Physician, Heal Thyself (Without Losing Your License)

Episode Transcript
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Speaker 2 (00:12):
the Lorna Breen Foundation was founded after the
death of Lorna Breen in April2020, and Lorna was an ER doc.
She was the chair of herdepartment and, like many, she
was called back.
Actually, she was on vacationto care for patients in the
first wave.
She took care of her communityand not just her community, but

(00:34):
her team, working 16, 18 hourdays, day after day.
She was exhausted and she gotCOVID.
She came back 24 hours after.
She was fever free, like manypeople did, and it all caught up
to her to the point where shewas emotionally, intellectually
and physically exhausted.
Her family called on herfriends from medical school and

(00:56):
residency to drive her down toVirginia, which is where she
grew up, and it was then thatshe had her first ever mental
health care.
She was admitted for three daysto get her bearings, get some
care, and when she wasdischarged to her family, she
expressed to them that now thatshe had received this care, she
was worried she was going tolose her license, her hospital

(01:18):
credentialing and the respect ofher colleague, and Lorna died
by suicide on April 26, 2020.
The next day, the New York Timespublished an article about her
colleague, and Lorna died bysuicide on April 26, 2020.
The next day, the New YorkTimes published an article about
her death, and her familyreceived first dozens, and then
hundreds, and ultimatelythousands of messages from

(01:39):
healthcare workers around thecountry, in the ER, out of the
ER, saying Lorna's not alone.
This is a problem for all of us.
We're all worried about whetherit's safe to get care, and this
is a problem that didn't startwith the pandemic.
This is a problem that's beengoing on for decades and we need
some change.
So my name is Stephanie Simmonsand I hail from Ann Arbor,
michigan.
Hail is chosen really mindfully.

(02:00):
There.
I am the chief medical officerfor the Dr Lorna Brain Heroes
Foundation and I am also an EMdoc.
So Lorna's sister andbrother-in-law, jennifer and
Corey Feist, started thefoundation to help eliminate
barriers to mental health accessand also to help improve work

(02:21):
environments for healthcareworkers.

Speaker 3 (02:23):
So, stephanie, tell us about the organization, how
big you are, what's the scope ofwork that you're doing?

Speaker 2 (02:28):
So we are national and we are small but mighty, so
we have under 10 employees.
We work in three verticals.
The first is advocacy at thefederal and state level.
We help to get the first everlaw specifically looking after
the mental health of the healthcare workforce the Dr Lorna
Breen Health Care ProviderProtection Act passed.

(02:49):
It's in reauthorization rightnow and we're working on getting
the reauthorization passed.

Speaker 3 (02:55):
So let me read you what that act is.
This is HR 1667, and it waspassed in 2022.
And this bill establishesgrants and requires other
activities to improve mentalhealth and behavioral health
amongst health care providers.
Specifically, the Department ofHealth and Human Services must
award grants to hospitals,medical professional
associations and other healthcare entities to improve

(03:16):
programs to promote mentalhealth and resiliency among
health care providers.
In addition, hhs may awardgrants for relevant medical and
behavioral training for healthcare students, residents or
professionals.
So you get the idea.

Speaker 2 (03:31):
We also work at the state level on licensing and
credentialing laws, priorauthorization, workplace
violence prevention and reallyanything where we feel it
benefits the mental health ofthe health care workforce.
The second vertical is inadvanced collaboration.
There are a lot oforganizations who have a stake

(03:51):
in the well-being of thehealthcare workforce, but
they're doing a lot of theirwork in a siloed way.
So we have All In Well-BeingFirst for Healthcare, which is
over 30 organizations that cometogether to share their work and
also advise us on what we do.
That includes the AMA, the ANA,the AHA, asap, ena, ihi,

(04:13):
schwartz Center forCompassionate Care, google
Health, feminem.
So these folks have beenmeeting every week to two weeks
for five years to try to advancethe work of removing barriers
to mental health care andpromoting healthy work
environments.
We also have an ambassador group, which is 300 strong health

(04:35):
care workers, family members whoare survivors of suicide,
health care leaders and mentalhealth professionals who help
carry this work forward.
And we have a medical studentcoalition and they are spreading
across the country and this isabout awareness and also getting
resource to those students.
The third vertical and I thinkwhere we're really making some

(04:56):
important impact is inaccelerating solutions.
This is removing stigmatizingand invasive language around
mental health care fromlicensing and credentialing
applications across the country,and last weekend I was at the
Federation of State MedicalBoard meetings recognizing 35
state medical boards that haveremoved these questions from
their licensing applications.

Speaker 3 (05:18):
So, for those of you that may not be aware, when you
apply for a job, you often haveto state whether you've had a
mental health issue, whetheryou've been admitted, whether
you've sought care, and itreally puts a dampener, a real
dampener, on clinicians going toget care for their mental
health, because it's not clearwhat happens with that

(05:39):
information.
Is that a ding against you?
And in the past there was a lotof stigma against saying yes to
any of these things.
So, frankly, people just didn'tdisclose and, worst of all,
worst of all, people didn't getcare.

Speaker 2 (05:51):
And we do this work with medical licensing, but also
nursing, pharmacy and dentistry.
We're doing this withcredentialing at individual
hospitals and health systems andwe've been able to recognize
over 600 hospitals where we canverify that they've removed
these questions from theirapplication, their repeat
application and their peerreference forms.

(06:13):
We're also working on a statebasis to do this work as a
cohort and then do leadereducation and form learning
communities between the healthsystems in the state to tackle a
workplace environment issue.
In our first state, virginia,they chose EHR optimization and
we're working with the HIMSS,the health informaticists in the

(06:34):
state, to make sure that workis thorough and has longevity.
We've added North Carolina, newJersey and Wisconsin since we
started and we're also workingwith a locum tenants company
called Jackson Cooker.

Speaker 3 (06:50):
So, Stephanie, give us a little bit of color about
why are people so reticent todisclose?
Is this concern that it's goingto affect their income,
basically that they are notgoing to get a job?

Speaker 2 (07:02):
Yeah, it's an economic decision for a lot of
people, and you've justdedicated 12 years of your life
at half a million dollars ofstudent debt and you're making a
decision about whether it'ssafe to get care.
We don't ask the same questionabout potentially impairing
medical conditions and, to makematters worse, we ask the
question right after have youever committed a felony and are

(07:24):
you a pedophile, right?
And so really there's threeways to fix this.
One is you just don't ask.
In my household we call this anunya question, like it's nunya
business.

Speaker 3 (07:39):
I will immediately immediately be adding that to my
lexicon.

Speaker 2 (07:43):
The second way is to ask are you impaired for any
reason right now?
And the third way is to say hey, we know you're a human being.
Things can happen.
Can you positively attest thatyou're going to take care of
yourself and any issues thatarise?
So those three options are allacceptable and what we've done

(08:06):
is we've said make the change,let us know, and then we're
going to trust, but verify.
So send us your applications.
We'll review them and oncewe've seen that they are
consistent with best practices,we will give you a badge to
serve as a visible sign to thehealthcare workforce that you're

(08:27):
not going to be asked thesequestions here.

Speaker 3 (08:28):
So my understanding is that all of the medical
boards are independent the statemedical boards and so are you
having to go state by state bystate to get some of these
changes made.

Speaker 2 (08:38):
Yes, the medical boards are state regulated, so
there hasn't been a federalsolution to this.
We're going state by state.
The good news is news is thatthe Federation of State Medical
Boards and the Federation ofState PHPs have been doing this
work since the 20 teens, and sowhen we started the work, there
were already 19 state medicalboards that had made the change.

(09:00):
Now there's 35.
And we are committed to beingcompletionist on this, so that
people don't have to worry aboutthis with their state license.
And we are also working withhospital and health systems,
with professional liabilityinsurers and with payers, so
that in any of the credentialingapplications that healthcare
workers have to fill out to dotheir job, they're also not

(09:23):
getting asked this question.

Speaker 3 (09:25):
So let me state it a bit more clearly.
So your state medical boardmight ask you this every few
years as you get sort ofrecertified and you have to pay
them lots of money to keep yourmedical license.
But also when you go to ahospital to apply for a job,
they might ask you thesequestions.
And so what do you do if you'restill in a place where these
questions are being asked?
What do you suggest we do,Stephanie?

Speaker 2 (09:46):
So what I would recommend that people do, if
they are applying for a job at asystem that's still asked with
their credentialing, is have aprepared statement about what
their mental health diagnosisand treatment has been and a
judgment that they are notcurrently impaired, so that they
are going in and don't have tothink like on the fly.

(10:09):
How am I going to answer thisquestion?
Because it is part of thecredentialing application.
Now that's increasinglychanging and our goal is that
this removed from credentialingapplications as well as
licensing.
At some states, this has beendone via legislation and is in
statute.
So we have 35 state medicalboards that have made this

(10:31):
change and because it's changingall the time as we add more
states, we have a map, and so onour website and I can give you
the link for the show notes wehave a map for medical licensing
, nurse licensing, dental andpharmacy licensing, and then we
also have a map of the statesand you can click on your state

(10:54):
and see which hospitals havealso changed their credentialing
applications.
So part of the reason why thesequestions have been so harmful
is that people assume the worstin the absence of information
about what actually happens Ifyou are not impaired by your
mental health condition and youseek care, you can explain that
as part of your licensingapplication and it is likely not

(11:18):
going to cause any problems foryou.
If you do have a concern forimpairment, like an impairing
condition, the state physicianhealth program or professional
health program for PAs, NPs,nurses can provide an
alternative to discipline way toget treatment where you have
some insulation from the medicalboard and some privacy.

(11:40):
Now there's a set of bestpractice about how that
relationship works, but it's alittle different state by state.
So the Federation of State PHPshas been working to get those
best practices out to the statesand I would encourage someone
first, if they think they needhelp, to get help.
Second, to educate themselvesabout what the rules are in

(12:03):
their state so they know whatthe likely procedure is going to
be.

Speaker 3 (12:10):
So in the past, one of the workarounds that we were
always told and many of us didwas if you need to get health
care mental health care do itoff the books, do it in cash,
don't use your insurance.
Do this workaround ask theprovider not to report.
Is that still a thing that issuggested or is done in these
places where you still have toreport?

Speaker 2 (12:30):
I think that there have been people throughout the
decades that have done exactlythat or have gotten care, paid
cash, used a pseudonym, donetelemed, used an email address
that they create for thatpurpose, and if that's truly the
only way that you feel thatyou're safe to get care, you

(12:51):
know I would want people to getcare more than anything else and
that I would encourage them toactually speak with their
physician, speak with theircounselor and their therapist
about how to address that whenthey do the licensing and
credentialing, because part ofthe stigma is in between our
ears, right, it's.

(13:13):
What does it mean about me thatI'm this competent, tough ER
doc, right?
Or trauma surgeon orpediatrician who needs help, and
so we need to work to get overthe stigma that's internal, and
then we can help our colleaguesget over the stigma that's

(13:34):
external and in the meantime, wecan be advocates to change the
institutional stigma that thesequestions represent.

Speaker 3 (13:42):
So specifically about insurance, then if you use
insurance for your mental health, is that reportable to the
state medical board or somestate medical boards?

Speaker 2 (13:52):
There's a record and a paper trail and that could be
discoverable, and so there are alot of different options for
healthcare workers who want toget help.
Options for healthcare workerswho want to get help First of
all, I always encourage peopleto think about the level of help
that they want or need, and alot of people start with peer
support or with coaching, whichare not formal mental health

(14:17):
care and don't need to bereported.
Next, you can think about someof the anonymous care resources
that are out there.
Now we've been compiling theseas part of our All In for Mental
Health campaign and again I cangive you the link for the show
notes.
But some of the best ones thatI've found are the Emotional PPE

(14:41):
Project, which will get you toa healthcare worker for mental
health in your state who'sculturally competent to care for
healthcare workers and who willprovide free care that's
anonymous.
There's also the physiciansupport line, which is
psychiatrists, who offer thatfree, anonymous support.

(15:05):
Asap also has really greatwellness resource and I
encourage people to look at thatwebsite under the wellness
resources and take advantage ofthose.
So we've compiled thesetogether on this All In for
Mental Health website and wewant people to visit this, learn
about the rules right, learnabout how the PHP works and also

(15:29):
have access to these anonymousresources that will stay off of
your insurance.
And you know, mel, this isn'tjust about life and death, right
, there's a lot of healthcareworkers who are out there who
are suffering and carrying a lotof pain, and I liken it to like
this big backpack that we allwear on our backs and it's like

(15:51):
you have a bad case and youthrow it in your backpack.
Right, and this is the copingmechanism that we learn it's
compartmentalize and move on.
You got to see the next patient, but if you never unpack that
backpack, you're going to end upon your back like a turtle with
your arms and legs in the air,incapacitated by that pain and

(16:13):
suffering, and that might meandepression, that might mean
anxiety, ptsd.
It also just might mean thatyou are not thriving in your
life and your relationships inthe way that you could.

Speaker 3 (16:27):
I love this message.
We need to move past this lifeand death decision making about
whether we're going to get careand also talk about we just need
to be happier in our work ifwe're going to do it a long time
, because the world needs us todo this work.
Now, my bias has always beenthat I believe every single ER,
doc and nurse should be in careand that should be systematized.

(16:48):
It should be at the residencylevel, it should be at the
nursing school level.
Everybody should get it,because if everybody gets it,
there goes the stigma.

Speaker 2 (16:56):
There are some training programs that have
opt-out therapy for theirtrainees.
As an employer, we are not atthe point yet where employers
say this is going to be opt-outin the medical profession.
I think it's a great idea.
I don't think that there's asingle healthcare worker who

(17:17):
would not benefit from some ofthe tools of cognitive
behavioral therapy, who wouldnot benefit from coaching and
sort of having that externalvoice to help us as a thinking
partner but also call us outwhen we start to spiral a little
bit and think that the wholeworld operates on the rules of

(17:38):
the emergency department,including what you're going to
experience with relationshipsand in daily life.
I think it's a great idea.
And one way to de-stigmatizethe question on licensing and
credentialing applications is ifeveryone's answering yes.

Speaker 3 (17:54):
So is this getting better?
Are we making some progresshere?
Are you making progress here?

Speaker 2 (17:59):
Well, mel, if you had asked me five years ago if I
was going to be in the office oflegislators or talking to
regulators at a state levelabout how to change licensing,
or talking to the CEO of ahealth system about how they
need to change their policies orprocedures, I would have told
you no way, and what I'velearned in the last five years

(18:23):
is that physicians have a uniquevoice and a unique ability to
get this stuff changed, and sowhat I would encourage everyone
listening as a clinician is thatyou not only have a unique
ability to care for yourself andyour colleagues, but to make
change in the whole countryabout how this works.

(18:45):
You can lead the credentialingwork at your organization, and
we have had a medical student dothis in their organization.
We have had multiple singleattendings and we've had
multiple sort of chief of staffmed staff leaders take this on
all by themselves.
So, first and foremost, I'dwant them to know that you can
have a thriving, rich life, andthat all of us need to have the

(19:10):
help and the tools to do thatwith the work that we do.

Speaker 3 (19:15):
So right now, how can we help the Lorna Breen
Foundation?

Speaker 2 (19:19):
Well, we are working on getting the Dr Lorna Breen
Healthcare Provider ProtectionAct reauthorized and we're using
a grassroots, grass topsapproach, and so the foundation,
through our all-in coalition,is doing a lot of legislative
visits, but we also have alegislative call to action tool.

(19:41):
I'd love to include that in theshow notes for MRAP and
encourage all of your listenersto write their representative.
Asap has been key to movingthis forward and has been a
proponent of the legislation,and there's also a lot of ways

(20:01):
that the foundation gets infront of healthcare workers and
talks about mental health.
So the pit has really driven anational conversation around
mental health with healthcareworkers.

Speaker 3 (20:18):
And I want to express my gratitude, and those
messages have been passed on tothe incredible people that put
together that amazing show.
So what's the longer term goalof the foundation?
Where do you see it going inthe next five or 10 years?

Speaker 2 (20:26):
We've got time and we're not going anywhere.
We are working with the stateslongitudinally over three to
five years, because we know thatculture change doesn't happen
overnight and we really want tosee things get better for
healthcare workers.
We also, as I said andsometimes I joke as an ER doc,

(20:49):
we're not always known for beingcompletionist on things.
As an ER doc, we're not alwaysknown for being completionist on
things, but we're committed tobeing completionist on the
licensing work and we want everydoctor, nurse, pharmacist and
dentist to know that they're notgoing to be asked this question
on their licensing.

(21:10):
You know the Department ofJustice has actually weighed in
and say that it violates the ADA, so there's no reason why all
of these licensing applicationsshouldn't be changed.

Speaker 3 (21:21):
And, as we wrap up here, what's your source of
funding and is there someopportunities to help here as
well?

Speaker 2 (21:26):
It's a great question .
A lot of people think that theDr Lorna Breen Healthcare
Provider Protection Act fundsthe Dr Lorna Breen Heroes
Foundation, and it does not.
So we are fullyphilanthropically funded and we
have a mix of earned income,like the work that we do with
our states, and we have a mix ofsort of directed philanthropy

(21:49):
to the foundation.
This comes from institutions,it comes from individuals, and
so we do rely on philanthropicsupport to do this work.
We do not charge anything forthe licensing and credentialing
work that we do, and we nevercharge a healthcare worker for
access to our resources.
So we would also love supportand I could certainly include

(22:15):
the donation link in ourmaterials that I sent to you,
because that's an important wayto move the work forward.

Speaker 3 (22:21):
And we have all of those links in the show notes,
thanks to Stephanie Simmons.
Thank you to the Lauren BreenFoundation.
This is really important work.
These are good people trying tochange the way we disclose so
that we can stop being worriedabout the stigma and the
ramifications and get the helpthat everybody in this
profession needs.
Thank you, stephanie, and yourteam.

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