SafeHaven Program Confidentially Supports Physician Mental Health

John Whyte, MD, MPH; Teresa W. Babineau, MD; J. Corey Feist, JD, MBA

Disclosures

March 03, 2021

Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

  • During the pandemic, frontline medical workers have experienced both burnout and repetitive trauma, which may lead to harmful long-term effects. Hospitals and health systems need to implement programs that support the well-being of their workforce.

  • Changes needed include starting conversations about well-being early in medical training, working on teams with fellow healthcare professionals who can provide needed support, and modeling behavior from the top down in a hospital.

  • The SafeHaven program, run by the Medical Society of Virginia, allows physicians and physician assistants to seek support for burnout and mental health issues without the fear of undue repercussions on their medical license.

  • The mission of the Dr Lorna Breen Heroes' Foundation is to reduce burnout of healthcare professionals and safeguard their well-being and job satisfaction. Dr Breen made national news after she died by suicide in April 2020 after caring for COVID-19 patients in overwhelmed emergency rooms at the height of the pandemic in New York City.

  • Pre-pandemic, there were more than 400 physician suicide deaths each year in the United States.

This transcript has been edited for clarity.

John Whyte, MD, MPH: Welcome, everyone. I'm Dr John Whyte, chief medical officer at WebMD, and you're watching Coronavirus in Context. We've been talking a lot about burnout. We know that burnout was a problem pre-COVID, and Medscape recently put out a report about how widespread burnout is. But we also have to address solutions and innovative ways to provide care and get people the help that they need.

To help provide some insights, I've asked Dr Teresa Babineau, an associate professor of family medicine, and J. Corey Feist, CEO of the UVA Physicians Group at the University of Virginia Health, to join me. Thank you both.

J. Corey Feist, JD, MBA: Thank you for having us.

Teresa W. Babineau, MD: Thank you, John.

Whyte: I want to start off with something that you both have talked about. Terri, is this idea that for too long, suffering burnout, PTSD, and challenges with wellness has been a secret? The medical community has made it such, partly because of our training. Is it really not getting any better?

Babineau: I think it is starting to get better; even in the beginnings of medical school, we are starting to speak about these kinds of issues. People who go into medicine to become healthcare providers tend to be very other-centered. Because of that, everything that they are doing is centered on another person. That is starting to change as we are starting to discuss these kinds of issues and are also bringing more and more humanism into medicine.

Whyte: Is it more acceptable now to say you need help?

Babineau: It's getting there. It's still very difficult. When you go through the rigors of medical education and you spend 20 hours out of a day studying — and it's a very competitive thing, and it's very difficult to get a residency — you become kind of in a competitive realm. Because of that, you don't want to show any chink in the armor. But it's starting to change. As we become more team-centered, it's also starting to change because you're relying on other members of your team.

Whyte: Corey, you've talked about this concept of repetitive trauma. September 11, 2001, was a horrible event. For many people in the ER and hospital settings, it was a single point in time. You pointed out that the pandemic is like running into a burning building every single day for over a year. Talk to us about how that impacts the physicians that you're working with.

Feist: It's a great question. We've got two things happening in this country right now. We've certainly got burnout, and we have this second repetitive trauma. What I hear from the front lines (from all healthcare providers, physicians, and nurses) across Virginia and the country right now is that they are very tired. They are also taking on the burden of being the proxy for the families of the dead and dying. They're seeing a volume of death and dying that they have not seen before.

These individuals were humans before they received the accolade "hero" recently. Because of that, I think we need to recognize the traumatic toll that this is taking and bring resources to bear to support those individuals. Many times the symptoms or the manifestations of the trauma don't really come out until further down the line. Even though our COVID numbers and our vaccine numbers are looking better, the manifestations and the harm of this trauma are going to be long-lasting. And hospitals and health systems need to come together to support the well-being of their workforce. This is going to be an important component of that work.

Whyte: You've been a proponent of saying we need to change the conversation. So I'll ask you both: How do we change the conversation?

Babineau: I think that's a spectacular question because it's going to take a long time. One of the ways that we change the conversation is we make the conversation necessary and important. And we start from the very beginning. So even before, when we're admitting students into healthcare provider and professional schools, we start discussing how important the humanness that they bring to that is, and it needs to stay that way. It really has to be that we have to understand that, indeed, they are human. They are going to mess things up occasionally. (It is rare.) The heart that these folks bring to taking care of others is huge, but sometimes there are going to be mistakes. Sometimes you're going to have to wait a little bit in order to get a result, or in order to have that conversation that you might need, while still expecting the best from healthcare providers.

The way that can be done is by banding into teams. We rely on each other. We use the expertise that each individual provider brings, be they a nurse, a nursing assistant who's there at the bedside all the time, a physician, specialists, or subspecialists. Today was a perfect example. I got an email from a subspecialist who worked with four other physicians in the care of one particular patient, so they didn't feel like they were out there on their own. Those are some of the ways that we can start to change things, and then the law is another way.

Feist: If I could add to that, John, I think there are a couple of important additions. First of all, like any change or behavior-change initiative that starts by modeling behavior, that behavior has to be modeled from the top down and the bottom up, across all healthcare organizations. That's a behavior change; it doesn't cost this country a nickel to do that. That's just about checking in on each other and making sure that people recognize that their well-being is important not just to the hospital executives who are responsible for bringing resources, but to each other as peers and colleagues.

I would say that from a long-term perspective, we want to start these conversations as early as possible. I've now been asked to have speaking engagements with students as early as high school who are considering going pre-med, and then at colleges for pre-med students. We have to recognize that to normalize this conversation, first we have to have it, but we have to have it early and often.

Whyte: Clinicians will say they're concerned about their personal health, but they're concerned about their professional reputation and their ability to work. The aspects of licensure will often ask them questions such that they're concerned that if they seek help, they'll be penalized. So, Terri, I want to ask you about a program called SafeHaven. You're the volunteer chief medical officer of that program. Tell our audience what SafeHaven does.

Babineau: SafeHaven is an innovative program that adds to other programs that are available in many healthcare workplaces. SafeHaven began with a change in the law in the state of Virginia that now is being replicated in multiple other states. With that change, the Medical Society of Virginia advocated (and it was signed into law last year) that if a physician recognizes that they need not only mental health care but some coaching — maybe they need a little bit of help in how to more effectively see patients, or time constraints that they are found under —they can seek that help without any retribution to themselves.

The one caveat is if the physician is deemed to be either a threat to themselves or to a patient; then those protections are no longer in evidence, and the normal way that those kinds of things are reported to the board of medicine happen. For instance, if a physician, especially in the midst of the COVID pandemic, finds that they are really under so much pressure (eg, they have young children at home, can't see their patients fast enough, or have older parents that they're concerned about bringing the disease home to) and they feel that they have no one to reach out to, it used to be that many physicians and physician assistants felt that if they did [reach out], they would end up harming their license or losing their ability to earn a living as a physician. For most of them, the biggest thing was that they would lose the ability to see patients.

If you go into a program such as SafeHaven, which is run by the Medical Society of Virginia, you no longer need to have that concern. Those things cannot be found by your employer. In addition, it is a program that is run outside of your workplace, so that if you have those concerns about your workplace bringing some kind of action against you, you don't need to have that concern any longer.

Whyte: As you said, it's being duplicated in other states around the country. Corey, what have you found has been the response to the SafeHaven program?

Feist: There's been great support for this. If you start from the perspective of the stigma associated with getting mental health support, it's pervasive and there are many layers to it; the licensure is one of those. Credentialing and privileging applications, medical malpractice forms, insurance credentialing forms — there are so many layers across the healthcare industry. This is an excellent starting point, and the physicians and others are very supportive.

But there's a degree of trepidation because this has been so reinforced. As a medical society and a healthcare community, we need to launch a significant education campaign as to what is real and what is not. The hardest part about this work is that every state is different; whereas a physician may be working in a state that has favorable laws today, they may think about going to a different state tomorrow, which has less favorable laws. That may still be an impediment to getting help, so we really need to make this change and offer programs like SafeHaven across the country.

I was speaking with the American Medical Association just this morning, and they were talking about this program as a model that they're trying to help replicate. It's a great program, and it's one that we need to scale and advertise so that we can help make a long-lasting impact.

Whyte: Corey, you're also the co-founder of a foundation, the Dr Lorna Breen Heroes' Foundation, in honor of your sister-in-law. Can you share with us her story?

Feist: Sure. Dr Lorna Breen was an incredible academic physician at NewYork-Presbyterian Hospital and lived her whole life for the dream of being an emergency room doctor in New York. She studied at Cornell as an undergrad, got her medical degree from the Medical College of Virginia, did her training at Long Island Jewish Hospital, was double-boarded in emergency medicine and internal medicine, and was the medical director for Allen Hospital in the northern part of Manhattan for over a decade. Lorna was at the pinnacle of her career. In her last year, she was going back to get her MBA from Cornell's MBA/MS program in healthcare administration. And she was at the top of her game.

She was an amazing sister, family member, sister-in-law, the crazy aunt to eight nieces and nephews. Last year, she made national news because of her death. In a very short period of time, Lorna contracted COVID while treating patients in Manhattan and continued to serve in her role as a medical director remotely while trying to recover at the height of the pandemic in March. She went back to the workforce as soon as she was afebrile for about 48 hours and was so overwhelmed with the death and dying, coupled with 12- to 24-hour shifts day in and day out, that she became suicidal, which is just baffling for a human who had never had one scintilla of mental health history.

So, my wife, Jennifer, after receiving a call from Lorna after she'd been back on service about 4 or 5 days, got Lorna out of New York City and got her an inpatient admission to the University of Virginia, where she spent about 11 days. Tragically, she took her own life about 5 days after that.

The conversation that we're having is in part inspired by her real desire to take care of the well-being of her colleagues. She was published on well-being and well-being in emergency room operations just over a year ago, in November 2019. She cared deeply about her colleagues as much as she did about her patients. We believe that this is an extension of her work, to take this well-being conversation to the national scope as well as every single state, trying to change the laws.

There were three big contributors to her death. The first was contracting COVID. The second was the trauma associated with seeing the death and dying and not being able to do anything about it. The third was the stigma about asking for help. Then finally getting formal help was literally the nail in the coffin. It's a tragic ending to a really unfortunate story.

I would just end by saying that my wife, Jennifer, and I are doing this work not for one individual here. We're doing this as an extension of Lorna's caring for her healthcare community, and our caring, so that we can prevent future similar cases to Lorna's.

Tragically, we know that the number of suicides by physicians in this country before the pandemic was more than one physician a day, 400 a year. And so we're going to do everything in our power to make that number zero by sharing this story, sharing best practices, and working with Dr Terri and others to shine a light on this issue and make change.

Whyte: It is tragic, and I'm sorry for your loss. I want to thank you for sharing your sister-in-law's story. Terri, are you optimistic that we're going to get to where we need to be? We've had bumps all along the road. Where can people go for help right now?

Babineau: Well, I really am optimistic. There are multiple wonderful programs that healthcare entities have. The University of Virginia — I'm privileged to work with theirs as well as with the Medical Society of Virginia — is phenomenal. As we start to change the culture, I think more providers will find their way to those places and gain that trust.

I'm also optimistic because of what people like Corey and Jennifer are doing and talking about. It used to be that we would try to hide from the tragedy of Lorna's life. That's just horrible because her life was not a tragedy. Her life was just an incredible gift. As we start to change that and discuss this openly, I am optimistic. I honestly believe that we become better physicians because then we can accept where our patients are, and they find us to be more approachable. As a physician, you have that fine line of sharing yourself. Our ability to listen to their stories and to understand — I think that will make us better.

As Dr William Osler said, "If you want to know the diagnosis, ask the patient." In this particular case, I really think that is true. If you want to know the diagnosis, ask the doctor. However, we have to make it so that the doctor thinks that they can share that.

Whyte: Well, it's hard to argue with Osler. With that, I want to thank you both for sharing your insights, for sharing your own stories, and working to change that conversation around burnout and trauma. Thank you both.

Feist: Thank you for having me, John.

Babineau: Thank you so much for opening the conversation as well.

Whyte: If you have questions about burnout or anything COVID related, send us a note. You can email me at drjohn@webmd.net, as well as post on our social media properties. Thanks for watching.

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