna Breen Act are important, but inherently limited. Organizational and health system change is also desperately needed. We hope that the Dr. Lorna Breen Act will be able to fulfill its stated goal to improve “mental health and behavioral health among health care providers.”
We are encouraged that one day we will have a world where COVID-19 will no longer be a threat. We are honored that as health care workers, we have been publicly recognized for our work during the pandemic. Let’s use this time to address the mental health sequelae that have been unmasked among members of our rank. It is time we change how we work, to incorporate mental health and wellness as part of our practice.
As our country starts to return to our pre-pandemic activities, we cannot continue business as usual for the healthcare profession. Let’s honor Breen’s memory with true changes in how we address the culture of burnout.
Janice Blanchard is a professor of emergency medicine at George Washington University.
Guenevere Burke is an assistant professor of emergency medicine and principal investigator at the Mullan Institute for Health Workforce Equity at the George Washington University.
The opinions expressed are their own.