Time to Enforce Physician Protections in Lorna Breen Act at Federal Level

Dr. Lorna Margaret Breen was a 49-year-old emergency room physician in New York City, a frontline physician who treated patients with COVID-19 and contracted the virus and recovered.

She died by suicide on April 26, 2020. When I learned about her death, it resonated with me not only because I had friends and colleagues working in hospitals throughout New York City, but also because Dr. Breen and I were the same age. Her foundation website describes her as “passionate about patient care and … always looking for ways to improve the patient experience.” These are words I hope that others would use to describe me.

Like Dr. Breen, I am a committed patient advocate, but advocating for myself and other physicians has proven to be more difficult than I could have anticipated. In the United States, 300 to 400 physicians die by suicide each year. Many others, especially Black physicians, suffer in silence, fearful that intentional efforts to protect their physical and mental health will not be met with support or resources. Black physicians fear not only losing their medical license, but also risking their professional reputation and livelihood when demonstrating vulnerabilities.

Dr. Breen’s family and friends channeled their grief by working to ensure that physicians have access to resources and protections to address their own health. Their efforts led to passage earlier this year of The Dr. Lorna Breen Health Care Provider Protection Act. This federal law establishes professional protections, education, research, and grants for training health profession students, residents, and health care professionals in evidence-informed strategies to reduce and prevent suicide, burnout, and mental and substance use disorders among the health care workforce and promote well-being.

When the legislation passed, I celebrated—but the moment of joy was almost immediately replaced by the reality that these protections will not trickle down to all. Many physicians, particularly Black women physicians, will continue to balance the duties of advocating for our patients and our own health under the threat of being labeled “angry,” “not a team player,” “hostile,” and “aggressive.”

In the article “Superhuman, but Never Enough: Black Women in Medicine,” Singh Bajaj, M.D., and colleagues wrote, “Black women suffer from a version of the Goldilocks dilemma: They are either insufficient and unsuitable or boastful and overdone—never just right. In fact, if they do speak up about inequities, advocate for reform, or seek to advance institutional diversity, these physicians can be caricatured as just another angry Black woman and dismissed as being unreasonable and melodramatic.”

A study released in July by the Association of American Medical Colleges found that Black women physicians are more likely to report mistreatment or discrimination in the previous year at their workplace. They are more likely to experience identity-based discrimination, microaggressions, and overt racism. They are underpaid compared with their counterparts yet expected to accept a higher workload, especially organizational duties.

I am a federally employed Black woman physician. Federally employed physicians are not afforded traditional workplace protections such as caseload caps, administrative support, professional time, or even employment contracts. Minority physicians and physicians employed in nontraditional settings are vulnerable to professional burnout, according to a report in the May 19 JAMA Network Open. Laws protecting most physicians are a phenomenal achievement, but we need protections for those most disenfranchised. As a patient advocate, I am persistent in my efforts to improve health access and treatment outcomes, but when advocating for myself and other physicians, it often feels like silent screaming. In the early stages of my career, learned helplessness would have best described my approach to coping with a sometimes hostile work environment. But as the physical and mental health stress began to manifest, I took active steps to advocate for myself as quickly as I would do for patients.

I have learned to mostly ignore the background noise of microaggressions and intentional harms so the joy I feel treating many of the most vulnerable patients is not sacrificed in an effort to preserve my own health. So the question stands, How do you evoke meaningful change in a system as vast as the federal government?

After all, the federal government is the nation’s largest employer. The federal government regularly sets the standard for workplace protections but as the architect, not the builder. The federal government provides its employees with vital missions—including serving as the employer for physicians providing health care to prisoners, members of the military and veterans, researchers, and physicians addressing public safety and the safety of food and drugs. Therefore, it is critical that future federal legislation reflects a commitment by the federal government to protect the well-being of all federally employed physicians and other health clinicians by providing access to the protections included in the Dr. Lorna Breen Health Care Provider Protection Act: implementing patient caseload caps and ensuring sufficient administrative support, on-call compensation, and employment contracts. In short, it is well past time for the federal government to actively support civil servants not just through “acts” but action.

To educate state and federal legislators on these and other issues that impact psychiatrists, APA members are encouraged to get involved in one of APA’s advocacy programs. Don’t leave it to others to do what you can do. More information and the latest issues on which APA needs your advocacy are posted https://www.psychiatry.org/psychiatrists/advocacy. ■

Dionne Hart, M.D., is a member of APA’s Council on Advocacy and Government Relations, an APA delegate to the AMA House of Delegates, a member of the Minnesota Medical Association Board of Trustees, president of the Minnesota Association of African American Physicians, chair of the National Medical Association’s Region IV, and the AMA liaison to the National Commission on Correctional Health Care Board of Representatives. She can be reached on twitter.