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Efforts to Assist with Physicians Well-Being Now Law
PRACTICE MANAGEMENT
By Shawn P. Parker, JD, MPA NCAFP General Counsel & Chief of Staff
Effort to Assist Physicians with Well-Being Now Law
On March 18, President Biden signed the Dr. Lorna Breen Health Care Provider Act (H.R. 1667/S.610) into law1. The law is named after Lorna Breen, M.D. who died by suicide in April of 2020 following an intense stretch treating COVID-19 patients at the onset of the pandemic. The Lorna Breen Act requires the Department of Health and Human Services to establish grant programs and conduct other activities intended to address the behavioral health and well-being of health care professionals.
Even before the pandemic, the U.S. clinical workforce was experiencing a crisis of burnout. A study conducted in 2019 found that more than 300 physicians die by suicide each year, nearly one per day2. According to the CDC, physicians in the U.S. face higher incidence of suicide than almost any other profession. As noted in the study, despite working to improve the health of others, physicians often sacrifice their own well-being to do so. Furthermore, there are systemic barriers in place that discourage self-care and help-seeking behaviors among physicians.3 Physician suicide is a growing public health concern. The COVID-19 pandemic not only magnified this issue but exasperated it with painful clarity regarding the personal hardships physicians faced as they cared for patients, themselves, and their families resulting in a surge of physical and emotional harm tantamount to a second parallel crisis.
The Lorna Breen Act makes a long overdue investment in mental health resources to help provide suicide and burnout prevention training in health professional training programs and increase awareness and education about suicide and mental health concerns among health care professionals.
Specifically, the Act authorizes up to $135 million, over three years as funding for grants to promote mental health among the health professional workforce, as well as for an education and awareness campaign encouraging healthy work conditions and greater use of mental health and SUD services by health care providers.
Those funds are to be used to provide sustained and predictable programming to support the behavioral health and well-being among health care providers through (i) the establishment of programs that offer behavioral health services for front-line health care workers, (ii) the authorization of studies and recommendations about strategies to address provider burnout and facilitate resiliency, and (iii) the creation of a public awareness campaign encouraging health care workers to seek assistance when needed.
In addition, the Act directs the US DHHS Secretary, upon consultation with relevant stakeholders, to develop a national evidence based or evidence informed awareness initiative on best practices and recommen-
PHYSICIAN WELL-BEING RESOURCES
American Academy of Family Physicians-Physician Well-being Resources
www.aafp.org/family-physician/practice-and-career/ managing-your-career/physician-well-being.html
Additionally see Editorial on Preventing Physician Suicide
www.aafp.org/afp/2021/0401/p396.html
Mental Health America- COVID-19 Mental Health Resources
www.mhanational.org/covid19
dations for preventing suicide and improving mental health and resiliency among health care professionals, and for training health care professionals in appropriate strategies to promote their mental health.
The initiative shall (i) encourage health care professionals to seek support and care for their mental health or substance use concerns, to help such professionals identify risk factors associated with suicide and mental health conditions, and to help such professionals learn how best to respond to such risks, with the goal of preventing suicide, mental health conditions, and SUDs, and (ii) to address stigma associated with seeking mental health and SUD services.
Finally , the Act directs the Secretary of HHS, in consultation with stakeholders, to conduct a review on improving health care professional mental health and the outcomes of programs authorized under the legislation that takes into account (i) the prevalence and severity of mental health conditions for health care professionals and factors that contribute to those conditions, (ii) barriers to seeking and accessing mental health care for health care professionals, which may include consideration of stigma and licensing concerns, and actions taken by State licensing boards, schools for health professionals, health care professional training associations, hospital associations, or other organizations, as appropriate, to address such barriers, (iii) the impact of the COVID–19 public health emergency on the mental health of health care professionals and lessons learned for future public health emergencies, (iv) factors that promote mental health resiliency among health care professionals, including programs or strategies to strengthen mental health and resiliency among health care professionals and (v) the efficacy of health professional training programs that promote resiliency and improve mental health.
Your NCAFP will continue to monitor the implementation of the act and provide updates as grants are awarded and programs are created. In addition, below is a short list of resources intended to help physicians manage their mental health and well-being during these challenging times.
1 “H.R. 1667-117th Congress: Dr. Lorna Breen Health Care Provider Protection Act.” www.GovTrack.us. 2 “Physician Suicide: A Call-to-Action.” Molly C. Kalmoe, Matthew B. Chapman, Jessica A. Gold, Andrea M. Giedinghagen Mo Med. 2019 May-Jun; 116(3): 211–216. 3 ibid
National Academy of Medicine - Clinician Well-being Strategies and Resources
https://nam.edu/initiatives/clinician-resilience-and-well-being/clinician-well-being-resources-during-covid-19
North Carolina Medical Board - Clinician Wellness- Resources and Links
https://www.ncmedboard.org/resources-information/professional-resources/special-topics/ clinician-wellness-resources-and-links
Physician Support Line -
A support line that offers free confidential peer support for physicians and medical students via telehealth by volunteer psychiatrist. 7 days a week 8:00 AM-1:00AM ET www.physiciansupportline.com
If you or someone you know is considering suicide, call Doctor Lifeline (1-888-409-0141), the National Suicide Prevention Lifeline (1-800-273-8255), text “HOME” to 741741 or visit https://suicidepreventionlifeline.org.
ENCOUNTERS
This visual art presentation by Duke Undergraduate Mr. Aaron Zhao aims to viscerally capture the state of medicine and health care in six rural North Carolina towns: Laurinburg, Bladenboro, Red Springs, Raeford, and Elizabethtown. Accompanied by photo captions generated from the interviews of rural physicians and patients, this collection of artistic-documentary photographs depicts the unforeseen triumphs and challenges of practicing 21st century rural medicine in North Carolina. Mr. Zhao completed this photo essay as an undergraduate capstone project. He hopes to enter medical school focusing on primary care in rural areas in the near future.
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A) DISCOUNT DRUGS, AMERICA (2022): A self-portrait taken in-front of a prescription drugstore in Lumberton, NC. America has been plagued with opioid crisis; prescription drug abuse has skyrocketed; rural regions have it especially difficult. B) COMMUNITY DOCTOR (2021): Dr. Smith serves the town of Raeford and its surrounding community. Her dedication to serving her community motivates her to partake in community events, advocating for her patients like family. C) FUTURE (2022): A self-portrait taken in front of a Cape Fear Valley clinic at night. This journey served as my own exploration of rural medicine. Is this the right path for me? Could I envision myself working as a rural physician? D) CLINIC (2021): A rural doctor documents his notes following a patient visit in his small but homey clinic. E) BLOOD DRAW (2021): Patients in rural areas are disproportionately more likely to have chronic illness than urban areas. F) Patient Connection (2022): A patient rushed through the clinic door complaining about shortness of breath. Being from a rural area, the doctor knew the patient personally. A few minutes later, the asthma attack cleared, and a fist bump was earned. G) BORN AND RAISED (2022): Rural doctors
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who grew up in the same community they practice in have a better understanding of their patient population, resulting in better patient care. Dr. Rich, born and raised in Garland, NC, works a mere few miles from his hometown. Medicine becomes heavily personalized. H) Graveyard (2021): Unfortunately, rural American towns typically have a lower life expectancy than its urban peers. With a health professional shortage in many rural areas, there remain patients who lack adequate access to medical care.
addition to the state’s loan repayment programs. A scholarship program reduces overall debt and reduces interest payments on that debt.
• A tax credit for community preceptors who want to be role models for medical students, and/or other incentives for teaching.
• And finally, a sustained effort around healthcare professional workforce led by the state’s AHEC Program.
NCAFP will continue to be involved in the work of the Joint Legislative Committee on Access and Coverage as one of our key ongoing advocacy priorities, but that will be just part of our efforts.
We must focus on solving the key issue, not putting a band-aid on systemic underfunding of primary care. It seems that every fix the Legislature or others bring up is just treating the symptoms, not solving the underlying problem. So, as we have previ-
suicide and overdose (largely due to more easily accessed and far more lethal synthetic opioids like fentanyl).
PAIN, MENTAL ILLNESS & ADDICTION: Comorbidities are common in the chronic pain population, and this added complexity contributes to the undertreatment of pain. It is known that Major Depression is seen in over 60% of chronic pain patients, along with high rates of anxiety/PTSD/TBI/ADHD. The goal of reducing exposure to opioids in pain management does not factor in the reality that death from suicide is five times greater than death from overdose in pain patients taking opioids (https://pubmed.ncbi.nlm.nih. gov/26082321/). Timely access to psychiatric care, in general, continues to be a challenge, and psychiatric access for pain patients is even more limited. This combination of chronic pain with psychiatric comorbidity is commonly seen as the most difficult patient population to treat and is clearly a challenge for front-line • Reducing the administrative burden you face in practice each day;
• Increasing the investment in primary care not just in North Carolina, but throughout our country;
Moving to a system that allows you to truly take time with your patients so you can truly address their issues rather than spending time on your EHR.
I believe the move to value can fix many of these issues, paying for results, valuing your time, and putting the physician-patient relationship at the center of healthcare once again.
Have faith. I can’t guarantee we will be successful on every issue, but I do believe your voice – the voice of North Carolina’s family physicians – is being heard.
practitioners, as well as pain management specialists. This comorbid population is also the most challenging to the healthcare system, with some of the highest healthcare utilizers and total expenditures of at least 25% of all healthcare dollars. To date, little attention has been paid to this cohort. The bottom line is that with further restrictions on opioid prescribing, we can expect that more patients with higher acuity chronic pain, psychiatric comorbidity, and substance use disorders will not have access to care.
Registration for the Complex Pain Project is open! To review course schedule times and to learn more about these free, unique virtual learning opportunities, please visit the conference site at www.ncafp.com/complexpain.
This Governor’s Institute and NCAFP collaborative project is supported by the NC Division of Mental Health, Developmental Disabilities, and Substance Abuse Services with funding from the SAMHSA Substance Abuse Prevention and Treatment Block Grant.
www.ncafp.com Raleigh, North Carolina 27607 2501 Blue Ridge Road, Suite 120,
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