In the demanding world of healthcare, the mental health and well-being of healthcare professionals are paramount. Reducing stigma and providing support can prevent burnout and improve care quality, sustaining a resilient system. Tune in and learn how you can support your peers’ mental health and well-being today.
This transcript of the discussion has been edited for clarity and length.
Mike Sacopulos: My guests today are Corey Feist and Tim Fischer. Mr. Feist is the founder and CEO of the Dr. Lorna Breen Heroes’ Foundation. Mr. Fischer is the President of Jackson and Coker. Corey Feist, Tim Fischer, welcome to SoundPractice.
Corey Feist: Thanks for having us.
Tim Fischer: Thank you.
Sacopulos: Corey, can you tell me about the Dr. Lorna Breen Heroes’ Foundation and the work that it does?
Feist: The Dr. Lorna Breen Heroes’ Foundation was created in the summer of 2020, following the publicity around the passing of my sister-in-law, Dr. Lorna Breen, who was an emergency medicine physician and the Medical Director of the New York-Presbyterian Allen Hospital. Lorna was also a member of the Columbia faculty. The response from the workforce was so strong, identifying this hidden-in-plain-sight issue around concerns around their own mental health and well-being that we felt it was important to honor Lorna’s legacy, and, even more importantly, step into this arena to try to make the workplace a better operational environment for healthcare workers, as well as an environment where their mental health and well-being is thought about as much as we think about the well-being of patients.
Our foundation has been focused on the entire healthcare workforce, and specifically on improving their well-being, decreasing their burnout, improving their mental health, and envisioning a world where seeking mental health treatment, particularly for healthcare professionals, is viewed as a sign of strength.
Sacopulos: Something that we should all be supportive of. Tim, you’re with Jackson and Coker. Can you tell me a little bit about your organization?
Fischer: Jackson and Coker is a firm that focuses on locum tenens, which is a term that probably 20 years ago meant something a little different than it does today. We will partner with about 2500 physicians this year in 2024. Some of them do locum tenens full time; some of them do it on the side and are employed elsewhere. We basically try to connect physicians and advanced practitioners with communities around the United States to transform lives. That’s our mission statement.
Sacopulos: Your organization, Jackson and Coker, has formed up a partnership with the Dr. Lorna Breen Heroes’ Foundation. Can you tell me a little bit about that and how it came to be?
Fischer: Corey tells the story better than I do, but basically Corey and I were on a call similar to this, and I’m pretty embarrassed to admit that I didn’t really realize — I’ve been in healthcare for a good number of years, and I didn’t really realize that healthcare providers in general, not just physicians, were hurting in our country the way that they are. And he brought that to my attention.
I realized we weren’t doing a good enough job here at Jackson and Coker to ensure that we were part of the solution, and that led to us changing how we do business here. We’re continuing to do that. I don’t think you ever get to the point where, okay, we’re done. But it just changed the mindset of our organization on how we interact with physicians, advanced practitioners, and our clients, which are hospitals and healthcare organizations around the country, and how we do business.
Sacopulos: Corey, I’m interested to know more about the ALL IN: WellBeing First for Healthcare program. I know that your foundation has some partnerships and maybe you could tell me about that program.
Feist: One of the very first things that we did when we started our work was to recognize our limitations as a small startup and partner, partner, partner with organizations. As someone who came from within the house of medicine, we know that healthcare is a team sport. So we wanted that partnership to be incredibly inclusive and not just focused on one subset of the healthcare workforce.
We created a coalition called ALL IN: WellBeing First for Healthcare with some traditional and a-traditional players. Traditional players included the Harvard School of Public Health and Johnson & Johnson, a-traditional players included the Creative Artist Agency and Thrive Global, which is Ariana Huffington’s mental health company. Then we expanded to include professional organizations — the American Hospital Association, the American Medical Association, the American Nursing Association, and The Schwartz Center for Compassionate Healthcare, IHI — many of the organizations that you would traditionally think of as the leading health associations and professional associations.
We have two very focused goals. The first is to help scale well-being solutions as a coalition. We’ve done that through certain programs, which I can explain. And the second thing that we’re focusing on is to make sure that the barriers to mental health access for healthcare workers, and particularly the institutionalized stigma around getting mental health treatment, are removed so that healthcare workers can get the same treatment they prescribe to their patients and take care of themselves so they can do the best job taking care of patients. Those are our two goals as a coalition.
Very briefly, one of the very first things we did with that second goal was to identify that one of the key drivers to suicide among health workers is their concerns regarding what getting mental health treatment will do to their professional license, their hospital credentials, their insurance credentials, et cetera.
Working with partners such as the American Medical Association and others, we developed a toolkit where we give organizations, at no cost, the ability to audit the questions that they’re asking of their applicants, change them where necessary, and then, importantly, be recognized by our foundation through a badge, which we call the Champions Challenge Badge. We’re doing that for a couple of reasons.
One is that we want to prevent as many suicides as possible. We want to improve and increase healthcare professionals’ access to getting mental health treatment. We also feel that it’s incredibly important that the healthcare workers themselves simply know the rules around this stuff.
What I’ll tell you is that my sister-in-law’s example unfortunately is not atypical — where someone who was licensed in a state working in a single hospital system her whole career had a set of assumptions around the ramifications, and, I should say, the negative consequences on her ability to work as a doctor, that were not correct. They were not correct. There was a whole series of assumptions that she was making.
We believe, and in speaking with other families of those who have been lost to suicide, we all believe, that simply letting the workforce and the loved ones who support them know what the rules are — for example, “are there actual consequences to getting mental health treatment?” is critical in that time of need. You don’t need it until you need it. And then when you need it, you might be in a crisis like the one my sister-in-law found herself in.
As a family, it would’ve been incredibly helpful for us to know what the rules in New York State are. This badge program that we’ve created through the ALL IN Coalition allows people to make a very quick determination. Is my state one that’s been recognized by the Breen Foundation and the ALL IN Coalition for their work, or not? We can talk more about other programs that we’ve got, but this is what we do. We do this together, and by doing it together, we are elevating all the boats and also bringing in the voices, many of whom are the smaller organizations, and really elevating everybody together. It’s been a very successful coalition. We would invite anyone of your listeners to go to allinforhealthcare.org where you can learn more about the ALL IN Coalition.
Sacopulos: Well, it is certainly extraordinarily important work. Tim, Jackson and Coker was named as a WellBeing First Champion by ALL IN: WellBeing First for Healthcare Coalition. So off the bat, congratulations.
Fischer: Thank you.
Sacopulos: Can you tell me what the process was, what steps you had to take to receive this designation?
Fischer: I think Corey just touched on it at a high level. Basically it’s looking at how, when somebody applies to partner with us, what questions we’re asking in the application process. Are there intrusive questions? Are there questions that will contribute to the stigma that Corey just talked about, where healthcare workers are afraid to raise their hand and say they need help?
As an industry, we have to do better with making sure that people are comfortable going through the process, that they don’t feel that stigma. The great thing about partnering with the Dr. Lorna Breen Heroes’ Foundation is they have a process and they make it very simple for people to understand, like us at Jackson and Coker, and they walk you through it, and you don’t have to have all the answers. You just have to care.
Sacopulos: Well, that’s very nicely said. Tim, I’m interested. Jackson and Coker certainly works with large numbers of physicians. I think you mentioned that you’ll have worked with 2500 or more in calendar year 2024. Does your organization see mental health issues that vary by age or by specialty of provider or geographically? I’m just trying to get a feel. Is it uniformly the same across our country despite where a professional is located, or are there some unique mental health issues for certain segments of the healthcare community?
Fischer: I think I’m always careful to generalize at a high level. I would say overall we have a problem. It doesn’t matter if you live in small town Illinois where I grew up or New York City, healthcare workers overall are feeling they’re struggling with their well-being, they’re struggling with burnout, they’re struggling with feeling that they’re important in this world that we live in, and they’re feeling not as appreciated as they should. I think you probably have people who are doing great in all those areas in New York City, and you probably have them in rural America, but we also have a lot of people that are struggling. It’s tough to put it in a box, but we have an issue in this country and probably in the world.
Feist: If I could just add something to Tim’s answer. A year ago, in October of 2023, just down the road from where Tim is in Georgia, the CDC published their monthly Vital Signs report. In that report it identified that the mental health among healthcare workers in the United States was worse than in any other job sector in the United States. Just to underscore Tim’s point, this isn’t just anecdotes. This is from the CDC saying there’s a mental health crisis among healthcare professionals.
The other piece, in terms of the irony of us asking these kinds of inappropriate questions that prevent mental health treatment, is that the number one chronic condition across the globe experienced by people is depression. When you realize that — as a lawyer, I’m looking at, you’ve got a lot of smart-looking books behind you. As a lawyer to a lawyer here, I can tell you I didn’t know that. I also didn’t know that these questions, as someone who actually sat on the credentials committee of our hospital for a long time, I didn’t go and look at all these questions in that level of detail to think about it from the perspective of, well, we know what these questions could potentially, as lawyers, we try to ask specific yet general questions because we want to be as inclusive as possible. But I never thought about it from the perspective of the negative consequences of what this might do to reinforce a stigma that I didn’t know existed because I wasn’t a licensed healthcare professional.
So when you ask questions about “have you ever gone to therapy in your life” and you realize the fact that the most common chronic condition in the world is depression, what you’re doing is you’re sending and reinforcing a message to healthcare professionals that there might be some negative consequence, real or perceived, if you do something about that depression. And you’ve worked your entire life putting others first to get to this point in your career, you’ve amassed hundreds of thousands of dollars of debt, you have all this pressure and stress, and this is just one more reason why you shouldn’t take care of yourself when you need to, and it’s a valid reason. Why would you risk all of that for what might be a short bout of mental health illness?
What I would say on the other side of that is that’s exactly what my sister-in-law thought. She had a very short bout of mental illness associated with COVID and the overwhelming experience that she had in the emergency room. She was so concerned about it, she didn’t do anything about it until the point of no return — and now she’s not here anymore. These things can happen so quickly. It’s this law of unintended consequences.
As Tim said, what we’ve done at the Lorna Breen Foundation is create a very simple toolkit for organizations to follow, and, more importantly, a simple mechanism to communicate to the workforce where it’s okay and where it’s not okay, putting ourselves in their shoes for a minute. It’s helping to knock down that institutionalized barrier to seeking help, and hopefully those healthcare professionals can take better care of themselves and then do the best job they can taking care of patients, which is what they’re in the business of doing.
Fischer: Just to follow up on that, I think what Corey just said is a key point because — and that’s how I found out about this — I don’t think anybody intentionally is saying, “Hey, let’s put questions in these applications that are going to contribute to someone’s mental health decline.” I don’t think the intent is there, but I didn’t know. I didn’t know what questions were on the application as a leader or a hospital administrator.
A lot of times people just don’t know that something is causing the issues that it is. This is something that we, Corey and I, talk about. We don’t run into many people who say, “Hey, we don’t believe in what you’re doing.” Most people believe in it. They aren’t aware or they’re not putting the pieces of the puzzle together to understand that by asking those questions, it could lead to someone being afraid or concerned if they raise their hand and say they need help.
Sacopulos: Corey, where did the state boards of medicine stand on reporting requirements related to mental health and treatment of their license providers?
Feist: We have a very strong partnership with the Federation of State Medical Boards. We have growing partnerships with the other licensing board federations for pharmacy, for dental, and for nursing. As you probably know, and maybe your listeners are also aware, sometimes the boards have the ability unilaterally through their own internal mechanism to change these questions. Sometimes you have to go through a legislative approach or sometimes it’s nice to take a legislative approach the way we did in Virginia a couple of years ago. We got all the boards, and benefited 500,000 licensees in 62 different types of health professions.
I would say that we have made incredible progress with this badge program. We now have, between the hospitals we credential and the licensing boards, about 1.2 million health workers in the United States currently working in an institution or being licensed by a board that has our badge.
Sacopulos: Tremendous.
Feist: It’s been fantastic. When we started the work, there were about 17 medical licensing boards that we had given the badge to. Now we are up to about 30. Our goal this year with the Federation of State Medical Boards is to get to 100%. They want to be the first out of the gate, because now all these other licensing boards are going, “Hold on. We want the badge too, and we’re going to beat you to it. We’re going to beat you to it.”
It’s great to see the engagement. And I’ll just echo something that Tim said in his answer. We worked with a bipartisan multidisciplinary coalition in Virginia — the Medical Society, Nursing Association, Pharmacy Association, Healthcare Association — to get a new law passed in Virginia, which said that if you’re a licensing board, you can only ask basically two questions, and they’re about current impairment. It’s about current impairment, not about any past impairment.
When I testified in favor of that legislation, the chair of the committee looked across the dais after I spoke to his colleagues and he said, “Would anyone here dare speak against this legislation?” It passed unanimously in a bipartisan way, and it worked with an emergency activation clause. As soon as the governor signed it, it became law, as opposed to having to wait another 45 days. It was that important.
We are making incredible progress at the licensing board level. Some of the fastest process, though, I’ll just say is at the credentialing level. This time last year we had 75 hospitals that we had given the badge to. As I sit here today, we are hovering at close to 500 hospitals in the country that we’ve given the badge to. That’s over a 400% increase — such a big increase that we are now publishing maps of hospitals, licensing boards, et cetera. Every quarter now, we’re having to update the list on our website at drlornabreen.org, because as soon as we publish them, they’re out of date. That’s how quick this progress is, which is so wonderful to see.
It’s so important because, as Tim said, a lot of times when you educate organizations about the unintended consequences of these questions and you point out to them, as an example, that as the Department of Justice has said, when you ask these questions, it’s a violation of the Americans with Disabilities Act, it perks them up pretty quickly to say, “Oh, there’s a relatively straightforward solution that can take me about 48 hours to implement, and I could do it at almost no cost to my organization. How do I sign up for that?”.
We’re hopeful that we will be able to celebrate giving the badge to 100% of the medical licensing boards. Then as we’re doing it through nursing and pharmacy and dental and all the other licensing boards, we want to keep giving this badge away so that the workforce can simply get the same care that I could get without worrying about my legal license being put in jeopardy.
Sacopulos: Tim, what immediate actions can organizations take to prioritize mental health and well-being of their healthcare workforce?
Fischer: Well, I think there’s two different tracks to the question that you just answered. There’s the check-the-box approach where you can go through and do everything that Corey’s foundation will help you do, and then you can say you did it. Or you can go through and get the badge and really dig into the problem. We’re still learning ourselves as we’re a year into this partnership.
I think we have to be careful as administrators or leaders sometimes that you want to get the badge. What is really the problem we’re trying to solve? Getting the badge is one step in doing that. I think there’s the check-the-box approach and then there’s really being part of the solution and partnering with Corey and his team to do that.
Sacopulos: As our time together draws to a close, I’m sure that some people listening to this podcast would like to reach out to one or the other, or both of you. First, Corey, how may people reach you and learn more about the ALL IN: WellBeing First for Healthcare Coalition?
Feist: They can go to our website at drlornabreen.org to find out more about our work as well as our ALL IN: WellBeing First for Healthcare Coalition. I think that’s a great starting point.
I’ll also say, from a grassroots perspective, we now have almost 200 volunteer ambassadors to our organization, and we haven’t even advertised the program yet. On our website, if anybody’s interested in becoming more personally involved in this work and helping to carry this work out, they can become an ambassador to our foundation. All that information is at drlornabreen.org, as well as information on our current maps. I look forward to hearing from your listeners and engaging with them so that they can do this, help us do this work together.
Sacopulos: Tim, how may people reach you and learn more about Jackson and Coker and how your organization supports well-being of healthcare providers?
Fischer: I would say that they’re going to get a lot more by going to drlornabreen.org than they are by contacting me. I mean that seriously, because there’s so much there and the foundation has done a great job at laying out their website on how you can get involved at whatever levels you want to. That’s definitely where people should go. If they want to contact me on the partnership and the value that we see in partnering with Corey and his team, the best way is probably to just email me at tfischer@jacksonandcoker.com.
Sacopulos: My guests have been Corey Feist of the Dr. Lorna Breen Heroes’ Foundation, and Tim Fischer of Jackson and Coker. Gentlemen, thank you for being on SoundPractice and more importantly, thank you for the great work of supporting the well-being and mental health of our healthcare workforce. It’s such a tremendous service that you’re doing not only to the healthcare workers, but really to the whole country. So, thank you very much. Well done gentlemen.
Feist: Thanks for having us and thanks for helping us advance this work.