Why We Need Change
I share all this not to garner sympathy, but to provide context for my passion and commitment to inspire and create change in my own health system and others. I am by no means the only second victim. In fact, every healthcare professional who is part of their patient’s journey of disease and healing, recovery, or death is a potential second victim. We are all at risk, because we simply can’t guarantee perfect outcomes, even when we give the best care possible.
Explore This IssueApril 2020
Despite years of widespread academic and media acknowledgement of physician burnout, most health systems and hospitals likely still underappreciate the prevalence of burnout in their own medical staff and workforce. The competing demands and the ever-growing gap in revenue versus volume achieved continue and change our entire daily experience from one of joy to one of frustration, anger, extreme fatigue, and hopelessness. Despite increased awareness, effective systematic solutions for individuals and organizations are not obvious and typically slow to implement. Physician suicides are tragically still occurring, upwards of 400 or more annually (NAM Perspectives. 2016. Discussion Paper, doi: 10.31478/201606a).
I have observed that health systems have a blind spot for understanding the unique challenges and specific mental health support needed to adequately address the sentinel events physicians and healthcare workers may experience.
The Problems with Employee Assistance Programs
All employers, including academic centers and health systems, assume mental health is adequately addressed because human resources offers an Employee Assistance Program (EAP) as a benefit. EAP is a mandate by the U.S. Office of Personnel Management, described as a “voluntary, work-based program that offers free and confidential assessments, short-term counseling, referrals, and follow-up services to employees who have personal and/or work-related problems.” Most of you reading this article will likely never go to human resources and ask for mental health support through your EAP. Physicians generally have a negative bias against human resources, associating the department with receiving corrective action, being let go, or being fired. We all know about and fear the stigma of letting anyone know we need help. Who would share that they are in crisis with their employer and have that information get in the human resources file or be reported to the state board?
I have observed that health systems have a blind spot for understanding the unique challenges and specific mental health support needed to adequately address the sentinel events physicians and healthcare workers may experience. —Julie L. Wei, MD
Furthermore, the EAP service is often a third-party vendor, and while it provides several free sessions, often no one has vetted the list of mental health counselors it provides. The providers listed may no longer take new patients, sometimes don’t call back, and often do not have experience treating physicians. I have yet to meet a physician colleague who has ever utilized this service as a way to access mental health counseling. After using free EAP sessions, people who require ongoing counseling still need to find a provider who is in network for their insurance plan.