Despite lower suicidal ideation among physicians, New York hospitals maintain vigilance

Even as COVID-related hospitalizations decrease in the city, the mental health challenges accumulated by providers during the past two years are not likely to dissipate easily.

A recent survey from Medscape, a West Village–based medical news source, found that suicide remains a pertinent risk for physicians experiencing stress. In its Physician Suicide Report released this month, surveying more than 13,000 doctors across 50 states, it found that 9% of respondents had thought of suicide but did not act on it; 1% of survey takers said they'd attempted to take their own life.

The rate of survey respondents with suicidal thoughts improved from a survey conducted during the height of the pandemic in 2020, in which 22% of survey takers said they had such thoughts.

Local health systems said they recognize the need to adapt their mental health strategies implemented during the pandemic as trauma evolves, to build resiliency for future crises.

"It is important that provider mental health is something we're talking about in New York City," said Dr. Eric Wei, senior vice president and chief quality officer for NYC Health + Hospitals. He noted that physician suicide was an issue even prior to the pandemic, and said annually there were about 400 physicians lost to suicide in the country.

The death of Dr. Lorna Breen, emergency department director at New York–Presbyterian Hospital, by suicide in 2020 thrust an underdiscussed topic into national limelight. It resulted in the Dr. Lorna Breen Health Care Provider Protection Act being passed in Congress in February. If signed by President Joe Biden, the law will provide federal funding to address burnout and mental health among health professionals.

"The death of Dr. Breen was a collective gut punch for the New York and medical community," Wei said. "We're still behind, but at least we're taking steps in the right direction to have the right conversations."

The work to address mental health challenges for providers needs to be maintained and transformed as trauma from the pandemic evolves over time, said Dr. Manish Sapra, executive director of the behavioral health service line at Northwell Health.

Telehealth and other new tools make accessing help easier. Making the services available at flexible hours would help, Sapra said, adding that health systems need to think about building resilience not just for any future COVID waves but other health crises as well.

At Northwell, core to its employee mental health strategy was establishing its Center for Traumatic Stress, Resilience and Recovery, announced in April last year. It provided both clinical and preventive services at launch, including resilience coaching and stress first aid, and it has since launched additional resources for employees. They include a confidential behavioral health navigation hotline and mental health training for residents and fellows.

The city's public health system, NYC Health + Hospitals, organized its mental health efforts under its Helping Healers Heal initiative. It now has 18 teams and 1,000 peer support leaders across the system's 11 hospitals. The program, too, has evolved to consider integrating wellness as part of resilience building, and H+H has leveraged philanthropy dollars to invest in the field, including bringing on its first chief wellness officer, Wei said.

But those resources will not necessarily be used.

"The biggest barrier to seeking help is stigma," Sapra said. "We think we're supposed to be helping others and not stop to take time for ourselves." There's a stigma in talking about mental health issues among physicians, much less actually receiving treatment, he said.

Among qualitative responses in Medscape's report, there were answers that said providers avoided receiving psychiatric treatment because it could be reported to credentialing or licensing boards.

"One doctor wrote that to seek professional help, the doctor had to drive two hours to another town, didn't use medical insurance and was treated under a different name, all so it wasn't traceable," said Leslie Kane, a senior director at Medscape.

Download Modern Healthcare’s app to stay informed when industry news breaks.

Some state medical boards and hospitals do ask physicians about mental health and substance-use conditions, Sapra said. But New York is fairly liberal, and local hospitals that do ask such questions tend to revolve around "impairment" rather than mental health, he added.

Sometimes, it's not just the fear of not obtaining a license, Wei said: "It's just the fear of being labeled weak." There's a sense that labels will stick with a doctor, closing doors to opportunities where "tougher" mindsets are needed, he said.

"That's what we're chipping away at with our programs," he said.

Younger physicians seemed to respond to mental health and wellness programs better, the survey showed. Millennials were more likely to have confided in a friend or colleague (35%) about suicidal thoughts, compared with Generation X doctors (26%) and baby boomers (23%).

"It seems that millennials feel there is less shame in getting help, and are more willing to talk to anybody, not just a therapist, for seeking help," Kane said.

More research and studies with cited data are being done, especially during the pandemic, that will help normalize seeking mental health assistance, Sapra said.

"It's time for us to realize it's OK not to be OK," he said. "Our younger generation are absolutely leading the charge and asking the right questions."

This story first appeared in our sister publication, Crain's New York Business.