May 2, 2025 • 41 mins
Comment on the Show by Sending Mark a Text Message.
Beneath the pristine white coats and confident demeanors of hospital physicians lies a growing mental health crisis that threatens not only the wellbeing of doctors but potentially the care we all receive. Drawing from alarming 2024 survey data showing that 6 in 10 physicians experience burnout and over half know colleagues who have contemplated suicide, this episode exposes the dangerous reality of physician mental health in hospital settings.
When physicians reach their breaking point and seek support, many hospital employers respond not with compassion but with discrimination. Through examination of real cases, including physicians being told to "take your baggage elsewhere" or facing termination after requesting accommodations, we uncover a disturbing pattern of hospitals prioritizing profit over the mental wellbeing of their most valuable assets.
The episode delves into the powerful stigma that prevents physicians from seeking help - with nearly 8 in 10 acknowledging this barrier exists within medicine. We explore how the relentless demands of 24-hour shifts, sleep deprivation, and emotional exhaustion create perfect conditions for mental health deterioration, while fear of professional consequences keeps doctors suffering in silence.
Beyond identifying the problem, we discuss practical solutions for hospitals and physicians alike, emphasizing the legal protections available under the Americans with Disabilities Act and similar state laws. The message becomes clear: physicians are employees with rights, deserving of reasonable accommodations and compassionate support.
This conversation matters not just for healthcare professionals but for every patient who expects quality care. After all, wouldn't you want to know that the physician treating you is working in an environment that supports their mental health rather than pushing them to the brink? Listen now to understand this hidden crisis and what can be done to address it.
Association for Academic Surgery: Removing the Mask with Dr. Carrie Cunningham speech
2024 The Physicians Foundation Survey
National Suicide Prevention Lifeline
If you enjoyed this episode of the Employee Survival Guide please like us on Facebook, Twitter and LinkedIn. We would really appreciate if you could leave a review of this podcast on your favorite podcast player such as Apple Podcasts. Leaving a review will inform other listeners you found the content on this podcast is important in the area of employment law in the United States.
For more information, please contact our employment attorneys at Carey & Associates, P.C. at 203-255-4150, www.capclaw.com.
Disclaimer: For educational use only, not intended to be legal advice.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Hey, it's Mark and welcome back to another edition
of the Employee Survival Guide.
I want to address a veryimportant topic today that's
captured my attention and shouldprobably capture yours, because
it's a very significant issue.
The title of the podcastepisode is for lack of better
(00:24):
phrasing is Physician, mentalHealth and Hospital Employers.
How do I get topics like thisto come into my stratosphere?
It's because I have cases thatI'm dealing with, or dealing
with a current one now,involving a physician in a very
reputable hospital in theNortheast, and so I put out a
(00:48):
previous episode, most recentone of Dr Cunningham and that
started me down that rabbit hole.
Very powerful episode.
I used the AI device to do itto kind of make it clean.
I can't really control thesubject matter as well as I can
by doing it this way with youand talking with you.
(01:10):
That's why I chose to do itthis way.
Generally, I leave the AIdevice to do cases, legal cases.
Specifically Dr Cunningham ifyou didn't listen to her speech
on YouTube, I would ask you togo do that.
It's a very powerful speech.
It's about 45 minutes long, butit addresses her travels
(01:33):
through mental health a verydifficult conversation, or at
least a discussion she gave at aconference and I encourage you
to look at it.
But this episode I wanted to dosomething that addresses the
physician in the hospitalsetting and attack an issue that
(01:54):
really no one really wants totalk about, and that issue is
the mental health of physiciansworking in hospitals.
This is kind of your synopsisfor this episode.
Is, you know, working in thegrind of?
You know, whatever they do,24-hour shifts, whatever that is
, it's insane.
I mean I personally couldn'twork those hours.
(02:15):
And the level that the doctorsare pushing themselves, but also
the hospital employers arepushing on the physicians to
work to the wee hours and24-hour shifts, I mean I don't
know how people are functioningand whether they're getting care
.
That's even appropriate givenhow fatigued they are, but
(02:41):
nonetheless, that's the topicI'm hitting on.
So it's hospital employers andphysicians who are highly
competent but are being putunder an intense amount of
pressure, even though they'repaid well or even though the
hospital systems aredramatically changing and
through mergers and acquisitions, that whole atmosphere is
(03:01):
changing, but nonetheless,doctors and mental health it's
quite a serious issue.
I mean, doctors are employeesand so hence why I'm talking
about it.
It's not the first time I'veseen this before in clients.
So here we go.
If you ever spent time in anemergency room or a surgical
unit which I have in bothinstances you presume your
(03:25):
physicians are providing youwith the best medical care they
can muster.
There is this innate sense thatthe person in the white lab
coat is going to take care ofwhatever is wrong with you,
including the nurses.
So shout out to the nurses,because they're really the
caregivers.
But what if the physicianhimself or herself is overworked
(03:46):
, under extreme pressures,experiencing emotional
exhaustion, they're sleep,deprived from a 24-hour shift,
and are extremely depressed anddiagnosed with depression?
You may react that you want adifferent doctor working on you
If you knew that they weresuffering from these conditions.
(04:06):
But you wouldn't know thatbecause HIPAA prevents that
disclosure and the doctor is notgoing to tell you hey, by the
way, I'm having a really bad day.
But remember, physicians arehuman beings too and they also
experience the same everydaydepression and anxiety and other
forms of mental illness that weall do from time to time
(04:27):
periodic, episodic orsituational or chemical
disorders.
In 2024, a survey was conductedby the Physicians Foundation, a
not-for-profit involvingphysicians and residents and
medical students focusing onwell-being.
(04:47):
The survey found some prettyalarming data.
I think the sample size is1,700 people and I'm not citing
everything from the survey, butI'll put it in the show notes
for you as well so you can readit.
But here are the notables Forthe fourth year in a row, 6 in
(05:09):
10 physicians often havefeelings of burnout, compared to
4 in 10 before the pandemic in2018.
More than half of physiciansand medical students and nearly
half of all residents know aphysician or colleague or peer
respectively, who has everconsidered, attempted or died by
(05:29):
suicide.
That's pretty alarming.
18% of residents, 22% ofstudents and 12% of physicians
know a colleague peer who hasconsidered suicide in the last
12 months.
Again, that's a pretty highnumber.
It is well documented thatphysicians face high rates of
(05:50):
burnout, stress, mental healthchallenges, which can increase
the risk of suicide, and thefactors that lead to that
include a high workload and timepressure by the hospital.
Emotional exhaustion, againcaused by the hospital.
Emotional exhaustion, againcaused by the hospital and also
the patient care they're dealingwith and think like a pandemic
(06:12):
outbreak 2019, 20, whatever andyou're on the front lines of
something and death issurrounding you.
That could be an emotionalexhaustion, medical errors and
fear of litigation so that'slawyers and malpractice cases.
Sleep deprivation because thehospital is causing a 24-hour
(06:32):
work shift.
Impaired relationships becauseof you're always working Again.
Hospitals putting you on thosedeadline or those time
commitments.
Access to lethal means Doctorshave access to medication that
can be lethal.
Now the last one reluctance toseek help due to a stigma or
(06:57):
fear of professionalrepercussions.
Licensing issues I'll get intothat further now.
There's a real stigma amongstphysicians for seeking medical
health care.
According to the same surveyfrom the Physicians Foundation,
for the third year in a row,nearly eight in ten physicians
agree that there is a stigmasurrounding mental health and
(07:18):
seeking mental health care amongphysicians.
I mean eight in ten.
That's a lot.
Approximately half ofphysicians said they know a
physician who said they wouldnot seek mental health care Half
that's a big problem.
And four in 10 physicians wereafraid or knew another physician
(07:40):
who was fearful of seekingmental health care.
Given questions asked inmedical licensure and
credentialing insuranceapplications, I mean because
these applications ask have youever been diagnosed with a
mental health ailment?
And you have to report that youdid or you didn't.
Stigma is an impediment toreporting or seeking health when
(08:06):
you're reaching that point,when, as a physician, you're
working around the clock and youare just maybe you're
self-medicating.
You have a substance usedisorder, as Dr Cunningham did
in her speech that she admittedshe had one for her I think it
was alcohol.
(08:26):
Others I've read up on they'vehad people who are like
anesthesiologists and haveaccess to medications.
All doctors have access tomedications and you can create
these substance use disorderstoo so that they're
self-medicating just to copewith what they're going through.
Again, you know, cope with whatthey're going through as
(08:49):
related to work and working inthe hospital setting can be very
intense and extreme.
And the stigma of reportingbecause you know the doctors,
you know they are, you knowthey're experts at covering up
their emotions from everyone.
They have this self-expectantpersonification that you should
(09:13):
be just stoic in terms of yourbehavior and, god forbid, you
suffer from a mental healthissue that you don't want to
report it.
What if you report it?
That license can be revoked.
I mean the early stories werepeople were getting their
license revoked by the statesbecause of mental health
disorders and I just did someresearch today on the Westlaw
(09:38):
legal database and searching oldcases and people were in fact
their licensing was revokedbecause of mental health
infirmities, I mean severe ones,but I'm not talking about the
severe cases where the person isunable to perform their
essential functions of their job.
I'm talking about physicians whoare highly competent,
(10:02):
well-regarded, pedigreed, workedat fine institutions, fellows,
research fellows, et cetera, topof their game, and they
themselves are reporting totheir employers.
They're having problems, need abreak, and so what do employers
do about it?
Hospitals are employers, whatdo they do?
(10:22):
How do they react to it?
What do employers do about it?
Hospitals or employers, what dothey do?
How do they react to it?
So what captured my attentionwas well, why do employers ask
of physicians, with the wake ofall this knowledge They've known
, the physician suicide issuehas been increasing.
We did hear about it through thepress during the pandemic.
(10:44):
It's not an old thing, it's notsomething, it's not new to them
.
I mean, so shouldn't they be?
You know, if they're a hospitalsetting, you know, address the
issue.
Ironically, they don't.
And I have a current case I'mworking on where the employer
(11:06):
did the exact worst casescenario, worst decision, you
know, bundle, or just made amistake in terms of their
decision making.
I'll get to that in a second,without disclosing the case, but
I'll disclose the facts, butit's the insanity of that
culture of driving these doctorsto work this insane hours,
(11:27):
shifts, et cetera, under intensepressures, without sleep
whatever.
Just why does that exist?
Is it a profit motive?
You're always having the doctorworking the floor and around
the clock and they're billing,billing, billing.
Is that a money greed issue?
Why does the culture exist?
I went deeper into the rabbithole on that one and you should
(11:50):
know this.
Historically, this is a truestory.
There's a doctor, uh, I thinkthe midwest, um, we're talking
back in the 1930s, etc.
Uh, he would uh basically usecocaine just to keep him alert
and awake, to work theseround-the-clock shifts and then
told his students and otherresidents to do the same just to
(12:16):
keep up with.
Of where the insanity, cultureof the place, of employment, of
the hospital and requiring thephysicians to work these insane
hours and causing them to burnout.
But it's part of the culture.
They control it.
I think it is profit motive.
(12:37):
At this juncture, squeeze everydollar, dime, et cetera out of
the time that the doctor spendson the floor.
So we're aware of that, we knowit exists in our culture.
We know hospitals.
You know, obviously, if it's anemergency room, you're there to
treat people.
I've been there.
I mean you want them there, butyou want them there to be, you
(13:01):
know, on their A game and had agood night's sleep, but you want
them there to be on their Agame and had a good night's
sleep.
So what attracted my attentionis this is an employer, hospital
setting, and somebody is aphysician and they're an
employee.
And physicians are employeesjust like everyone else.
They have employment rightsagainst discrimination based on
(13:22):
perceived and real disabilities,including mental health
disabilities such as depression,which can lead to suicide.
People have suicide ideation,meaning they're thinking about
it.
Their employers, typicallyhospitals, are required to treat
(13:44):
them fairly in andiscriminatory manner.
Hospitals are required toprovide reasonable
accommodations to physicianswhen physicians reach out to
their managers andadministrators that they're
experiencing burnout, fatigueand mental nervous conditions,
including suicidal ideation.
Physicians with mental nervousconditions such as depression
should not be disregarded.
Conditions such as depressionshould not be disregarded,
(14:08):
discriminated against oridentified as having
quote-unquote baggage.
That's a quote from an actual,real, current case.
The administrator, whenconfronted by the physician,
said to the administrator, tothe physician, you know, take
your baggage elsewhere.
I mean literally told her toget another job somewhere else,
(14:28):
when the doctor was saying ohshit, I'm having a lot of
problems at work and I'vereached my breaking point.
These are physicians who areyou know, they've been educated
in psychology to some degree, Iimagine in medical school, and
they're running this crazy workenvironment so they must be
(14:48):
aware of these issues.
I mean, if a suicide happenedon hospital time let's say the
physician committed suicidewhile working that would be a
lawsuit, a negligence claim bythe hospital.
It wouldn't be a working copclaim, it would be a lawsuit
against the hospital for theirown negligence to allow it to
happen.
So when you refer to somebodyas having baggage, well how does
(15:15):
that make you feel?
Let's say you're the physicianand the administrator and
supervisor says take yourbaggage elsewhere, get another
job and then I'll layer it onfor you.
The the hospital, a prominentEast Coast teaching hospital,
well-regarded and awell-regarded faculty member,
(15:38):
identified herself as having amental nervous condition and
needed a reasonableaccommodation in the form of
less work and a differentschedule.
I did some research today.
That was a very commonaccommodation that was asked for
by physicians in the samecircumstance in other reported
legal cases, which I'll get toin a second.
So less work and a differentschedule to allow them to what
(16:01):
have a better work-life balance,because they're just like us.
I mean, everybody wants abetter work-life balance.
You can't work all the time,it's insane.
But yet that's what attractedmy attention to the hospital
setting, that culture and thedemands put upon physicians to
do that.
So the administrator did notrenew the physician's contract
(16:21):
in this example I'm speaking of.
So told the person you know,take care of your baggage and do
it elsewhere and go get anotherjob somewhere else and didn't
renew the contract.
And this person was on contractand been affiliated for quite
some time.
So obviously there's adiscrimination case there.
The quote baggage comment iswhat we call direct evidence
(16:43):
made by a supervisor.
Pretty hard to escape it.
It'll get to a jury trial onthat basis alone.
The failure to accommodateaspect because the doctor was
asking for accommodations thattoo, you know, gets it to a jury
.
You don't want to.
What is a jury?
If you're in a jury, you heardthis type of dialogue happening
when somebody's pleading, whenthey're at the.
(17:05):
You know the breaking point, thebottom you know.
When they refer to people ashaving their lowest point,
they're bottoming out.
What happens when you commitsuicide.
Well, you bottom out.
And when you're contemplatingor having suicidal ideation
which is the DSM-5 psychiatrybook on how you label something
(17:27):
you're bottoming out.
You're bottoming out.
You know any rational, saneperson is going to say whoa,
let's sit down.
What do you need?
Express compassion, empathy, doall the normal things to take
care of, like if you were takingcare of a family member.
(17:47):
But that didn't happen here andthat's a very common experience
that physicians areexperiencing.
So think about when I saidstigma.
If they report this worst casescenario I just described it,
they get shickhand and theircontract doesn't get renewed.
Is that the type of help thatthe physician who is having
(18:07):
suicidal ideation is expectingto hear?
And that's the last thing theyever wanted to hear.
But that happened.
So it attracted my attention toaddress the issue.
The elephant in the room thesebig employer hospitals pushing
these physicians into the brinkof despair for their greed I
(18:29):
don't know, it's corporate moneyat this juncture, the
physicians, the supervisors, theadministrators are paid a lot
of money, but it's part of alarge corporate environment now,
but yet they're still pushingthese physicians to.
They're breaking their backsmentally and this is how they
react to it and they say goelsewhere because you've got
(18:51):
baggage, for Christ's sake.
I mean, everybody has baggage,so that's a real example.
I wanted to weave into theepisode and attack the issue,
because this is not how youhandle the issue.
Physician suicide is real and itis increasing, as evidence of
(19:11):
the 2024 Physician Foundationsurvey.
It's not going away.
There have been numerousstories in the press of
physician suicides that are justshocking.
These are highly functioning,well-regarded members of the
medical profession who suffer insilence Again, think about that
stigma and they do not seekassistance and eventually, as
(19:36):
you see the data from the survey, they take their own lives.
Here's one example.
It occurred in the New YorkTimes back in 2020.
Dr Lorna Bream, age 49, theformer medical director of the
emergency department at New YorkPresbyterian Allen Hospital,
died by suicide in 2020.
Dr Breen did not have a historyof mental illness but who had
(20:02):
worked in the frontline trenchesof the COVID-19 outbreak in New
York City and witnessed manyCOVID-related deaths.
Her colleagues were shockedabout her death.
Colleagues were shocked abouther death.
Dr Cunningham, in the priorepisode of the podcast you can
hear about.
I guess you would call her asuccess story that she survived
(20:24):
it, and even the applause at theend of the speech, the standing
ovation she received.
She started a speech saying I'mgoing to interrupt in,
tragically, my career by givingthis speech, but she was well
received in terms of her beingtransparent and vulnerable in
(20:51):
expressing what happened to herand, by the way, she was
motivated by a good, dear friendof hers who was younger, also a
physician, who did in factcommit suicide, and she does
actually call that out in thespeech.
Again, listen to the speech.
It's very heartfelt.
So I went deeper into the rabbithole in this issue and I began
(21:13):
looking for cases againsthospitals brought by physicians
who had mental illness, and Ididn't find much.
I had to search very, very hardto locate what I did find.
I'll give you examples of themI wanted to bring out.
Is there a pattern or theme andthen talk about what should be
done in each circumstance?
Pattern or theme and then talkabout what should be done in
(21:34):
each circumstance, because thereshould be something done to
take care of physicians beforeit ever reaches the point where
they're brink and they'rebottoming out.
Hospitals should do somethingtoo, and they are.
I'm not saying that they're not.
But let me get into one ofthese cases.
(21:58):
John Lindsay sued OSF HealthcareSystems in the Southern
District of Illinois, I think.
This lawsuit was filed July 3rd2019 against his employer
alleging disabilitydiscrimination for his mental
health disabilities under theAmericans Disabilities Act.
Dr Lindsay was diagnosed withdepression and anxiety and made
his employer aware of hisdisabilities.
He requested accommodations,including adjustments to his
(22:18):
patient's schedule Remember Itold you that was a pattern.
He also asked for a medicalassistant to be assigned, but
the employer never engaged inany conversation about the
accommodations being requested.
That's called a failure toengage in the interactive
process.
That's a big blunder on theemployer's part.
The failure of theaccommodations requested
(22:42):
exacerbated Dr Lindsay'ssymptoms.
However, the employerterminated his employment,
citing alleged performanceissues happening many years
earlier.
That's again another pattern ofnonsense crap that employers do
.
They go back in time, which isbasically worthless, because in
(23:03):
this case, dr Lindsay, hisperformance was always rated
satisfactory.
That's an admission by anemployer, by the way, you've
heard me say that before,including the patient treatment.
So all things were good,satisfactory in terms of the
performance.
So the employer really didn'thave a defense.
I deep dive even further intothe docket, as you know, I do
(23:24):
because I was curious and thecase was reported settled July
25th 2019.
That was less than a monthafter it was filed.
Why do you think that is?
I read the complaint.
First count was about a breachof contract, about what a breach
of contract is, and then thesecond count was a violation of
the ADA, and I read through it.
(23:46):
It wasn't my style of writingon complaint.
It was more I don't knowformulaic lawyers, but kind of
boring.
There was no pizzazz and dramato it, but the mere fact that
the case settled less than amonth after it was filed.
It was removed, meaning it wasin state court first for a
period of time.
I didn't check the actual date,but it only survived in federal
(24:07):
court for less than a month.
It means the employer settledthe case, did not want that, you
know whatever that storyline toget out further about.
Osf healthcare systems wasconcerned about their reputation
, I'm sure.
But here there was Dr Lindsaywho said I need an accommodation
, I have a disability ordisabilities plural.
And what did the employer do?
(24:29):
The employer didn't do anythingand fired him.
That was like the worst thingyou should do, and so maybe
there was a decision there forthe.
They'll just get rid of thisbad egg, fire him and then
settle it, and then maybe that'swhat they decided to do.
We don't know the amount thesecases are and the settlements
are confidential, so we don'tknow.
So, doctor having a disabilitydepression, you know, coming to
(24:52):
his brink of his bottom, he'sbottoming out and he's asking
for accommodations and theydidn't give it to him and his
symptoms get exacerbated.
And you know what happens.
You know, there's the doctor inthe white lab coat but he's
having problems and taking careof patients, but the patients
he's taking care of them.
So he's still operating, he'sstill functioning at a very high
level and patients are beingtaken care of, but he himself is
(25:16):
suffering and the employeedidn't do shit to handle that.
That's the point.
They work them in this crazycultural environments of the
hospital and they don't takecare of the very people who are
making them money.
Physicians, they're bread andbutter.
I actually would say the nursesare bread and butter, but we
(25:40):
all know.
But it's a small little tidbitexample.
I had to search for that.
It was very hard to find thatcase.
Here's another case I found DrMark Ryden versus Essentia
Health.
This case, out of Minnesota,alleges his employer knew about
his worsening depression but didnot provide any reasonable
accommodation and wrongfullyterminated him because of his
mental illness.
Dr Ryan allegedly proposed areasonable accommodation plan to
(26:01):
catch up on backlog work thathe had missed, but his
accommodations were denied.
Again a similar patternaccommodations being denied.
The Minnesota's Department ofHuman Rights found probable
cause for disability,discrimination in that case and
a failure to accommodate andalso retaliation.
(26:23):
I deep dive further.
I was, you know that was at thestate agency level.
So I said well, let's see ifthere's a state or a federal
court filing here so I can readthe facts in the complaint and
give you more facts.
I researched the federal andstate courts and found no
further litigation as the casewas never publicly filed in a
court and most likely it'ssettled.
(26:43):
I had found that case by some Idon't know hospital reporting
type of newsletter or whateverreporting type of newsletter or
whatever, but regardless, hardto find cases like what I was
speaking about, much like thephysician who was told to take
her baggage elsewhere.
And what does that mean?
It means that you know, ifdoctors are having a fear of a
(27:10):
stigma being attached to them ofmental illness, they're not
going to report.
So it's not surprising that I'mnot finding legal cases out
there that are being reported infederal and state courts.
It doesn't mean the issuedoesn't exist.
It's just that there's a stigmaand there's a fear of reporting
.
So I did find two cases atleast.
(27:32):
Again, it was very specific.
I was looking for a hospitalsetting physicians with mental
health conditions,accommodations, termination,
that type of thing but no casesI found talked about the
rigorous 24-hour schedules.
These doctors are working undersleep deprivation.
Nothing really addressing thatissue.
So what I'm doing is trying tobring to light this is a very
(27:53):
real concern in the hospitalsetting, the very place that
when I recently went there foran issue I had, you want people
to take care of you.
You expect the 100% care anddoctors and nurses say they're
going to give it to you.
But if the doctor is havingconcerns because of being
(28:14):
overworked, that's concerning.
Are you going to give me thatcare?
Do you have to work thosedoctors that much?
I mean the physician suicideissue is really, I guess, the
end point of the decisions beingmade by the business, the
hospital, to make money to thenth degree by causing people to
(28:34):
feel like you know, burnout.
There's no escape other thancommitting suicide.
I mean that's the insanity,what I'm trying to poke at with
like a big long stick Well shortin this instance because I'm
inviting the hospitals to reactto it, if they can, inviting
people to react to it becauseit's a big issue that no one
(28:55):
really talks about.
It's the employment setting.
It's like the I guess it'sprobably the worst case scenario
setting where you're aphysician, you're highly
competent I mean, you have likeIvy League degrees behind you
and you are well accomplishedand you know you're facing this
and you have no choice otherthan reaching out to like an
(29:16):
employment lawyer or apsychologist or your
psychiatrist to cope and dealwith this issue.
Because, clearly, in theinstance of the baggage comment,
the hospital is not addressingyour issue.
They don't care.
I mean, it's as just basic asthat.
They do not care, they turn theblind eye to your personal
(29:39):
situation and that's why I'mtrying to call attention to it.
What should the employer reallydo when faced with someone
who's expressing a mentalnervous condition scenario,
burnout, wanting accommodations?
Here's what the solution is.
It's actually silly, stupid,because you would think that
employers would do this.
(29:59):
Hospitals would do this.
If a doctor is asking for areduction in the workload,
reduce the workload for a periodof time.
Have a conversation.
First, engage in theinteractive process, have a
discussion, document things,explore things, brainstorm
something.
This is your person who'smaking you money, the physician
(30:20):
and you want to make sure thatyour physician is well taken
care of physically, physicalhealth, mental health,
physically, physical health,mental health.
So if someone, a physician,asks for accommodations, you
know if I was the administratorI'd be saying, well, what do you
need, how can we accommodateyou?
(30:40):
And let's take care of this?
And you know what do you needand try to do everything you can
to avoid the issue of stigmathat the person, the physician,
already has in inside of themthe fear of disclosure.
But once they do disclose, youknow already has an insight of
the fear of disclosure.
But once they do disclose, youknow it's probably really bad.
If you're from theadministrator's standpoint, this
(31:02):
person's suffering and you wantto take care of this person
very carefully because they'revery fragile.
You know they're a physician,white lab coat.
Think about that again.
By the way, this is affectingmore female physicians than male
physicians, because there'sanother variable point of this
is that potentially femalephysicians are struggling even
(31:24):
to keep up with their malecounterparts in our today's
society, you know, because ofgender bias, and so they're
going to try even harder.
But they're also going to havemore fear fear of disclosure.
So when they do disclose,hospital administrator, you got
to be a real leader to take careof that moment, to take care of
(31:45):
that employee you have, andjust map out a game plan to get
that person the right care.
Put aside the issues of moneythat you're going to lose while
the person takes an absence.
They're an employee, they'vecome to you, they have a problem
.
So it's very simple you providereasonable accommodations by
(32:07):
having an interactive discussion.
You document everything, butyou're doing it in a way to make
it successful for the employeeto survive and continue working,
not to fire them.
That seems to be the defaultmechanism that all employers,
even hospitals, use, and I gaveyou two examples.
They just default screw it,you're out of here.
You got baggage, we don't wantyou, you're less than human.
(32:30):
We burned you out.
Next, please, because there'salways a next.
They believe these are highlypaid people.
They're paid $300,000, $400,000, $500,000 a year.
They're making the hospitalsexponential amounts of that.
So it's a weird scenario,culture-wise, that these
institutions and there areinstitutions, by the way and
(32:54):
they are making a ton of moneyoff the backs of physicians and
no one, no one is out thereproclaiming that these people
are victims of discrimination.
Until now, until I'm doing it,you know you may read about Dr
Bream in the New York Times andfeel sorry, and I am.
I feel sorry for what.
(33:15):
I don't know enough about whathappened to her.
Dr Cunningham, we know whathappened to her because she told
us.
She's telling us in her speech.
But something real is happeningin these institutions that
needs to be corrected.
That needs to be corrected.
The culture of physiciansworking has got to change and
maybe this discussion leads andI'm having through this podcast
(33:39):
episode leads somewhere.
These are real people.
They're employees.
They're working Under extremecircumstances.
Yes, they agreed to go tomedical school and they knew all
this was coming.
But listen, you don't take aprofession like to go into it to
eventually commit suicide.
That's not what they'reintending.
But the environment they'reworking in is very stressful.
(33:59):
We get that You're taking careof people who are sick, but you
would imagine there is even moreof a compulsion by the employer
to do the right thing andprovide the right cultural
environment to take care ofpeople when they self-report,
and that's what physicians doafter they get past the stigma,
fear, issue of disclosing thatthey have a mental illness.
(34:23):
So it attracted my attention.
I wanted to bring it to yourattention and it's not going to
be the last one I'm going to do,because it's a very serious
issue.
It's very systemic, obviouslyhappening in every hospital in
the country, I imagine, and fewdoctors are going to want to
call out.
(34:43):
But maybe we give themammunition and the courage to
call out and saying you knowwhat damn it.
The state and federal laws dofavor me here.
There's a requirement, and if Ilose my job over this, at least
I'll save my life.
And you know what comes firstlife or your job?
Well, obviously life.
(35:04):
And some doctors, you know theydo make the right choice,
choice even though they're goingto give up faculty progression
because they were, theircontract wasn't renewed.
They turn to lesser stresssituations.
That maybe and they work inlesser stress situations that
(35:25):
takes off the pressure offeeling like they're going to
end their life by suicide.
So life is first, job is second.
So the law is there to protectphysicians who are experiencing
depression and the laws arestate and federal.
The American Disability Act isthere.
(35:45):
If you're at a teachinginstitution like Yale.
There is the Rehabilitation Actif you're receiving federal
monies, which they do in otherinstitutions as well, and the
Rehabilitation Act and the ADAfunction very similarly.
I've read a case recently wherethere's Title III of the Rehab
(36:09):
Act or the ADA applied to thephysician in that circumstance A
very unusual case to read thatUsually it's Title I employment,
but these hospital systems arenow very complex.
There's individual practiceswhich have access privileges to
these hospitals.
It's a very complex worldenvironment that they're all
(36:31):
working in, but yet stillthere's an employer environment
that they're all working in, butyet still there's an employer
there that has to follow the law.
And even though it's complexdoesn't mean the law doesn't get
applied.
And so here the very simplicityof this is that reasonable
accommodations affect everybodywhen they're made and employers
have to respond to them, andthey have to respond to them in
the same manner.
(36:51):
It doesn't matter if it's ahospital setting or a private
business.
So we need to prevent I guessbottom line here is doctors from
working in environments thatproduce that outcome of
physicians feeling that there'sno way out and they have to just
commit suicide as a way out.
So it's a game changer andcalling attention to it.
(37:14):
And I have to remark onsomething that really bothered
me about this storyline, and itwas this fact, this not a fact,
but necessarily this momentumthing that happened.
There was a call to action formental health in the sports
arena, setting gymnasts,olympians and tennis players,
(37:38):
and it came to light and then itjust faded away.
Well, guess what happens?
Dr Cunningham says this.
She says in her speech there'sno number of Peloton rides that
will take care and solve myproblem of depression.
It's a disease and it's nevergoing away.
The point being it's nevergoing away.
So this awareness of mentalhealth and kind of social media
(38:02):
attention to it and the news,it's never going away.
But what bothered me is that Iknew when that thing came out,
that momentum of call intoaction, of taking awareness of
people with mental illness, itwas short-lived because our
society is 15 minutes and that'sit.
That's all attention we give tosomething we move on surgical,
(38:32):
whatever you know you're wantingto know I'm being taken care of
by the best there and thatemployer hospital is taking care
of those physicians in thewhite lab coats and you want to
rely upon that.
And if you knew that theyweren't, you'd be really pissed
and guess what folks?
It's really happening and thosephysicians as we now know by
the Physicians Foundation survey, this is a very big issue
(38:55):
happening and physicians areunder tremendous amount of
strain and they are thinkingabout suicide.
I guess that's the point andtakeaway of this and we need to
stop it.
And stopping it is tellingemployers they need to change
the dynamic of that worksituation permanently for a new
situation that physicians canwork in and not feel that they
(39:20):
have to bottom out, andemployers who should react in a
more compassionate manner.
I guess that's the final endpoint.
Again, I'll do another episodeat a later point on the same
subject matter, but I hope youenjoyed this subject.
It's rather intense, ratherscary, but it's real and it's
(39:41):
happening, and it's happeningtoday to physicians and so
they're great people.
They take care of us.
We want to try to take care ofthem.
Have a great week.
Hey, it's Mark and welcome back to another edition
of the Employee Survival Guide.
I want to address a veryimportant topic today that's
captured my attention and shouldprobably capture yours, because
it's a very significant issue.
The title of the podcastepisode is for lack of better
(00:24):
phrasing is Physician, mentalHealth and Hospital Employers.
How do I get topics like thisto come into my stratosphere?
It's because I have cases thatI'm dealing with, or dealing
with a current one now,involving a physician in a very
reputable hospital in theNortheast, and so I put out a
(00:48):
previous episode, most recentone of Dr Cunningham and that
started me down that rabbit hole.
Very powerful episode.
I used the AI device to do itto kind of make it clean.
I can't really control thesubject matter as well as I can
by doing it this way with youand talking with you.
(01:10):
That's why I chose to do itthis way.
Generally, I leave the AIdevice to do cases, legal cases.
Specifically Dr Cunningham ifyou didn't listen to her speech
on YouTube, I would ask you togo do that.
It's a very powerful speech.
It's about 45 minutes long, butit addresses her travels
(01:33):
through mental health a verydifficult conversation, or at
least a discussion she gave at aconference and I encourage you
to look at it.
But this episode I wanted to dosomething that addresses the
physician in the hospitalsetting and attack an issue that
(01:54):
really no one really wants totalk about, and that issue is
the mental health of physiciansworking in hospitals.
This is kind of your synopsisfor this episode.
Is, you know, working in thegrind of?
You know, whatever they do,24-hour shifts, whatever that is
, it's insane.
I mean I personally couldn'twork those hours.
(02:15):
And the level that the doctorsare pushing themselves, but also
the hospital employers arepushing on the physicians to
work to the wee hours and24-hour shifts, I mean I don't
know how people are functioningand whether they're getting care
.
That's even appropriate givenhow fatigued they are, but
(02:41):
nonetheless, that's the topicI'm hitting on.
So it's hospital employers andphysicians who are highly
competent but are being putunder an intense amount of
pressure, even though they'repaid well or even though the
hospital systems aredramatically changing and
through mergers and acquisitions, that whole atmosphere is
(03:01):
changing, but nonetheless,doctors and mental health it's
quite a serious issue.
I mean, doctors are employeesand so hence why I'm talking
about it.
It's not the first time I'veseen this before in clients.
So here we go.
If you ever spent time in anemergency room or a surgical
unit which I have in bothinstances you presume your
(03:25):
physicians are providing youwith the best medical care they
can muster.
There is this innate sense thatthe person in the white lab
coat is going to take care ofwhatever is wrong with you,
including the nurses.
So shout out to the nurses,because they're really the
caregivers.
But what if the physicianhimself or herself is overworked
(03:46):
, under extreme pressures,experiencing emotional
exhaustion, they're sleep,deprived from a 24-hour shift,
and are extremely depressed anddiagnosed with depression?
You may react that you want adifferent doctor working on you
If you knew that they weresuffering from these conditions.
(04:06):
But you wouldn't know thatbecause HIPAA prevents that
disclosure and the doctor is notgoing to tell you hey, by the
way, I'm having a really bad day.
But remember, physicians arehuman beings too and they also
experience the same everydaydepression and anxiety and other
forms of mental illness that weall do from time to time
(04:27):
periodic, episodic orsituational or chemical
disorders.
In 2024, a survey was conductedby the Physicians Foundation, a
not-for-profit involvingphysicians and residents and
medical students focusing onwell-being.
(04:47):
The survey found some prettyalarming data.
I think the sample size is1,700 people and I'm not citing
everything from the survey, butI'll put it in the show notes
for you as well so you can readit.
But here are the notables Forthe fourth year in a row, 6 in
(05:09):
10 physicians often havefeelings of burnout, compared to
4 in 10 before the pandemic in2018.
More than half of physiciansand medical students and nearly
half of all residents know aphysician or colleague or peer
respectively, who has everconsidered, attempted or died by
(05:29):
suicide.
That's pretty alarming.
18% of residents, 22% ofstudents and 12% of physicians
know a colleague peer who hasconsidered suicide in the last
12 months.
Again, that's a pretty highnumber.
It is well documented thatphysicians face high rates of
(05:50):
burnout, stress, mental healthchallenges, which can increase
the risk of suicide, and thefactors that lead to that
include a high workload and timepressure by the hospital.
Emotional exhaustion, againcaused by the hospital.
Emotional exhaustion, againcaused by the hospital and also
the patient care they're dealingwith and think like a pandemic
(06:12):
outbreak 2019, 20, whatever andyou're on the front lines of
something and death issurrounding you.
That could be an emotionalexhaustion, medical errors and
fear of litigation so that'slawyers and malpractice cases.
Sleep deprivation because thehospital is causing a 24-hour
(06:32):
work shift.
Impaired relationships becauseof you're always working Again.
Hospitals putting you on thosedeadline or those time
commitments.
Access to lethal means Doctorshave access to medication that
can be lethal.
Now the last one reluctance toseek help due to a stigma or
(06:57):
fear of professionalrepercussions.
Licensing issues I'll get intothat further now.
There's a real stigma amongstphysicians for seeking medical
health care.
According to the same surveyfrom the Physicians Foundation,
for the third year in a row,nearly eight in ten physicians
agree that there is a stigmasurrounding mental health and
(07:18):
seeking mental health care amongphysicians.
I mean eight in ten.
That's a lot.
Approximately half ofphysicians said they know a
physician who said they wouldnot seek mental health care Half
that's a big problem.
And four in 10 physicians wereafraid or knew another physician
(07:40):
who was fearful of seekingmental health care.
Given questions asked inmedical licensure and
credentialing insuranceapplications, I mean because
these applications ask have youever been diagnosed with a
mental health ailment?
And you have to report that youdid or you didn't.
Stigma is an impediment toreporting or seeking health when
(08:06):
you're reaching that point,when, as a physician, you're
working around the clock and youare just maybe you're
self-medicating.
You have a substance usedisorder, as Dr Cunningham did
in her speech that she admittedshe had one for her I think it
was alcohol.
(08:26):
Others I've read up on they'vehad people who are like
anesthesiologists and haveaccess to medications.
All doctors have access tomedications and you can create
these substance use disorderstoo so that they're
self-medicating just to copewith what they're going through.
Again, you know, cope with whatthey're going through as
(08:49):
related to work and working inthe hospital setting can be very
intense and extreme.
And the stigma of reportingbecause you know the doctors,
you know they are, you knowthey're experts at covering up
their emotions from everyone.
They have this self-expectantpersonification that you should
(09:13):
be just stoic in terms of yourbehavior and, god forbid, you
suffer from a mental healthissue that you don't want to
report it.
What if you report it?
That license can be revoked.
I mean the early stories werepeople were getting their
license revoked by the statesbecause of mental health
disorders and I just did someresearch today on the Westlaw
(09:38):
legal database and searching oldcases and people were in fact
their licensing was revokedbecause of mental health
infirmities, I mean severe ones,but I'm not talking about the
severe cases where the person isunable to perform their
essential functions of their job.
I'm talking about physicians whoare highly competent,
(10:02):
well-regarded, pedigreed, workedat fine institutions, fellows,
research fellows, et cetera, topof their game, and they
themselves are reporting totheir employers.
They're having problems, need abreak, and so what do employers
do about it?
Hospitals are employers, whatdo they do?
(10:22):
How do they react to it?
What do employers do about it?
Hospitals or employers, what dothey do?
How do they react to it?
So what captured my attentionwas well, why do employers ask
of physicians, with the wake ofall this knowledge They've known
, the physician suicide issuehas been increasing.
We did hear about it through thepress during the pandemic.
(10:44):
It's not an old thing, it's notsomething, it's not new to them
.
I mean, so shouldn't they be?
You know, if they're a hospitalsetting, you know, address the
issue.
Ironically, they don't.
And I have a current case I'mworking on where the employer
(11:06):
did the exact worst casescenario, worst decision, you
know, bundle, or just made amistake in terms of their
decision making.
I'll get to that in a second,without disclosing the case, but
I'll disclose the facts, butit's the insanity of that
culture of driving these doctorsto work this insane hours,
(11:27):
shifts, et cetera, under intensepressures, without sleep
whatever.
Just why does that exist?
Is it a profit motive?
You're always having the doctorworking the floor and around
the clock and they're billing,billing, billing.
Is that a money greed issue?
Why does the culture exist?
I went deeper into the rabbithole on that one and you should
(11:50):
know this.
Historically, this is a truestory.
There's a doctor, uh, I thinkthe midwest, um, we're talking
back in the 1930s, etc.
Uh, he would uh basically usecocaine just to keep him alert
and awake, to work theseround-the-clock shifts and then
told his students and otherresidents to do the same just to
(12:16):
keep up with.
Of where the insanity, cultureof the place, of employment, of
the hospital and requiring thephysicians to work these insane
hours and causing them to burnout.
But it's part of the culture.
They control it.
I think it is profit motive.
(12:37):
At this juncture, squeeze everydollar, dime, et cetera out of
the time that the doctor spendson the floor.
So we're aware of that, we knowit exists in our culture.
We know hospitals.
You know, obviously, if it's anemergency room, you're there to
treat people.
I've been there.
I mean you want them there, butyou want them there to be, you
(13:01):
know, on their A game and had agood night's sleep, but you want
them there to be on their Agame and had a good night's
sleep.
So what attracted my attentionis this is an employer, hospital
setting, and somebody is aphysician and they're an
employee.
And physicians are employeesjust like everyone else.
They have employment rightsagainst discrimination based on
(13:22):
perceived and real disabilities,including mental health
disabilities such as depression,which can lead to suicide.
People have suicide ideation,meaning they're thinking about
it.
Their employers, typicallyhospitals, are required to treat
(13:44):
them fairly in andiscriminatory manner.
Hospitals are required toprovide reasonable
accommodations to physicianswhen physicians reach out to
their managers andadministrators that they're
experiencing burnout, fatigueand mental nervous conditions,
including suicidal ideation.
Physicians with mental nervousconditions such as depression
should not be disregarded.
Conditions such as depressionshould not be disregarded,
(14:08):
discriminated against oridentified as having
quote-unquote baggage.
That's a quote from an actual,real, current case.
The administrator, whenconfronted by the physician,
said to the administrator, tothe physician, you know, take
your baggage elsewhere.
I mean literally told her toget another job somewhere else,
(14:28):
when the doctor was saying ohshit, I'm having a lot of
problems at work and I'vereached my breaking point.
These are physicians who areyou know, they've been educated
in psychology to some degree, Iimagine in medical school, and
they're running this crazy workenvironment so they must be
(14:48):
aware of these issues.
I mean, if a suicide happenedon hospital time let's say the
physician committed suicidewhile working that would be a
lawsuit, a negligence claim bythe hospital.
It wouldn't be a working copclaim, it would be a lawsuit
against the hospital for theirown negligence to allow it to
happen.
So when you refer to somebodyas having baggage, well how does
(15:15):
that make you feel?
Let's say you're the physicianand the administrator and
supervisor says take yourbaggage elsewhere, get another
job and then I'll layer it onfor you.
The the hospital, a prominentEast Coast teaching hospital,
well-regarded and awell-regarded faculty member,
(15:38):
identified herself as having amental nervous condition and
needed a reasonableaccommodation in the form of
less work and a differentschedule.
I did some research today.
That was a very commonaccommodation that was asked for
by physicians in the samecircumstance in other reported
legal cases, which I'll get toin a second.
So less work and a differentschedule to allow them to what
(16:01):
have a better work-life balance,because they're just like us.
I mean, everybody wants abetter work-life balance.
You can't work all the time,it's insane.
But yet that's what attractedmy attention to the hospital
setting, that culture and thedemands put upon physicians to
do that.
So the administrator did notrenew the physician's contract
(16:21):
in this example I'm speaking of.
So told the person you know,take care of your baggage and do
it elsewhere and go get anotherjob somewhere else and didn't
renew the contract.
And this person was on contractand been affiliated for quite
some time.
So obviously there's adiscrimination case there.
The quote baggage comment iswhat we call direct evidence
(16:43):
made by a supervisor.
Pretty hard to escape it.
It'll get to a jury trial onthat basis alone.
The failure to accommodateaspect because the doctor was
asking for accommodations thattoo, you know, gets it to a jury
.
You don't want to.
What is a jury?
If you're in a jury, you heardthis type of dialogue happening
when somebody's pleading, whenthey're at the.
(17:05):
You know the breaking point, thebottom you know.
When they refer to people ashaving their lowest point,
they're bottoming out.
What happens when you commitsuicide.
Well, you bottom out.
And when you're contemplatingor having suicidal ideation
which is the DSM-5 psychiatrybook on how you label something
(17:27):
you're bottoming out.
You're bottoming out.
You know any rational, saneperson is going to say whoa,
let's sit down.
What do you need?
Express compassion, empathy, doall the normal things to take
care of, like if you were takingcare of a family member.
(17:47):
But that didn't happen here andthat's a very common experience
that physicians areexperiencing.
So think about when I saidstigma.
If they report this worst casescenario I just described it,
they get shickhand and theircontract doesn't get renewed.
Is that the type of help thatthe physician who is having
(18:07):
suicidal ideation is expectingto hear?
And that's the last thing theyever wanted to hear.
But that happened.
So it attracted my attention toaddress the issue.
The elephant in the room thesebig employer hospitals pushing
these physicians into the brinkof despair for their greed I
(18:29):
don't know, it's corporate moneyat this juncture, the
physicians, the supervisors, theadministrators are paid a lot
of money, but it's part of alarge corporate environment now,
but yet they're still pushingthese physicians to.
They're breaking their backsmentally and this is how they
react to it and they say goelsewhere because you've got
(18:51):
baggage, for Christ's sake.
I mean, everybody has baggage,so that's a real example.
I wanted to weave into theepisode and attack the issue,
because this is not how youhandle the issue.
Physician suicide is real and itis increasing, as evidence of
(19:11):
the 2024 Physician Foundationsurvey.
It's not going away.
There have been numerousstories in the press of
physician suicides that are justshocking.
These are highly functioning,well-regarded members of the
medical profession who suffer insilence Again, think about that
stigma and they do not seekassistance and eventually, as
(19:36):
you see the data from the survey, they take their own lives.
Here's one example.
It occurred in the New YorkTimes back in 2020.
Dr Lorna Bream, age 49, theformer medical director of the
emergency department at New YorkPresbyterian Allen Hospital,
died by suicide in 2020.
Dr Breen did not have a historyof mental illness but who had
(20:02):
worked in the frontline trenchesof the COVID-19 outbreak in New
York City and witnessed manyCOVID-related deaths.
Her colleagues were shockedabout her death.
Colleagues were shocked abouther death.
Dr Cunningham, in the priorepisode of the podcast you can
hear about.
I guess you would call her asuccess story that she survived
(20:24):
it, and even the applause at theend of the speech, the standing
ovation she received.
She started a speech saying I'mgoing to interrupt in,
tragically, my career by givingthis speech, but she was well
received in terms of her beingtransparent and vulnerable in
(20:51):
expressing what happened to herand, by the way, she was
motivated by a good, dear friendof hers who was younger, also a
physician, who did in factcommit suicide, and she does
actually call that out in thespeech.
Again, listen to the speech.
It's very heartfelt.
So I went deeper into the rabbithole in this issue and I began
(21:13):
looking for cases againsthospitals brought by physicians
who had mental illness, and Ididn't find much.
I had to search very, very hardto locate what I did find.
I'll give you examples of themI wanted to bring out.
Is there a pattern or theme andthen talk about what should be
done in each circumstance?
Pattern or theme and then talkabout what should be done in
(21:34):
each circumstance, because thereshould be something done to
take care of physicians beforeit ever reaches the point where
they're brink and they'rebottoming out.
Hospitals should do somethingtoo, and they are.
I'm not saying that they're not.
But let me get into one ofthese cases.
(21:58):
John Lindsay sued OSF HealthcareSystems in the Southern
District of Illinois, I think.
This lawsuit was filed July 3rd2019 against his employer
alleging disabilitydiscrimination for his mental
health disabilities under theAmericans Disabilities Act.
Dr Lindsay was diagnosed withdepression and anxiety and made
his employer aware of hisdisabilities.
He requested accommodations,including adjustments to his
(22:18):
patient's schedule Remember Itold you that was a pattern.
He also asked for a medicalassistant to be assigned, but
the employer never engaged inany conversation about the
accommodations being requested.
That's called a failure toengage in the interactive
process.
That's a big blunder on theemployer's part.
The failure of theaccommodations requested
(22:42):
exacerbated Dr Lindsay'ssymptoms.
However, the employerterminated his employment,
citing alleged performanceissues happening many years
earlier.
That's again another pattern ofnonsense crap that employers do
.
They go back in time, which isbasically worthless, because in
(23:03):
this case, dr Lindsay, hisperformance was always rated
satisfactory.
That's an admission by anemployer, by the way, you've
heard me say that before,including the patient treatment.
So all things were good,satisfactory in terms of the
performance.
So the employer really didn'thave a defense.
I deep dive even further intothe docket, as you know, I do
(23:24):
because I was curious and thecase was reported settled July
25th 2019.
That was less than a monthafter it was filed.
Why do you think that is?
I read the complaint.
First count was about a breachof contract, about what a breach
of contract is, and then thesecond count was a violation of
the ADA, and I read through it.
(23:46):
It wasn't my style of writingon complaint.
It was more I don't knowformulaic lawyers, but kind of
boring.
There was no pizzazz and dramato it, but the mere fact that
the case settled less than amonth after it was filed.
It was removed, meaning it wasin state court first for a
period of time.
I didn't check the actual date,but it only survived in federal
(24:07):
court for less than a month.
It means the employer settledthe case, did not want that, you
know whatever that storyline toget out further about.
Osf healthcare systems wasconcerned about their reputation
, I'm sure.
But here there was Dr Lindsaywho said I need an accommodation
, I have a disability ordisabilities plural.
And what did the employer do?
(24:29):
The employer didn't do anythingand fired him.
That was like the worst thingyou should do, and so maybe
there was a decision there forthe.
They'll just get rid of thisbad egg, fire him and then
settle it, and then maybe that'swhat they decided to do.
We don't know the amount thesecases are and the settlements
are confidential, so we don'tknow.
So, doctor having a disabilitydepression, you know, coming to
(24:52):
his brink of his bottom, he'sbottoming out and he's asking
for accommodations and theydidn't give it to him and his
symptoms get exacerbated.
And you know what happens.
You know, there's the doctor inthe white lab coat but he's
having problems and taking careof patients, but the patients
he's taking care of them.
So he's still operating, he'sstill functioning at a very high
level and patients are beingtaken care of, but he himself is
(25:16):
suffering and the employeedidn't do shit to handle that.
That's the point.
They work them in this crazycultural environments of the
hospital and they don't takecare of the very people who are
making them money.
Physicians, they're bread andbutter.
I actually would say the nursesare bread and butter, but we
(25:40):
all know.
But it's a small little tidbitexample.
I had to search for that.
It was very hard to find thatcase.
Here's another case I found DrMark Ryden versus Essentia
Health.
This case, out of Minnesota,alleges his employer knew about
his worsening depression but didnot provide any reasonable
accommodation and wrongfullyterminated him because of his
mental illness.
Dr Ryan allegedly proposed areasonable accommodation plan to
(26:01):
catch up on backlog work thathe had missed, but his
accommodations were denied.
Again a similar patternaccommodations being denied.
The Minnesota's Department ofHuman Rights found probable
cause for disability,discrimination in that case and
a failure to accommodate andalso retaliation.
(26:23):
I deep dive further.
I was, you know that was at thestate agency level.
So I said well, let's see ifthere's a state or a federal
court filing here so I can readthe facts in the complaint and
give you more facts.
I researched the federal andstate courts and found no
further litigation as the casewas never publicly filed in a
court and most likely it'ssettled.
(26:43):
I had found that case by some Idon't know hospital reporting
type of newsletter or whateverreporting type of newsletter or
whatever, but regardless, hardto find cases like what I was
speaking about, much like thephysician who was told to take
her baggage elsewhere.
And what does that mean?
It means that you know, ifdoctors are having a fear of a
(27:10):
stigma being attached to them ofmental illness, they're not
going to report.
So it's not surprising that I'mnot finding legal cases out
there that are being reported infederal and state courts.
It doesn't mean the issuedoesn't exist.
It's just that there's a stigmaand there's a fear of reporting
.
So I did find two cases atleast.
(27:32):
Again, it was very specific.
I was looking for a hospitalsetting physicians with mental
health conditions,accommodations, termination,
that type of thing but no casesI found talked about the
rigorous 24-hour schedules.
These doctors are working undersleep deprivation.
Nothing really addressing thatissue.
So what I'm doing is trying tobring to light this is a very
(27:53):
real concern in the hospitalsetting, the very place that
when I recently went there foran issue I had, you want people
to take care of you.
You expect the 100% care anddoctors and nurses say they're
going to give it to you.
But if the doctor is havingconcerns because of being
(28:14):
overworked, that's concerning.
Are you going to give me thatcare?
Do you have to work thosedoctors that much?
I mean the physician suicideissue is really, I guess, the
end point of the decisions beingmade by the business, the
hospital, to make money to thenth degree by causing people to
(28:34):
feel like you know, burnout.
There's no escape other thancommitting suicide.
I mean that's the insanity,what I'm trying to poke at with
like a big long stick Well shortin this instance because I'm
inviting the hospitals to reactto it, if they can, inviting
people to react to it becauseit's a big issue that no one
(28:55):
really talks about.
It's the employment setting.
It's like the I guess it'sprobably the worst case scenario
setting where you're aphysician, you're highly
competent I mean, you have likeIvy League degrees behind you
and you are well accomplishedand you know you're facing this
and you have no choice otherthan reaching out to like an
(29:16):
employment lawyer or apsychologist or your
psychiatrist to cope and dealwith this issue.
Because, clearly, in theinstance of the baggage comment,
the hospital is not addressingyour issue.
They don't care.
I mean, it's as just basic asthat.
They do not care, they turn theblind eye to your personal
(29:39):
situation and that's why I'mtrying to call attention to it.
What should the employer reallydo when faced with someone
who's expressing a mentalnervous condition scenario,
burnout, wanting accommodations?
Here's what the solution is.
It's actually silly, stupid,because you would think that
employers would do this.
(29:59):
Hospitals would do this.
If a doctor is asking for areduction in the workload,
reduce the workload for a periodof time.
Have a conversation.
First, engage in theinteractive process, have a
discussion, document things,explore things, brainstorm
something.
This is your person who'smaking you money, the physician
(30:20):
and you want to make sure thatyour physician is well taken
care of physically, physicalhealth, mental health,
physically, physical health,mental health.
So if someone, a physician,asks for accommodations, you
know if I was the administratorI'd be saying, well, what do you
need, how can we accommodateyou?
(30:40):
And let's take care of this?
And you know what do you needand try to do everything you can
to avoid the issue of stigmathat the person, the physician,
already has in inside of themthe fear of disclosure.
But once they do disclose, youknow already has an insight of
the fear of disclosure.
But once they do disclose, youknow it's probably really bad.
If you're from theadministrator's standpoint, this
(31:02):
person's suffering and you wantto take care of this person
very carefully because they'revery fragile.
You know they're a physician,white lab coat.
Think about that again.
By the way, this is affectingmore female physicians than male
physicians, because there'sanother variable point of this
is that potentially femalephysicians are struggling even
(31:24):
to keep up with their malecounterparts in our today's
society, you know, because ofgender bias, and so they're
going to try even harder.
But they're also going to havemore fear fear of disclosure.
So when they do disclose,hospital administrator, you got
to be a real leader to take careof that moment, to take care of
(31:45):
that employee you have, andjust map out a game plan to get
that person the right care.
Put aside the issues of moneythat you're going to lose while
the person takes an absence.
They're an employee, they'vecome to you, they have a problem
.
So it's very simple you providereasonable accommodations by
(32:07):
having an interactive discussion.
You document everything, butyou're doing it in a way to make
it successful for the employeeto survive and continue working,
not to fire them.
That seems to be the defaultmechanism that all employers,
even hospitals, use, and I gaveyou two examples.
They just default screw it,you're out of here.
You got baggage, we don't wantyou, you're less than human.
(32:30):
We burned you out.
Next, please, because there'salways a next.
They believe these are highlypaid people.
They're paid $300,000, $400,000, $500,000 a year.
They're making the hospitalsexponential amounts of that.
So it's a weird scenario,culture-wise, that these
institutions and there areinstitutions, by the way and
(32:54):
they are making a ton of moneyoff the backs of physicians and
no one, no one is out thereproclaiming that these people
are victims of discrimination.
Until now, until I'm doing it,you know you may read about Dr
Bream in the New York Times andfeel sorry, and I am.
I feel sorry for what.
(33:15):
I don't know enough about whathappened to her.
Dr Cunningham, we know whathappened to her because she told
us.
She's telling us in her speech.
But something real is happeningin these institutions that
needs to be corrected.
That needs to be corrected.
The culture of physiciansworking has got to change and
maybe this discussion leads andI'm having through this podcast
(33:39):
episode leads somewhere.
These are real people.
They're employees.
They're working Under extremecircumstances.
Yes, they agreed to go tomedical school and they knew all
this was coming.
But listen, you don't take aprofession like to go into it to
eventually commit suicide.
That's not what they'reintending.
But the environment they'reworking in is very stressful.
(33:59):
We get that You're taking careof people who are sick, but you
would imagine there is even moreof a compulsion by the employer
to do the right thing andprovide the right cultural
environment to take care ofpeople when they self-report,
and that's what physicians doafter they get past the stigma,
fear, issue of disclosing thatthey have a mental illness.
(34:23):
So it attracted my attention.
I wanted to bring it to yourattention and it's not going to
be the last one I'm going to do,because it's a very serious
issue.
It's very systemic, obviouslyhappening in every hospital in
the country, I imagine, and fewdoctors are going to want to
call out.
(34:43):
But maybe we give themammunition and the courage to
call out and saying you knowwhat damn it.
The state and federal laws dofavor me here.
There's a requirement, and if Ilose my job over this, at least
I'll save my life.
And you know what comes firstlife or your job?
Well, obviously life.
(35:04):
And some doctors, you know theydo make the right choice,
choice even though they're goingto give up faculty progression
because they were, theircontract wasn't renewed.
They turn to lesser stresssituations.
That maybe and they work inlesser stress situations that
(35:25):
takes off the pressure offeeling like they're going to
end their life by suicide.
So life is first, job is second.
So the law is there to protectphysicians who are experiencing
depression and the laws arestate and federal.
The American Disability Act isthere.
(35:45):
If you're at a teachinginstitution like Yale.
There is the Rehabilitation Actif you're receiving federal
monies, which they do in otherinstitutions as well, and the
Rehabilitation Act and the ADAfunction very similarly.
I've read a case recently wherethere's Title III of the Rehab
(36:09):
Act or the ADA applied to thephysician in that circumstance A
very unusual case to read thatUsually it's Title I employment,
but these hospital systems arenow very complex.
There's individual practiceswhich have access privileges to
these hospitals.
It's a very complex worldenvironment that they're all
(36:31):
working in, but yet stillthere's an employer environment
that they're all working in, butyet still there's an employer
there that has to follow the law.
And even though it's complexdoesn't mean the law doesn't get
applied.
And so here the very simplicityof this is that reasonable
accommodations affect everybodywhen they're made and employers
have to respond to them, andthey have to respond to them in
the same manner.
(36:51):
It doesn't matter if it's ahospital setting or a private
business.
So we need to prevent I guessbottom line here is doctors from
working in environments thatproduce that outcome of
physicians feeling that there'sno way out and they have to just
commit suicide as a way out.
So it's a game changer andcalling attention to it.
(37:14):
And I have to remark onsomething that really bothered
me about this storyline, and itwas this fact, this not a fact,
but necessarily this momentumthing that happened.
There was a call to action formental health in the sports
arena, setting gymnasts,olympians and tennis players,
(37:38):
and it came to light and then itjust faded away.
Well, guess what happens?
Dr Cunningham says this.
She says in her speech there'sno number of Peloton rides that
will take care and solve myproblem of depression.
It's a disease and it's nevergoing away.
The point being it's nevergoing away.
So this awareness of mentalhealth and kind of social media
(38:02):
attention to it and the news,it's never going away.
But what bothered me is that Iknew when that thing came out,
that momentum of call intoaction, of taking awareness of
people with mental illness, itwas short-lived because our
society is 15 minutes and that'sit.
That's all attention we give tosomething we move on surgical,
(38:32):
whatever you know you're wantingto know I'm being taken care of
by the best there and thatemployer hospital is taking care
of those physicians in thewhite lab coats and you want to
rely upon that.
And if you knew that theyweren't, you'd be really pissed
and guess what folks?
It's really happening and thosephysicians as we now know by
the Physicians Foundation survey, this is a very big issue
(38:55):
happening and physicians areunder tremendous amount of
strain and they are thinkingabout suicide.
I guess that's the point andtakeaway of this and we need to
stop it.
And stopping it is tellingemployers they need to change
the dynamic of that worksituation permanently for a new
situation that physicians canwork in and not feel that they
(39:20):
have to bottom out, andemployers who should react in a
more compassionate manner.
I guess that's the final endpoint.
Again, I'll do another episodeat a later point on the same
subject matter, but I hope youenjoyed this subject.
It's rather intense, ratherscary, but it's real and it's
(39:41):
happening, and it's happeningtoday to physicians and so
they're great people.
They take care of us.
We want to try to take care ofthem.
Have a great week.
Popular Podcasts
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
Cold Case Files: Miami
Joyce Sapp, 76; Bryan Herrera, 16; and Laurance Webb, 32—three Miami residents whose lives were stolen in brutal, unsolved homicides. Cold Case Files: Miami follows award‑winning radio host and City of Miami Police reserve officer Enrique Santos as he partners with the department’s Cold Case Homicide Unit, determined family members, and the advocates who spend their lives fighting for justice for the victims who can no longer fight for themselves.