Death by suicide among physicians and nurses is now twice the national average before the COVID-19 pandemic. The Dr. Lorna Breen Heroes’ Foundation’s mission is to increase awareness, advance solutions, and promote advocacy at the federal, state, and local levels. The Foundation has been doing good work, as evidenced by the recent federal passage of The Dr. Lorna Breen Health Care Provider Protection Act.
This transcript of their discussion has been edited for clarity and length.
Mike Sacopulos: My guest today is Corey Feist. He has served as the chief executive officer of the University of Virginia Physician Group, which is a medical group comprised of more than 1,200 physicians and advanced practice providers. Currently, Mr. Feist serves as the co-founder of the Dr. Lorna Breen Heroes' Foundation.
Corey Feist, welcome to SoundPractice.
Corey Feist: Thank you, Mike, for having me today.
Sacopulos: For those in our audience that are unfamiliar with Lorna Breen's story, could you tell us about Dr. Breen?
Feist: Sure. Dr. Lorna Breen is my sister-in-law, and she was as unique in some ways as her name. She was a crazy aunt to eight nieces and nephews and drove a convertible sports car in Manhattan where she worked her whole career. Was an avid snowboarder, a latecomer to the cello, loved salsa dancing, and was really just larger than life. And in some ways, Lorna was straight down the middle of the fairway, if you will, poor golf analogy, because I'm never in the fairway, but you can understand. Straight down the middle of the fairway in terms of her medical career. Deciding to be a physician in high school and then getting her way, working her way to Cornell as an undergraduate then to the Medical College of Virginia for a master's and ultimately her MD. And then she was double-boarded in internal medicine and emergency medicine, having trained at Long Island Jewish Hospital.
Her entire life she wanted to be a physician in New York, and she really was living that dream in 2020, which is when she died. Lorna was the medical director for Allen Hospital, which is one of the New York Presbyterian Hospitals. And she was the medical director of that emergency department for quite a number of years. She was also in the process of getting her MBA back at Cornell on the nights and weekends that she was not working full-time as an attending physician, as well as in this administrative role.
Lorna died by suicide on April 26th, following a short bout of COVID herself. In March of 2020, we were on our annual ski trip with Lorna because she loved to impart her knowledge of the slopes to my children. Since she never married or had children, Lorna was always excited to share her loves and passions with my kids who were really two of the eight that she was really, really close to.
So, she left Big Sky Montana, and went right back to taking care of patients in mid-March right when the peak was happening. And pretty shortly thereafter contracted COVID herself. Was not hospitalized, but was quite sick with COVID, all kinds of the traditional symptoms we were learning about at the time. And, in fact, because she was so concerned about her oxygen levels, she asked us to help her get a blood oximeter, which we were able to secure through Amazon of all places and sent it to her apartment where she really convalesced on her own for quite some time until she was without a fever for one day. And then she said, "Put me back on the schedule." April 1st was that day, 2020.
And when she returned to the emergency department on April 1st, 2020, she conveyed two very clear messages to us. The first was that what she was observing was Armageddon--not enough supplies, not enough beds, not enough oxygen. Patients just literally stacking up in the hallways and in the waiting rooms, literally dying in their chairs. It was a degree of or a volume of death and dying that she in her career had never experienced.
Remember she was on very depleted faculties because she was just coming off of COVID and probably still had it to some degree. Lorna also conveyed to us on that first day that she was having trouble keeping up. And her concerns were that her colleagues would notice she couldn't keep up and it would impact her career negatively. She was scheduled for 10 12-hour shifts in a row, and she wasn't working 12-hour shifts. She was working 15, 18-hour shifts and trying to take care of just this volume that she was observing, pushing through.
As the days went on, her challenges really increased. And on the 9th of April, she called my wife, Jennifer, who's her closest sibling in age, her younger sister, also an attorney down here in Charlottesville, and said that she basically couldn't get out of her chair and needed immediate help.
This was the first time that Lorna had ever asked for help in her entire life, had ever really recognized or verbalized that she couldn't function. She had never had any mental health issues. She had never been treated for inpatient or outpatient mental health treatment, and certainly had never been on any mental health medications.
Jennifer was able to identify very quickly a close friend of hers from medical school who rushed into New York, intervened, got Lorna in a car, and just started driving south on I-95, where she connected with another colleague who was a childhood friend of Lorna's who met her on the side of the road in Philadelphia. All the while, Jennifer was driving as fast as she possibly could north to get her big sister, where she picked her up on the side of the road, outside of Baltimore, Maryland.
Luckily, the physician who had driven her was a psychiatrist by training and had called Jennifer while she was en route and said Lorna needed inpatient help. And so, Jennifer drove her down to Charlottesville, Virginia about a three-hour drive from where she'd picked her up and directly to the emergency department where she was then admitted to the inpatient psych unit, her first and only inpatient and/or any mental health treatment of her life.
So that was on the 9th of April. And about two days later, Lorna started calling saying she was feeling better, but you needed to recognize that now that she'd received mental health treatment, she was going to lose her license to practice medicine, and she would never be able to practice again. And we needed to be aware of that. And she continued on that very negative front for quite some time. She was convinced beyond any doubt that this was going to impact her ability to practice medicine.
And as two attorneys, we were telling her that this is 2020, and that doesn't happen anymore. That's not something that you could ever even worry about. We just need to get you better. And so, after about a 10-day stay in the inpatient psych unit, she was discharged. She was doing a lot better. And then tragically on the 26th of April, she died by suicide.
One of the things that happened right after she died by suicide was there was a significant amount of publicity. And in fact, over the family's objection, a major New York newspaper published her cause of death. And we really didn't want anyone to know about this. Really there were two real reasons for that. The first was that we were convinced that COVID had impacted her brain. And at that point, there was only very little information coming out about the impact of COVID on hospitalized COVID patients.
And we were convinced that something had happened here because we'd just seen her. We were literally just with her, and she was great. I mean, she's running an emergency department. She was working on the installation of an electronic medical record. She was getting her MBA. She was at the top of her game. And then this person that we saw was not the same, but then even more to the point, we were just overcome with the stigma of suicide. Like so many, we were ill-prepared for it. And then on the other side, we just didn't want to talk about it, but we were not given that choice.
And so, 12 hours after she died, this was front-page news. And what I would share with you as I kind of wrap up this answer is that it was really because of the response from the medical community to her death, that we began looking at how we could make an impact through a foundation or otherwise on this issue. For me, I'd spent over 20 years in healthcare both in a legal capacity, as well as an executive capacity looking out for, or thinking I was looking out for, our physicians and our advanced practice professionals.
But I really did not have any appreciation for just how challenging life was, if you will, or life continues to be for many in the healthcare field. So that's Lorna, an amazing physician, on top of her game, lost tragically and in a highly preventable set of circumstances.
Sacopulos: How many physicians kill themself each year?
Feist: After Lorna died, we learned some staggering statistics on death by suicide in the medical community, both doctors and nurses. We learned that twice the national average physicians are dying by suicide as well as nurses. From a doctor's perspective, it's roughly 350 to 400 that died by suicide each year prior to the pandemic, a number that we were completely blown away from, especially when you think about how many doctors are in a medical school class. That's losing multiple medical school classes every single year. We also learned about National Physician Suicide Awareness Day, which we didn't even know was a day, September 17th. And so, we started working with the founders of NPSA Day to create a new website called NPSAday.org, which has lots of suicide prevention resources, but it continues to be a significant issue for the medical community.
Sacopulos: You helped create the Dr. Lorna Breen Heroes Foundation. Can you tell us about the foundation?
Feist: Absolutely. So, as I said, after she died, we were in shock, and we just wanted to draw the shades and grieve. But what happened was just, I would say, this remarkable outpouring, not just of support, which you would think to some degree when something like this happens, but also, I would categorize it as a cry for help. And so many examples from doctors themselves, nurses, family members, and friends who just said, "This has got to change."
And so, in June of 2020, only a handful of months after Lorna died, Jennifer and I created the tax-exempt organization called the Dr. Lorna Breen Heroes Foundation, which is at drlornabreen.org. And we did that without really knowing exactly what areas of focus we would even begin with. We just knew we needed to step into this arena.
Our areas of focus have really found themselves into three main buckets. The first is awareness. We've done an incredible amount of speaking and writing and public appearances. We've reached over 150 million people with that awareness. In addition, we've heard from dozens and dozens of doctors and nurses who've said, "Hey, this helped me recognize in myself that I needed to do something different." It's also speaking with lots of hospital administrators. They've certainly come to understand the connection between the work and the worker if you will. And the impact that the work really has on the workforce.
In addition to that, we've spent a lot of time advancing solutions, launching an initiative called ALL IN: WellBeing First for Healthcare with a whole cohort of major associations that span the healthcare community, like the AMA, the American College of Emergency Physicians, like the American Hospital Association, the American Nursing Foundation. And the list goes on and on, the Schwartz Center for Compassionate Care. All of these organizations coming together to try to advance best practice solutions across the healthcare community.
And then finally we have been doing quite a bit of advocacy work both at the federal, state, and local levels because there are so many layers to this onion from a policy perspective. We absolutely need to step into that arena. We're invited to as well by our United States Senator Tim Kane when he reached out to us shortly after Lorna died. So, it's been less than two years since we started. And we have tried to make an immediate and long-term impact on these issues for the betterment of the healthcare workforce.
Sacopulos: I've read that Lorna worked to get eight hours of sleep a night, at times prioritizing sleep ahead of social activities. And I bring this up because, like mental health, sleep is often not treated as it should be by physicians. Every healthcare provider knows how important sleep and mental health are, but the healthcare system systematically devalues both, it seems to me, at least as far as their employees. It's a "Do as I say, not as I do," situation. Why do you think that is?
Feist: First of all, the training of the healthcare workforce is incredibly intensive in order to observe what is going on comprehensively with the patient. Residents and medical students are up all night. I mean, patients don't fit nicely, especially in-patients, between the nine and five working hours. So, I think it starts early in the career and it's an expectation that that's what you do. And you put others in front of yourself your whole life.
I mean, I've heard so many examples about how physicians in particular have put off self-care for whatever reason. Worked through illness, worked through morning sickness, stepping out into hallways, and getting sick with morning sickness while rounding patients and chewing some gum to try to make it look like all as well. I think it's a cultural statement, and it's also what has been just a traditional part of the training.
What I often reflect upon is that the workweek for residents was capped at 80 hours in the early 2000s and remember when that was going in. What I've often wondered is whether some magical thing happens when you transition from a resident to an attending physician that all of a sudden you can work over 80 hours a week and not have the impact negatively on yourself and potentially your patients? That the concerns that are applicable, the concerns that gave rise to that 80-hour workweek.
Obviously, being a little sarcastic in that statement. It's not really sensical. It's certainly not sustainable. And I think part of what we've seen over the last 10, 15 years is really an evolution toward physicians coming out of training and asking for a different lifestyle. And now that I've spoken again with thousands and thousands across the country, I certainly would say that medical students and residents have a different expectation as to how their work-life balance is going to be as they come out into the profession. But I think a lot of it is cultural. It's related to training, and I think we've got to find alternative ways to take care of our healthcare workforce so they can do their best job taking care of patients.
Sacopulos: Is physician burnout in part a result of physicians becoming employees instead of the traditional status of owners of their practice?
Feist: Prior to the pandemic, I think one of the seminal articles, and it's on our website, it was championed by Harvard School of Public Health, really looked at these issues of the root cause. And I would say the two that stand out most are administrative burden. So really electronic medical records and then the loss of control and the commensurate compensation models that kind of came with that productivity. And so certainly a contributor to it.
When I look at the most recent Medscape survey data that came out on January 21st, 2022, the number one by far reason for burnout continues to be the administrative burden on the workforce. And then kind of following that is this lack of respect from administration, colleagues, peers, that sort of thing, which in that second bucket is likely in that loss of control. I know I'm preaching to the choir here if you will. It's got to be incredibly challenging to work in an environment where you're just trying to do your best every single day. And you are relying on someone else who may not even understand what you're trying to do or even be aligned with your goals to achieve it.
And I know it leads to things, not just like burnout, but also moral injury where physicians feel like they are doing less than they are trained to do and want to do for their patients because of some external circumstance that is not in their direct control. And certainly, in this wave of mergers and consolidations of health systems and medical groups across the country, the employment of doctors has not helped the burnout. I know it's been a catalyst for it.
Sacopulos: Let’s talk about some good news. The Dr. Lorna Breen Health Care Provider Protection Act. Tell me, what does the act do?
Feist: Absolutely. And I've just got to say we are beyond honored to have this law named after Lorna. This law, let's be very clear, is for all of the healthcare workforce: doctors, nurses, and other healthcare trainees. We are also just incredibly fortunate to have created this first-of-its-kind law with a bipartisan bicameral group of senators and members of the House of Representatives. Now signed into law on March 18th, which was unbelievable, in the Oval Office.
This is a piece of legislation that provides for $140 million in new programs, and I'll bucket the legislation into four categories. The first two are very similar, so they are grants for programs I'll generally categorize as lookout for the wellbeing of the workforce and medical trainees, whether those be doctors or nurses, occupational therapists, or physical therapists, you go down the list.
The second category is grants for hospitals and health systems to look out for the current workforce. Those two grant programs have actually already been allocated by HRSA. On January 20th, the day before that Medscape survey, HRSA announced workforce grants and those healthcare workforce grants are coming from our new law. Our law hadn't been passed yet, so it didn't get the name Dr. Lorna Breen grants just yet, but it will in the future. That's exactly what it was. So, 46 institutions across the country receive those... Actually 103 million of the 140.
So, the third area is a nationwide awareness campaign targeted at institutions as well as individuals to help them understand how to support the healthcare workforce, whether that be through programmatic changes in the operations of a hospital or wellbeing programs to look out for mental health and other components. It's really two prongs. And its important people understand that because it's very clear that these issues, as we've just discussed, are not just about making the canary stronger, using the canary in the coal mine analogy. We really need to redesign this coal mine. And so, this nationwide awareness campaign is intended to do that.
Finally, a root cause study, which I think is going to be very important. You might say, why do I even need to study this? We know the answers. Well, one of the things that's really important about it in speaking with members of Congress is this formal study will give us a guide to further enhance the Lorna Breen Act. We know that the Lorna Breen Act is a starting point. You got to start somewhere. And so, we want this to be the foundation of more evolution, if you will, to healthcare workforce wellbeing-focused legislation. We can expand on the Lorna Breen Act. It'll be the Lorna Breen Act 2.0, 3.0, et cetera. But that study will give us a roadmap.
We have received an overwhelmingly positive amount of feedback from the healthcare workforce since the president signed the bill on the 18th of March, as well as some ideas about other areas to focus on. And we've already kind of begun all that work. So, it's an amazing thing to do. Most federal laws, new federal laws, take anywhere between five and 20 years to come to fruition if they ever do. We did ours in about 18 months. It was pretty amazing.
Sacopulos: Well, absolutely no doubt that you scored a major victory with the enactment of the Lorna Breen Health Care Provider Protection Act. And certainly, congratulations there. So, you started to allude to this, but what's next?
Feist: Well, from a policy perspective, what's next is to help the Centers for Disease Control with this national awareness campaign. Make sure that the awareness campaign includes both administrative changes or operational changes at a hospital or health system level, as well as supports that need to be put in place that provide a series of supports, not just formal mental health counseling, but peer support programs and others. As I also referenced participating in this study and making sure that this study really evolves into further iterations of the Lorna Breen Act will be huge. And then working right now with states to evaluate their questions in their applications for licensure and re-licensure as well as hospitals.
Now, let me digress for a second on that, because in that same Medscape survey, when 13,000 doctors across this country were asked, "Why aren't you getting help for either burnout or a mental health condition?" The first answer was, "I don't need to get help. I'm okay by myself." But the second, the third, and the fourth answers were all around these, what I call, structural barriers to accessing mental healthcare. Reporting to licensing boards. Remember that's what Lorna had articulated to us very clearly.
Although I'm quick to point out Lorna was incorrect about it. New York state has some of the best questions in the country in terms of licensure because they don't ask questions about prior mental health. And so, one of the questions that we've asked ourselves is, why didn't Lorna know that? She worked in New York her entire life. It wasn't new to her, but this concept of state licensure and the impact of mental health on your ability to practice medicine is huge. And I think it's so widely held. It's often incorrect. So, we've got to make sure that we're looking at the states where things are good already and letting the workforce know that they're fine. And then those that, there are about 30 of them, that need to be tweaked and working to prioritize changes at the local levels in the state licensing boards.
In addition to that, at the same time, we've got to work on credentialing questions, because they've got the same impact, but there are over 6,000 hospitals in this country. And we need each one to just take a quick look at their bylaws and their questions in their medical staff application and say, what do these questions look like? And how do we avoid violating the ADA, and how do we change them? And then, again, how do we let the workforce know what we've done for them?
Sacopulos: Corey, as you know, the audience of SoundPractice is primarily physician leaders and healthcare executives. How can members of this community support the Heroes Foundation?
Feist: Well, thank you so much for that. And I want to just pause for a second and let them know that we are thinking of them as well. We understand that everyone is burnt out. They can go to our website. There are two really important things to take action right now. The first is through the Take Action section at drlornabreen.org, certainly can make a donation to our work, which would be incredibly beneficial to us. We have made a great start and we want to be able to sustain it.
The second is in that same Take Action section, there's an opportunity for you to log in and send a quick note to your state licensing board, to say, "We need you to take a look at your questions." And then finally, I would say, look at our initiative around ALL IN: WellBeing First for Healthcare. These are free resources that you have at your disposal, including this thing we're calling the WellBeing 5, which is a data proven, if you will, series of five things that every hospital in this country can and should be doing immediately to support the wellbeing of the workforce.
I'll point out quickly that four of the five are operational in nature. Only one is really related to peer support programs and going beyond an employee assistance program. What I would say is if we could get monetary support, support with regard to licensing boards and credentialing at the local hospital level. And then finally joining us in the ALL IN initiative, that's my wish list.
Sacopulos: Our time’s just about up, but I wanted to end not with another question, but with a word of thanks. You've made the practice of medicine better for physicians across the country, and that's certainly no small feat. Well done, sir. Thank you very much.
Feist: I'm humbled. I'm humbled to be sitting here with you and hearing that. So, thank you so much. And I want to, I guess, make one last shout out to all of those who have been working so tirelessly for all of us in the healthcare workforce. The Dr. Lorna Breen Heroes Foundation is here to support all of our healthcare workforces. And so, thank you so much.
Sacopulos: We'll let that be the last word. My guest has been Corey Feist, co-founder of the Dr. Lorna Breen Heroes Foundation. Thank you so much for being on SoundPractice.