Tanya Wildes, MD, is one of those doctors who was born, not made. She’s known that medicine was her calling since she was four years old, when she instinctively reset her sister’s dislocated finger (please don’t try it at home, she warns). And yet last August, after 12 years of practicing medicine, she decided to resign from her job as an oncologist in St. Louis, Missouri — and, at least for now, leave medicine altogether.
Dr Wildes, who requested her workplace not be named for fear of retaliation, remembers three specific events that led to her decision to leave the field she adored. The first occurred after a long day of working with patients. When she came home, her son wanted to fly his model airplane in the park. She said no. “I knew if it crashed into a tree or something, he’d be devastated and I just knew I couldn’t comfort him,” Dr Wildes remembers. “I had nothing left to give.”
The second event took place the following week, when Dr Wildes went on a road trip with her family. She read books, played with her son, laughed, and even climbed a tree. “I didn’t cry that entire week,” she recalls. “Then I went back to work and cried every day. I’d struggled with seasons of depression before, and I know that depression doesn’t go on and off like a light switch. This was situational.” Not long after that, she was speaking with her older sister about her challenges, and floated the idea of quitting. “She’d championed me as a woman in medicine my entire life, but she immediately said, ‘Yes, that’s what you have to do,’” Dr Wildes says. That conversation was event number three, she says: “It became absolutely clear. I needed to leave.”
Dr Wildes is just one member of what appears to be the beginning of a mass exodus of medical professionals from their field. About 40% of nurses considered leaving or planned to leave their job in the next six months, according to a 2021 American Nurses Foundation survey of 22,316 nurses. To compare, the turnover rate for bedside registered nurses in 2019 was just under 16%. Between March and June of last year, 8% of doctors closed their practices due to COVID-19, with 43% of physicians reducing their staff because of the pandemic, a June 2020 survey by The Physicians Foundation found.
The stressors of the pandemic have taken their toll on pretty much every corner of society, but the strain has been particularly pernicious for medical professionals, who have faced a combination of uniquely frustrating, taxing, and even traumatic circumstances. Lynn Howie, MD, left her oncology job in a rural area in the South this January for a variety of reasons: a lack of PPE, untenable staff cuts that left her without support, and worries about spreading the virus to her family or catching it herself. Some doctors also shouldered significant financial burdens, since the pandemic had increased their overhead costs (due to stricter PPE requirements) while reducing their patient volumes (as many people began delaying non-essential care).
Prior to March 2020, Dr Wildes was already juggling her work with cancer patients, her research projects, and her family. “Before COVID-19, there was just enough bandwidth in our lives to deal with any extra issues that arose,” she says. “It meant that if someone got a flat tire, we could handle it. But a pandemic? No. That pushed everything from being at 93% capacity to being at 102% capacity all of the time.” She pushed through for as long as she could, but when the strain began taking her away from ability to spend time with her son and husband, she knew enough was enough.
Mental health concerns and burnout are major reasons droves of healthcare workers are leaving their field. More than half of doctors, nurses, and emergency responders working with COVID patients could be at risk for mental health conditions, including acute traumatic stress, depression, anxiety, substance abuse, and insomnia, according to a University of Utah Health study conducted in April and May 2020. ICU workers are especially at risk for meeting the threshold of post-traumatic stress disorder, research King's College London released in January 2021 indicates.
“Everyone is dealing with the mental health impacts of the pandemic, but if you’re a healthcare worker, you have an extra burden of constantly being seen as a hero,” says Michi Fu, PhD, professor and licensed psychologist. “We feel like we have to be a little bit superhuman. In a field where you save others, there’s much higher risk of burnout than other professions already, and now there’s more vicarious traumatisation of seeing what others are going through with COVID-19, sometimes being the last one to pass a message along from a loved one.”
And the mental load is even heavier for healthcare workers who are people of color, Dr Fu adds. They have seen firsthand how Black, Latinx, and Indigenous patients die of the virus at higher rates. Additionally, many Asian American doctors have experienced more racism during the pandemic, amid a backdrop of increased violence targeting Asian people. Many point to former President Donald Trump’s comments referring to COVID-19 as the “China virus” as a catalyst that encouraged anti-Asian sentiments and hate.
Lucy Li, MD, an anaesthesiology resident at Massachusetts General Hospital, says that after a shift in March, a man began following her, yelling profanities. He shouted, “Why are you Chinese people killing everyone? Why the f--- are you killing us?” Dr Li was terrified. “Even though I knew the hate was out there, I was shocked still when it happened to me directly,” she says. She was also offended: She was risking her health every day to save lives, not harm them.
Pre-pandemic, Dr Li already had mental health support, including a therapist, which she says made all the difference in her ability to move past the incident and continue doing her job. She praises her hospital for setting up support systems for residents. Her director even helped create a national program called Emotional PPE, which connects medical professionals with free mental health services.
But not all healthcare workers can access this type of support, in part due to a pervasive stigma around mental illness among medical professionals. Research presented at the American Psychiatric Association’s annual meeting showed that the suicide rate among physicians is more than double that of the general population, and yet other studies have shown that few seek out mental health care. Approximately 50% of physicians have experienced inappropriate anger, tearfulness, or anxiety as a result of COVID-19’s impact, yet only 13% of physicians have sought medical attention for a mental health problem caused by COVID-19, according to The Physicians Foundation’s September 2020 survey.
Medical professionals often cite fear of retaliation for seeking support; they could be concerned that asking for help could interfere with their licensing, according to a 2017 study in Mayo Clinic Proceedings. Others feel they don’t have the time or bandwidth to seek help, due to their demanding workloads, Dr. Li adds. These and other barriers can lead to burnout, more folks leaving medicine — and even more dire consequences.
Lorna Breen, MD, died by suicide in April 2020. She was a sister, a “cool aunt” to her eight nieces and nephews, and an emergency room director at New York Presbyterian Allen Hospital in Manhattan.
“She was always helping people, and jumped into action whenever she could,” Corey Feist, Dr Breen’s brother-in-law, tells Refinery29. He recalls a time a cab he was sharing with Dr Breen bumped into a cyclist’s tire. The driver got out to assess the damage, and the cyclist punched him square in the face. “Lorna immediately flipped into, ‘I’m an ER doctor, and I’m going to take care of everyone,’” remembers Feist, who is chief executive officer of the University of Virginia Physicians Group. This attitude was typical for her. Even when she contracted COVID-19 last spring, after weeks of working on the front lines of the pandemic, she made PPE care packages to send to her coworkers while she was homesick, Feist says. She returned to the emergency room and worked 12-hour shifts, often staying late to help out at a time when supplies were scarce and hospitals in New York were overwhelmed.
On 9th April 2020, though, she called her sister, Jennifer Breen Feist, and said she couldn’t get out of her chair. She hadn’t slept in a week and was overworked, Dr Breen’s family noted. Although she’d had no prior mental health problems, she was struggling now — but she was afraid to seek help.
A few weeks later, she died by suicide. Suicide is always complex and multifactorial, but physician suicide is all too common, says Gary Price, MD, president of the Physicians Foundation. "A little more than one physician per day dies by suicide — 400 doctors a year," he says. "That means a million patients lose their doctor. This is not something we can accept as the status quo."
“Our New York-Presbyterian and Columbia family continues to mourn the passing of Dr Lorna Breen,” said a spokesperson for New York-Presbyterian and Columbia University Irving Medical Center. “Dr Breen was a heroic, remarkably skilled, compassionate, and dedicated clinical leader who cared deeply for her patients and colleagues.
“Throughout the COVID crisis, our hospitals have faced unprecedented challenges, and our doctors, nurses, and other frontline healthcare workers have answered these challenges in heroic ways,” the statement continues. “We have worked to give them the support and resources they need to fight for every life while protecting their own health and safety.”
After Dr Breen’s story was published in The New York Times, Corey Feist says that their family received an onslaught of messages from physicians saying they had similar fears around asking for mental health support.
The family founded the Dr Lorna Breen Heroes’ Foundation and, along with Sen. Tim Kaine of Virginia, is working to pass federal legislation to prevent and treat burnout and mental health conditions among healthcare professionals. The bill was just approved for funding, and has bipartisan support.
“I can’t underscore enough that there’s a huge gap in understanding across the healthcare industry of the strategies that’ll work to improve mental health among healthcare professionals,” adds Corey Feist. “And the healthcare industry needs to act now to support the well-being of their workforce or we’re at risk of losing a large segment of our caregivers.”
In order to effectively treat this problem, hospitals, licensing boards, and healthcare institutions across the country and globe will need to come together, says Neil Greenberg, MD FRCPsych, a professor who researches mental health in military and healthcare settings at King’s College London. He suggests training managers to better identify the warning signs of mental health issues and to feel confident speaking with staff about their wellbeing.
Setting up peer support groups can also be beneficial. “Nurses have been through probably the worst year of their careers — they’ve had such pressure and trauma and relentless work,” says Jill Maben, OBE, PhD, RN, a professor of health services research and nursing who has been studying nurses’ wellbeing for 20 years. “But what seems to help nurses most is talking to each other.” During the pandemic, it’s been difficult to have casual get-togethers, however. Formal peer groups, like those provided in the Schwartz Rounds program (available in parts of the US and other countries) give healthcare workers a regularly scheduled time to get together and talk to the emotional, social, and ethical issues that take place at work in a supportive way that can be cathartic.
“It needs to be okay to say, ‘I’ve made these decisions and I’m not sure I’ve got it right,’” Dr Greenberg says. “Everybody has been in the same storm, maybe not the same boat. There have been no right answers over the last year. The story can’t be, ‘It’s all my fault’ or ‘It’s all my bosses’ fault,’ but that we’re all in this terrible storm together.”
Without meaningful dialogue, the right resources, and manager support, the mental health of medical professionals will continue to suffer and they will continue to leave the field. When that happens, “it inevitably impacts patients,” Dr Price says. “They lose access to healthcare. There’s going to be a growing problem of physician shortage over the next 10 years. This is felt mostly in rural areas where the doctor who leaves may be the only doctor around.”
When it comes to quitting jobs, everyone has to make the decision that’s right for them and their mental health. But Dr Greenberg suggests that medical professionals who are thinking of leaving their field consider seeking treatment first: Speak to your manager if you can, look into a program like Emotional PPE, or talk to a friend or family member you trust. “We know that many healthcare staff have expressed an intention to leave the profession, and it is likely that many of those intentions are linked to poor mental health,” Dr Greenberg says. “People think if they leave, things will automatically get better. But that’s often not the case.”
Dr Wildes, however, says she’s confident that leaving her job was the right call for her. “Leaving was a decision I made in great mental wellness, as a protective strategy for my mental health,” she says. “If I had continued to persist, I think it could have caused depression or led me towards burnout. I’m grateful I had the privilege to be able to leave.”
She plans to go back into medicine in some capacity at some point in the next year or two, but in the meantime she is enjoying spending extra time with her son. “My biggest fear when I was working was that when my son was 80 he’d tell his grandkids about the pandemic and his memory would be, ‘My mom was really a mess,’” she reflects. “But on New Year’s Eve, I asked him what he would say if he could go back to the beginning of 2020 and warn himself about what was ahead,” Dr Wildes says. “He looked at me quizzically and said, ‘It wasn't that bad a year.’ And for me, that was enough.”