133. Physician Suicide, Stigma & Hope in Healthcare: Corey Feist Speaks Out

We need to show people how to get from talking about the issues to implementing change. And they will literally change the way that healthcare is delivered for the good of clinicians and their patients.

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Let's begin in this episode. Dr. Joanne and I are so grateful to welcome Corey Feist, who is the co founder and CEO of the Dr. Lorna Breen Heroes foundation, leading national efforts to reduce burnout, remove barriers to mental health care and transform the culture of healthcare. He has over 20 years in the healthcare law and administration, has shaped groundbreaking policy and including the first federal law dedicated to healthcare worker mental health, and he continues to advocate for the Wellbeing for over 1.5 million healthcare workers nationwide. Corey, welcome to the show. We're so happy to have you here today.

Thank you so much for having me. It is really an honor to be.

Here with you both and I would love to hear more about or have you share with our listener more about the Dr. Lorna Breen Heroes foundation because not everyone may be aware of it and I know I'm working hard to get awareness spread through the state of Oregon where I live. And I just became an ambassador and attended an amazing meeting with the other ambassadors just yesterday. And please share more about this. And the reason why we want to share it today is because this month is National Suicide Awareness month and also September 17th is the National Suicide or Physician Suicide Awareness Day. So this week we are really wanting to make sure we put in front of people resources that will have an impact and serve this very important message.

Thanks for the question and the opportunity to, as you say, share this information during a really important month. Although all the other 11 months are equally as important when it comes to health workers. Right. So we created, and by we I mean my wife Jennifer and I created the doctor Lorna Bring Heroes foundation after we heard an absolute flood of feedback from healthcare workers, their families and friends in the wake of the suicide of my sister in law, Dr. Lorna Breen, who is an emergency medicine leader in New York City who was leading the charge as a medical director of the New York Presbyterian Allen Hospital, a member of the Columbia faculty for many, many years. And Lorna was just completely run over by not just the pandemic itself and the need to take care of others before herself, but she was also very burdened by the fact that she needed mental health care because of the fact that she could not keep up because she was debilitated from contracting Covid and took her life, citing for to us her concerns that once she had retained obtained mental health treatment, she would lose her license to practice medicine and lose her hospital privileges to work in her hospital system, and that her professional reputation, therefore would be ruined. When lorna died on April 26, 2020, I was wearing a different hat than I'm wearing today. I was the CEO of the University of Virginia Physicians Group, which is the group practice for all clinicians at the University of Virginia Health System in Charlottesville, Virginia, all the way across the country from where you are. Aaron and I had been working diligently with all of our 1200 clinicians at the time about removing administrative burden from their day and trying to make the operational environment much better. And I had been working there for multiple decades at the time. And despite the fact that I was working elbow to elbow with clinicians every day, no one ever talked to me about this big issue around the stigma and the penalties for getting mental health treatment. And so when Lorna started articulating these concerns to me as an attorney and my. And my wife Jennifer also as, as an attorney, but not a healthcare attorney, we both kind of looked at her like, it's 2020, sister. Like you don't have to worry about penalties for getting mental health care. There's the Americans with Disabilities act and there's all these other things, and so don't worry about it. But she said, no, healthcare is different. And I'm sitting there as reforming healthcare attorney, because I went back and I got a business degree and I was now in leadership going, how could she possibly be right about it? Well, as it turned out, after she died, and then the New York Times published her cause of death only 11 hours after she died, despite my strenuous objection, the publicity really opened this floodgate of feedback to us. And so when the flood had not subsided and in fact was just increasing by the summer of 2020, Jennifer and I said, we need to create a foundation focused on them, focused on improving the lives of our healthcare workforce, whose mission it is to support the wellbeing and mental health of our. Of all of our clinicians. Envisioning this world where seeking mental health treatment is a view as sign of strength. Sorry. Is viewed as a sign of strength. And so we created the foundation. And since that time, we have been bringing together in an interdisciplinary way organizations to prioritize this work as well as accelerate solutions, practical, common sense solutions that have not been adopted despite the fact that they've been discussed for many years. And then finally also advocating for policy solutions, most notably, as you reference, the Dr. Lorna Breen Healthcare Provider Protection act, which was signed by the President March 18, 2022. I created programs for the first time to support the well being of health workers. So that's a small overview, if you will, of our foundation and our work. And we're just honored for you to be an ambassador of it and would welcome and invite anyone who's interested in joining that volunteer ambassador group.

So powerful. And when tragedy strikes like the loss of your sister in law, you know, you decided to take action because you saw that she wasn't the only one. I know I led a retreat for women in medicine in 2020 right before the world shut down. And I specifically remember many of the women there saying there's no way in heck I would get mental health services, even though they knew they needed it because of that worry and it didn't matter. Some of them were physicians, some were PAs, some were NPs, and it was kind of a universal thought. And because of all the advocacy work, I see that there's some shifts, but it's not big enough yet. And I'm wondering from your inception of the foundation and how has the mission evolved?

Since its inception, our mission has remained laser focused. What has changed is the level of, I would say, maturity or sophistication in the work. And by that I mean, you know, when you, when you look at what, particularly during the pandemic and really now extending years later, how the healthcare industry has responded has been by encouraging the workforce to be more resilient. The, the dreaded four letter R word, if you will, now that the health workers just, just, just have a visceral negative reaction to. And what I would observe for you is that in some ways because of that, the market, if you will, has been flooded with those individual resiliency resources to a point that I think hospital leaders in many cases feel like they've checked the box. We talk about burnout, now we talk about mental health. I've got peer support, I've got an EAP program, I've got all this other stuff. What else is there to do? Well, for us from our inception, because as I said in my, my introduction, I came from this operational background, understanding about the administrative burden and other things that are driving the workforce to leave. We've really doubled down on this concept of we have to look at the root cause of this condition just like you would look at the root cause of any reason why a patient has got a disease, right? Let's look at what causes it and let's start treating the patient with what the patient is willing to take at this time and that at this point are common sense practical solutions like looking at your ehr, looking at learning communities around expanding into what I would call quadruple AIM goals. So you look at your existing quality infrastructure and you say I'm going to add to that the view and the impact of the work on the workforce. So Aaron, we haven't really changed our focus. In fact I think part of our success has been we've been laser focused as a small but mighty startup nonprofit and I think our message continues to be refined and targeted at those frontline leaders and all the way through the C suite governance, et cetera that say hey you all have done a great job flooding, flooding the resources to hold pressure on a bleeding wound. What we need you to do now is we need you to look at the root cause of that wound and we need to work to implement and bridge this implementation gap now on root cause solutions. And that's really where we've been laser focused.

That is so, so powerful. I like I'm here in awe listening to you and I have vivid memories and like it now feel so honor crossing paths with you of when I heard the news in 2020 of your sister in law passing so sorry for your loss. I imagine it can still hurt. It's wounds that don't go away and can't imagine for your sister and I remember then hearing because right like when we start talking about it then we hear other things and go that people don't talk about and remember very clearly hearing so much of how doctors were in healthcare in general. We were, I mean all of us were struggling in a way or another but the few that were struggling to that point of feeling hopeless and suicidal and that's part of why I'm doing what I'm doing here with Erin. And I remember vividly and again I've been a psychiatrist for more than 20 years and prevention and awareness, all of that has been part of my mission. But I remember feeling a fire in my heart of we have to do something about it and knowing that the systemic changes that you guys are working so hard for might be difficult but then the things that we can do in our small groups and individually and at that point was when I started thinking of what can we do for physicians and Erin and I talk a lot about coaching and I joined forces with another Doctor in the institution I work at. And we created a program that was free for physicians and it was just, you know, we created a ripple effect from there and dealt with some headaches of, you know, hearing a lot of no's like, no, we don't need that, or oh, no, we have this app that gives you a 30 minute call once a year. I'm like, we need some other things. Right? So it's incredible and so hopeful that we're changing the culture and that we are creating resources and talking about it so that people can know. Okay, I'm not alone. I like, we talk a lot about we need to stop the suffering in silence and all the obstacles. There's so many things that we can control. Let's work hard on the things that we can. So again, thank you so much. And yeah, I cannot wait to be more involved as well. So you have so many things going on. We can speak for a long time just on the thing. So I would want to hear more about the other program that you were telling us about, the all in well, being first, if I'm saying that correctly, for Healthcare. And I like the mental health campaign that you guys have started.

Yeah, thanks so much. And you're right, we could talk for hours and we don't have hours and our listeners don't have that kind of attention span. Right. And that's just fine. So in 2021, we launched a national coalition to do this work in an interdisciplinary way around wellbeing. That national initiative is a coalition called all in wellbeing first for healthcare. And it has over 35 of, I would say the most notable healthcare associations in the country. The ama, the ana, the aha, all the A's. Right. It's the A team and that group we worked with for, over the last year to develop what I would call are the six ways that organizations can demonstrate and take action to support the mental health of their workforce. We call that all in for Mental Health campaign. And it's grounded on a very basic premise. The premise is as follows. Patients have the right to access mental health care. Healthcare workers do too. Right. Like, they do too. And so how do we demonstrate that? We do that through six concrete actions. And as you just noted, one of the, the most impactful that we have had success on is what we call the Champions Challenge. But before I, before I get to the Champions Challenge, let me just walk through a little bit of these six actions and I promise you I will not go into incredible detail. But here's six things that organizations can and should be doing. First of all, they need to provide accessible and affordable mental health care to their workforce. Particularly during hours at the workforce doesn't work. Remember, most people in the United States who are providing clinical care are not providing, are not able to just break away to use the restroom, let alone go to go to therapy. And so we've got to make it accessible during the times that they need it. Also affordable. Particularly with concerns around confidentiality, what we see is that healthcare workers tend to pay cash and not want to report any mental health treatment to, you know, sadly to their insurance. And so that's number one. Number two, confidential professional or physician health program support. These PHP programs exist in many states. I know I had a brief conversation with Aaron yesterday about the program that that exists in Oregon. And I will just tell you that many clinicians still think about these groups as being sent to the timeout chair. This is a penalty if you will. But what we've learned by working with the Federation of State Physician Health Programs is they are all working just as hard at providing therapeutic care as the rest of the community. But of clinicians. But what most people don't recognize is if they go get mental health treatment from those PHP programs, it's done completely with a confidential umbrella so it doesn't get back to licensing or credentialing. The third is equal privacy in mental health care. Now this is that Champions Challenge that we talked about it in the introduction that Aaron read about my bio. This is how we've made the most demonstrable impact on healthcare workers. And that's as follows. We know that healthcare professionals, physicians, nurses and others are asked questions about their prior mental health treatment and diagnosis, including substance use, about, you know, their past in hospital credentialing applications to go work at a hospital or in their licensing applications. And so those questions all are asking inappropriately about and picking on mental health care. They also run afoul of the Americans with Disabilities Act. Like I was opining to my sister in law in 2020, what's an appropriate question is to ask if someone's currently impaired, whether that be a physical or mental impairment. So what we've done at the foundation is we've created a free set of resources and a free national recognition program which we call the all in Champions Challenge badge which allows organizations to use our resources, change their questions, literally get the eraser out on the top of the pencil and remove these questions and replace them with more appropriate questions and then be recognized for it on our website@drlornabreen.org you'll see an interactive set of maps on the progress we've made. You know, we began by recognizing 17 states for medical licensing. Now, between medical licensing, nursing licensing, pharmacy licensing, and dental licensing, we have over 50 states that we've recognized collectively. And on top of that, now 10% of the hospitals in the United States have gone through our process and have validated and obtained the badge about how they ask these questions from a credentialing perspective. So I'm not sure how, if you have all have seen this kind of rate of uptick of a national, new change, if you will, new and air quotes change. But we are seeing just a huge uptick in that, which is why I can sit here today and say 1.5 million health workers in the United States are benefiting from working under a license or in a hospital that has our badge. I can also guarantee you that 1.5 million health workers don't know that the rules have changed. And so part of this whole narrative around equal privacy in mental healthcare is we kind of let them know what the new rules are. So that was the third one, and sorry for the brief digression, but that's the one we've really gone very far on. Confidential peer support is the fourth. Okay, we know that peer support programs work. We know that doctors particularly want them. They want to have a conversation with somebody who's walked a day in their shoes. And so making sure that hospitals are delivering confidential peer support and having programs where and when I say confidential, that means not just in the medical record, but that also means it's free from disclosure and potentially any, any kind of lawsuit. It's gotta be protected for that to be really effective. The fifth is education and training on mental health and professional wellbeing. We know that healthcare workers go through a tremendous amount of training in their early years, but they don't necessarily all know about mental health and professional wellbeing as much as, you know, psychiatrists do, as an example. And so we also know that by training them in these interventions, training them in suicidal ideation, and knowing what to do and intervene and how to intervene can be life saving because we've seen dozens of examples of where it has been. And then finally, when clinicians step out of the workplace to get treatment, we know that they need supportive pathway for reentry into the workplace. We've heard time after time after time about how clinicians feel like they're wearing a scarlet letter and they're not welcome back, you know, with open arms. Although I also hear Stories about when hospitals and when leaders are welcoming back those clinicians into the organization. They are just in a sprint to take care of patients and do a great job again. And so treatment is very effective as you know. And we just need to make sure that if someone steps out for a little bit that they have that smooth glide path in. So those are the six actions that we are really trying to get all organizations to take on and individuals can find out more information about them@allinformentalhealth.org so.

Powerful and we will make sure that we have those links in the show notes and I know for one in Oregon we did get the licensure change through different organizations and we have a unique organization. It's called the Oregon Wellness Program. It's not part of the PHP programs. It's separate but it has provided free confidential counseling for it started with physicians and now it's NPs, PAs, nurses, dentists. And it started because of a series of three physician suicides in Eugene, Oregon within I think an 18 month span, very short amount of time. The local medical society took action and now it's a statewide program that helps and I'm going to make sure that they're aware of your foundation. And so we're leveraging all of these common missions. So are there specific things that individual healthcare leaders and organizations can do to make tangible changes to support workforce well being like in a nutshell, like if they're going to start, you know what's one thing they can do?

I think I'm going to give you two because you asked for one but I always like to over deliver. Aaron, the first thing from a pure mental health I want them to understand the difference between treating mental health conditions and treating burnout. That's the very first thing I want them to understand because burnout is an occupational syndrome. It, it manifests in individual symptoms, but it is occupationally and systemically driven. And so they need to understand that that's a different thing. And in order to get at the root cause of the burnout, they need to look at operational changes like removing the pebbles from the shoe. I think Muhammad Ali said it's not the mountain, it's not the mountain in front of you, it's the pebbles in your shoe that prevent you from obtaining your goals. There's a ton of work that's being done across the country along this line and it can be done at a very low to no cost. So that's number one thing. And then the second thing is on the pure mental health side Join our All in for Mental Health campaign. And the first thing I would ask them to do is I'd ask them to start our Champions Challenge because they can join the other 10% of hospitals in the United States and visibly and demonstrably change the landscape immediately for their workforce. You know, Aaron, I'll tell you, in one of the most complicated healthcare systems that we have in Virginia, it cascades multiple states, they were able to change their questions in 48 hours. That's pretty fast from a change perspective right now. Others might take a little longer because they have internal processes. But this is a great starting place to build momentum and to, I would also say, rebuild trust because healthcare workers in the United States are not feeling as trusting of leadership as maybe they had been in the past. And so it's a great way to demonstrate and start to repair that trust that's been broken down.

Okay, and, and are, is that program, the all in for mental health, is that just for hospitals? I know I'm working with smaller medical offices, optometry offices, and wondering like what's is that available for them as well? Because they're not necessarily credentialing, but they are starting to look at dealing with all of the burnout and mental health issues.

Absolutely. That whole list of six you need to look at for your organization and tailor it to your organization. I've picked on credentialing a lot, but let me tell you, policies and procedures in organizations are just as punitive. And so you can take that same exact approach. In fact, I know a lot of hospital systems who've gotten our badge initially for their credentialing. And then they've looked at the medical staff bylaws, they looked at their policies and procedures and that sorts of things and they're like, oh my gosh, I can't believe we're asking these questions still. And so I think when you look at things through the lens of destigmatizing mental health care, you'll find a whole list of opportunities to fix. But that's just one. I mean the peer making sure that there's peer support programs and confidential access to care and that list that I just articulated that folks know about, if your state has a PHP program, know how to access it, know that it is not punitive in nature. You know, all that, all of those things are things that we all have a role in in terms of supporting the well being and mental health of our health workers.

This is so important. And we talk about these topics and there's sometimes difficult to digest not everyone wants to hear about it. And sometimes we get, like, we get a little stuck into the systemic problems or kind of the more difficult aspect of it. And I love this conversation because like Erin said, you took a tragedy in your life, a horrible loss, and you use it to fuel all this movement and all this advances and it's creating a movement and a ripple effect that's so powerful. And I love the feeling that I'm having right now that it's so hopeful and hearing your passion and how invested you all are in this movement and can. Like I was saying in a previous episode, my oldest wants to go into medical school and we kind of tried to talk him out of it, which is so sad. And his dad is also a physician. And we said, like, you need to love this. Like this needs to be in your bones. You love it so much because it's not sustainable if you don't love it. And of course, hopefully things will be different once he's out in the real world. But to hear you talk about these are changes that are occurring now, it leaves us feeling very hopeful. And I hope that the audience is keeping that and that we can all use this information and bring it to our institution. Even if it's a small group, share it with a colleague. We never know how this ripple effect happens. And again, I'm going to say thank you like a million times. And in talking about that and kind of also infusing it with some hope, because I know that you've talked with so many people and you, you have amazing people involved in the organizations, what do you see kind of in the future of healthcare and, and mental health, for healthcare?

What we, what we see is, you know, right now, if you think about this, on a continuum of starting to advancing to really accelerating work, what we see is if you, if you start to dissect organizations kind of by different levels, whether those be the level of governance, the level of leadership training, the level of programs, etc. What we see is the need to, to put out a roadmap for the, for the country to see where we all should go. Now, I'm saying that because we are about to release something which we call the Breen Scale, which is a maturity model which will provide that roadmap for the United States. What I think is really important, and a healthcare leader at my old institution used to say this to me all the time. He would say, corey, you know, if you don't know where you're going, any road will take you there. And so we need to Develop this roadmap and really show people how to get from talking about the issues to implementing change. And that's really an implementation gap. So we see the Breen Scale and other significant initiatives helping to bridge this implementation gap. And as organizations get more accustomed to trying out these things, they will scale across the organization and they will literally change the way that healthcare is delivered for the good of, of of the clinicians and their patients. You know, a little earlier today I was on a call with an organization and they were showing me data just from the electronic medical record about the amount of time that clinicians, nurses, doctors, et cetera, spend during the day and out at the after hours in the electronic medical record. You're nodding your head, Joanna. You know where I'm about to go here. What's amazing is even the increase and, and I, and I asked him, I said, show me the increase when we are on paper charts to now. And he said, you don't even need to look that far. You just need to look at where we were pre pandemic in charting and in the EMR versus where we are now. It is a more than double the amount of inbox messages and time that clinicians are spending in the ehr. Now, now when we have a workforce shortage, Right. So do we have a workforce shortage or do we have the only clinically trained workers in the United States doing documentation or both? Right. So I see this implementation gap being really bridged in the future. And that's what we're trying to do through our national coalition, through our work at the foundation, is really make sure that organizations and individuals know what to do, not just sit around a table and talk about the issues until everyone is like, okay, I'm burned out on the conversation of burnout. We need to bridge that implementation gap. Things like the Breen Scale, this maturity model we're about to publish are, are going to be ways to help organizations see that roadmap for the future. And that's what I see. And that's why you do hear the optimism in my voice. Because I see how much just kind of that low hanging fruit exists and is able and is really impactful stuff. And it's just really a matter about us educating as many people as we can about what these resources are and then practicing and practicing and practicing.

Yes, I love that. Right. Like the, because we're, we're good at sitting at round tables and having discussions and like getting excited. And then it's, and it's not on purpose. We just go back to like you Said a horribly busy schedule and then we don't always implement. So that. That's definitely filling up that gap is. Is so important. Corey, we could talk with you for hours. Thank you so much for sharing this information. That it's important for all of us. And this is not. We talk a lot about physicians, but this is the whole health care workforce for our communities, right? Like if, when we're in need, we want our health care workers to be as healthy as they can be, to take care of us as well. So this is definitely something that everyone benefits from and we'll make sure that, that we share all the links. But if people want to work, reach out to you or something, we'll again, we'll add the links to the organizations. But anything else that you would want the audience to know, any message you want to leave them with.

We are doing this work as a nonprofit. And so to the extent that anyone is interested in helping to support that mission, we would be incredibly grateful. And if you see creative ways for us to be involved in your organization, provide support, connect you with resources, please reach out to our foundation. We are here, as you say, for all of our healthcare workers so that they feel seen and heard and they have the resources that they need to thrive. And we have found ourselves as a foundation kind of in the middle of this national conversation, which we, we cherish that opportunity to be in that conversation and be a part of this national conversation. We also have a tremendous amount of resources to help. So please don't be shy and reach out if you need anything.

Thank you. And I want to say we talked some about physician suicide in our last episode and we shared some resources, but I want to say it here, the important number 9, 8, 8 that we all have to have memorized in addition to 911988. So if this episode kind of triggered any emotions, any thoughts, please feel free to reach out, talk to someone. 988 is available to us all the time, and hopefully this was as helpful to you all as it was to us. Again, I have goosebumps right now. And thank you again for listening. Thank you again, Corey, for such an important podcast today and for our audience. Stay tuned. Our next episode is coming right up.

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