Fighting for the Mental Health of Physicians with Dr. Stefanie Simmons

Doctor Stefanie Simmons advocates for physicians and destigmatizes seeking mental health care

Dr. Frances Mei Hardin: Welcome to this week’s episode of promising young Surgeon. This week, Doctor Stefanie Simmons joins us to discuss her own mental health journey, as well as the incredibly important work that the Doctor Lorna Breen Heroes foundation does to advocate for physicians and destigmatizing seeking mental health care. To provide a quick introduction to the Doctor Lorna Breen Heroes foundation. Many physicians do not seek care for mental health concerns due to fear of impact on their future careers, their licensing, their credentialing, for instance. Because not everyone may have seen these questions before, but the application for a license to practice with an MD has historically included questions like, have you ever sought treatment for anxiety or depression? The foundation’s mission is to reduce healthcare professional burnout and improve well being. A quote that I love from the foundation itself is we envision a world where seeking mental health services is universally viewed as a sign of strength for healthcare professionals. One of their major initiatives has been to remove intrusive mental health questions from licensure and credentialing applications, and as of April 1, 2024, 27 state medical boards had changed their language on their licensure applications. Eleven additional states are in the process of making these changes, and a total of 19 health systems have changed the intrusive language on their credentialing applications, which include names like HCA Healthcare, Medstar Health, and an additional 18 health systems have been in the process of making these changes, such as children’s National Hospital, Johns Hopkins Health System, and Mass General Brigham, to provide an introduction to Doctor Stefanie Simmons.

Doctor Stefanie Simmons is an emergency medicine physician and healthcare executive

Doctor Stefanie Simmons is an emergency medicine physician and healthcare executive. She is the chief medical officer at the Doctor Lorna Breen Heroes foundation. She obtained her MD M from University of Michigan and completed her emergency medicine residency training at the University of Michigan, St. Joseph Mercy Medical center. She is the vice president of clinician engagement for Envision Healthcare’s national medical group in Ann Arbor, Michigan. Thank you so much for joining me today. Doctor Simmons, welcome to the show.

Dr. Stefanie Simmons: Thank you. It’s really nice to be here. please call me Stefanie.

Dr. Frances Mei Hardin: Okay, absolutely.

Stefanie May is a leading advocate for mental health care in medicine

So, Stefanie, you know, it’s really a pleasure to have you on and to share your story and the critical work that you do. I know that you’re a very strong advocate for physicians who feel like they can’t seek mental health care due to concerns about their future licensing implications on their career, and also just the stigma surrounding mental health. What led to your dedicated work in this area?

Dr. Stefanie Simmons: Thank you for the question. Frances Mei. This issue has really been with me from the beginning of my training as a medical professional. And what happened was, really in the first weeks of my internship, my, my best friend, my fast best friend, as often happens in internship when you meet someone and you just click. his wife was pregnant and, so was I as interns, and she had, a crash c section because of help syndrome. And so he had to, start his internship with a premature infant and a wife in the ICU, that the baby actually came home before his wife was able to come home. And so, he would bring her to lecture and I would sort of incubate this baby on top of my pregnant belly sometimes to give him a break. and I watched what he went through and I frankly thought, you know, as a, as a residency and as a profession, we could have done better in supporting him and his family. another one of my friends during residency developed encephalitis, ah, from her pediatrics rotation and was, left with a seizure disorder after that experience. And so, again, I felt like the support and the acknowledgement of the additional struggle that she was experiencing, could have been, there could have been more support. And it really brought to me that we have this, crucible that we go through in residency, this transformative experience where we’re really embracing our profession and learning the craft of our profession. And, there hasn’t always been a place for a lot of life to happen in there, ah, along with those experiences. So it was in my fourth year of residency, when life happened to me big time. So I had a three year old and I was pregnant with my second child and I developed really, strong depression, during my pregnancy and afterwards. So, I knew that I was at the end of my residency career and I was about to start work as an attending. I knew that I was going to be asked about any excess leaves, any mental health care, and I really had a lot of fear about what those questions would mean, for my career. Now, this is 17 years ago at this point, easy to remember because I just need to remember how old my second child is, right? And, I didn’t feel like I could seek care. And to be perfectly honest, I had a rockier first few years of my career than I needed to because I did not seek care at that time. And, in retrospect, I know that things, would have been better for me also for my family during that time if I had. So it was really the culmination of these three experiences together that, from the first few years of my career just really focused me on how we can do better as a profession at, caring for ourselves as well as each other.

Dr. Frances Mei Hardin: Absolutely. And thank you so much for sharing. I’m sorry that you went through that personally. Plus, it’s harrowing to hear about what your co residents experienced during training as well.

Once you were in your early career attending position, mental health became less scary

I do have a couple follow up questions about that. Do you feel like once you were in your early career attending position and already licensed, credentialed, you know, certified, then did you feel like a switch had flipped or that it would be suddenly more accessible, reasonable to pursue healthcare?

Dr. Stefanie Simmons: I did. I did feel more secure in that at that time. And there were a couple of things that helped with this. one is that one of my leaders, at my site, our believe at the time would have been our medical director, and later became our chair, was very open about, their mental health journey and that they had been in therapy, that they had, experienced anxiety. And that made me, I had nothing but respect for this person and their clinical skills and their leadership, and knew that they were highly regarded in our organization as well. And that helped me, to sort of understand that I would be able to get some help and it would be okay. So when I think about stigma, I think about three different types, right? There’s institutional stigma, which are the rules, the questions, the regulations, the applications that stigmatize mental health care. Then there’s internal stigma, which is, what do I think it means about me to have mental health care? And then there’s external stigma, which is, what do I think other people are going to think about me if I have mental health care? Once, I was past that first hump of exiting residency and being, and attending, having seen what the licensing questions were and what the credentialing questions looked like for the first time. And then also hearing from my colleague about their journey, all of a sudden it became a lot, a lot less scary. And one of my goals throughout my career is like, can we, can we make it a lot less scary from the beginning?

Dr. Frances Mei Hardin: I love that. That’s, that’s definitely the goal.

You were in a union residency, and you had maternity leave

You were in a union residency. How did that affect, like, maternity leave in your case, or, I don’t know, if your co resident was able to get paternity leave when his family was so ill and everything like that.

Dr. Stefanie Simmons: Yeah, so that, that’s a great question. And, you. My residency has had a resident union for a very long time. this was not new, even 17 years ago for our program. And it was highly regarded, both by the residents and also by the university. I did have maternity leave. I had six weeks of maternity leave, which I realize even now is the exception, not the norm. I did have to make that time up at the end of my residency, but that also was okay. the, you know, one thing that did happen for my colleague is the healthcare coverage did kick in for him and his wife, even though, like, she was pregnant before he started work. Right. And so, from that perspective, the sort of letters of the law were followed, and there were systems in place that supported us, that may not have been there had we not had that advocacy on our behalf. And I’m very thankful for that time away and for those supports. Having said that, where I felt like there was a real opportunity, was really in the attitudes towards, the residents who did experience difficulties. My son, I’ll speak for myself here, not my co residents, but if anything, I graduated residency and started practice with a better understanding of my patients than if I hadn’t gone through my postpartum depression. and particularly in the emergency department, where we take care of a lot of patients who are having mental health issues, my understanding of the just really concrete physiology that can drive, that phenomenon was much better. I am somebody who had, always sort of had this naturally cheerful affect, and may have had a down day or two, but never had experienced how, your internal chemistry can just rock your world. And starting my practice, I had that experience, and it really did help me with empathy and compassion for others. And so, rather than viewing these experiences as detracting from our ability to be professional physicians, they really added, at least to mine.

Dr. Frances Mei Hardin: Absolutely. I definitely agree with that sentiment. But in terms of the attitude that does need to change, I agree that there’s a way that we could culturally be a little bit more gracious and understanding towards, like, our colleagues. And so one example that I’ll give of that is where I’ve spoken to a resident before who did take a mental health sabbatical, you know, program sanctioned and everything, certainly set up through the PD, all official channels, very significant clinical need for that. Upon returning to the cohort, overall, a lot of people made no comments, which. That’s better than. That’s better than saying something unkind. But multiple people did say, did you enjoy your vacation? You know, those types of comments? And that’s such an easy way to kind of be passive aggressive at the hospital. But I do think that, like, the whole physician workforce, the whole healthcare workforce benefits from elimination of those kind of takedowns of people who are seeking help, you know, for clinical conditions and things like that. So I definitely agree with you on that.

Three pronged problem that physicians face: internal stigma, external stigma

I do want to highlight, like, the framework that you described, that three pronged problem that physicians face. So, number one, internal stigma. Agreed. And, I mean, I’m sure you and I could talk for 5 hours just on the internal stigma. There’s, number two, the external stigma. There’s also, as part of this external stigma, you know, we do seek advice from our peers and things like that, and often it has been my peers in healthcare or other physicians who are telling me, oh, you better not. Like, I would not recommend that squash it down, you know, for at least a few years. and number three is the institutional stigma. And I know that today I’d like to focus a lot on number three, the professional stigma, the institutional. And what I think was so beautiful about your story is that you talk about being in a department where the leader really was a phenomenal role model. Like, they talked openly, they led by example and made their constituents, you know, feel comfortable while also being a phenomenal physician and everything like that. So I don’t think that that can ever be discounted too much, you know, especially in surgery. I will say we see a lot of people who sometimes they act like they came out of the womb this way, just like perfect, the world’s best surgeon, the world’s best hands, which I have so far, you know, not seen on a baby, and then they act like the process, the crucible to get there didn’t happen. And, that, you know, that’s kind of a disservice to the next generation. And, like, all the young people who look up to them and they try to emulate them and they try to imitate that path.

Dr. Stefanie Simmons: That’s right. I have this mental image, Francis may, of someone say, like, I actually performed my own c section. That’s. I think that’s came for me. yeah, so it is interesting. And specialties tend to have different cultures, right? And I would say emergency medicine is definitely not known for being the kindest, gentlest specialty, either, because we really pride ourselves on being able to handle anything, anywhere, anytime. Right. anything that comes through that door, I’m at least going to be able to stabilize and get to the right place. And so, the internal component of that is you’re like, okay, well, if I am supposed to be that for other people, right, then I should be able to be that for myself, too. And, take care of anything, do anything, handle any problem on my own, independently. And any strength, when it is taken to an extreme, becomes a weakness. So that self sufficiency becomes a weakness when you actually do need help. And every human being, and we are social creatures, and every human being in their life is going to come to a point where they need help from somebody. And if you don’t allow yourself to get that help, to have those conversations, even asking your loved ones for help, right, your parents, your siblings, your significant other, for their help, then that becomes a critical weakness in you. And, you know, there’s those strikes that we have that we’ve been selected for in medical training, right? you don’t get to medical school unless you are a perfectionist who likes to work hard, who’s driven by achievement, and maybe even a little compulsive about ticking all of the boxes and crossing all of the t’s and dotting all of the I’s, which are strengths that you need in medicine. You need to check and double check your orders. You need to like to work. And if you’re writing orders on my kid in the hospital, I hope you’re a perfectionist. Right? So those are all good qualities. But if you take those tools and you use them in every single situation in your life, you know, being self reliant doesn’t work very well in a marriage. Being a perfectionist doesn’t work very well when you’re raising teenagers. I’m here to tell you, as a mom of two, two kids, two teenagers and a younger kid right now. so those tools need to be put away in favor of other tools from time to time.

Dr. Frances Mei Hardin: I love that. That definitely resonates with me and what it became, the way that that manifested when I was a resident is that, you know, ent residency is a lot of airway emergencies. It’s a lot of potentially very dangerous, high acuity types of, like, consults, pages. We were getting things that we were dealing with. Not only that, but then there’s all the other grueling hours and call, even when it’s not immediately life threatening in the next couple minutes. And in totality, I did internalize that in this way where it did spill outside the hospital because I couldn’t tell what was an emergency anymore. So, like, you know, something in the house breaks or, you know, like, something small with the lawn. Like, it was very difficult, and I kind of had to spend years untangling. Like, most things are not a big deal, but it’s very true. Some things are an enormous deal, especially primarily, you know, the detail oriented work we do in the hospital, like, attention to orders, attention to surgery, attention to post op care, things like that. But, yeah, it’s interesting because it’s obviously not part of, like, the taught or modeled training in terms of, like, hey, be mindful about this. Like, make sure that you don’t start treating everything this way, right. Because you are not just an Ent. And if somebody is firing on all cylinders 24/7 you know, they’re not going to make it.

Dr. Stefanie Simmons: Yeah, it’s, you know, it’s almost like your scale gets changed. and for me, it was almost, if I’m understanding you correctly, it was almost the opposite for me, where, all of a sudden, my level of what constituted an emergency went way up, right. And so, because I was every day at work dealing with, people who are trying to die, and really critically injured and ill patients, when I was outside of work, it was really hard to get my attention, right. Because, I think if you ask my kids, the quote that I quoted to them most frequently growing up is, nobody’s dying here. Right? Or, like, it’s okay, all bleeding stops eventually. You’re not hurt that bad, you know? and so for me, it was okay. How do I adjust my scale back to normal levels when I’m not at work dealing with critically ill so that I can give the things in my life, my relationships, my fitness, my diet, like, all of those things, the attention they deserve, because, I was either off or on, and I wanted to be on for my life outside of work too.

Dr. Frances Mei Hardin: Yeah. And I think that it’s interesting for people to realize how differently these things can manifest because I totally agree with you. It’s almost like inverse experiences, although we both maybe didn’t feel like we were our best and most mindful selves in life outside the hospital. And I do think that part of it is that we did take home call and things like that. So in terms of, like, lines being blurred, yeah, we were, you know, there wasn’t really an off, unless you really had call coverage or had somehow, like, left town or things like that. And so I just think it’s very easy. Like, my takeaway is just, it’s very easy for any physician, any resident, to have, like, a deranged balance between, like, whether they are over calling, hey, this is a big deal, or if nothing is a big deal to them. I just think that being more mindful about it before we even develop certain habits during training, like, that’s awesome. Any bit that, like, even younger people can kind of go into residency being like, I actually heard, like, this could be a pitfall. Maybe I should look out for that. And if I start to see myself going the wrong way, one year in, I’ll intervene.

Dr. Stefanie Simmons: Yeah, another. Another place, because I love that idea, is like, what can you sort of be on, the lookout for, right. In yourself and in your friends to be like, oh, hey, you’re doing that thing.

As you’re developing your professional identity, bring that home into your relationships

another thing for me was, as you’re developing your professional identity and your team leadership, we operate in some pretty hierarchical ways in the hospital. and some of that has broken down in a very positive way over the past 20 years, but some of that still definitely exists. Right. just think about the phrase giving orders. Right? So I’m going to write my orders. What’s an order? You are telling somebody to do something, you expect them to do it. Right.

Dr. Frances Mei Hardin: It’s true.

Dr. Stefanie Simmons: You get home, that no longer flies in a relationship. And so one thing that, I noticed in myself, I definitely got called out on, at home and have had to be careful with over the years, is, hey, when you get home, there are no orders. Right? So let’s have a collaborative conversation about how things are going to get done. And, that’s with your significant other, but also with your kids, also with your family. and so, that’s one thing as you get acculturated to this medical, hierarchy. First of all, question when it’s helpful, even in the hospital, because the answer is not always in terms of psychological safety and culture of safety, but then definitely be aware of when you’re bringing that home and how it may be impacting your relationships. And I’m happy to say, like, I married my high school sweetheart, Frances may, and we’re still together. So, like, everything worked out. and something to look. Something to look out for and watch for.

Dr. Frances Mei Hardin: Yeah. It reminds me of a story that actually one of my favorite attendings told. really love this attending. Incredible surgeon, like, hard worker, you know, crazy work ethic. Just a true surgeon. And they had gone on a friend’s birthday party. So, like, a rare event, which is, like, left town for a few days, reconnected with the college crew, came back, and so we’re operating the next week. And of course, I was like, oh, my gosh. How was that? That’s awesome. You got the crew back together. And again, like, this person doesn’t leave town a ton. I don’t think that they’re, like, frequently meeting up with the college crew, and their response was, I actually, like, the craziest thing happened. I got kind of miffed because we were all talking in a group, and people were not listening to me, and I kind of was like, I’m attending here. Like, what’s up? You know, like, everyone be quiet. Because they were truly so used to it. And, like, absolutely all of us, like, you know, adored this attending, but whether or not you adore the attending, you are pretty much there to make their life run as smoothly as possible. You know, that’s how we were trained. And, like, everyone’s at your beck and call, and also, no one would ever, ever, ever talk over you. So it was so funny to hear their perspective that their friends were, like, being disrespectful, but I love that. Like, yeah, your friends don’t care that you’re an attending. Like, none of them, you know, they’re not in medicine. This is just the college crew.

Dr. Stefanie Simmons: It’s super important to have those relationships where you’re not in that physician mode, whether it’s at the gym or in, you know, with your family, with your friends in the neighborhood. you know, it’s not that you can’t tell people what you do, but, like, I want someplace where I’m stuff, and I’m not doctor Simmons. I want someplace where I have to maintain my non hospital social skills. It is a different social skill set, and for a lot of us, you know, we spent college grinding and medical school grinding. And it’s not to say we didn’t have a social life, but we didn’t always develop the complex emotional intelligence skills that some of our friends who maybe went into business. Right. Or went into other types of programs, even like teaching and, you know, more relational fields, have had to develop over time. We have a really specific, highly honed set of relational skills, but they’re not necessarily generalizable. And so I love the idea of, hey, maybe don’t make the first time you hang out with those folks, you know, five years into your attending career, make sure you’re keeping those relationships going and making time for people. If nothing else, they will keep you humble and remind you of where you came from.

Dr. Frances Mei Hardin: That’s so true.

Program directors have to fill out evaluations at the end of residency regarding impairment

Well, to switch gears a little bit here, I did want to make sure that we honed in on resident specific issues as it relates to some of these questions. So program directors have to fill out evaluations at the end of residency, including notes regarding performance improvement plans, significant interpersonal issues, and any impairments to physical or mental health. So I’d love to hear about your call to action for program directors, because obviously, even separate from the licensing credentialing questions, we have this legal document.

Dr. Stefanie Simmons: Right. It’s a great question. I would love to see every program director answer the question about impairment only. For instance, if you can. If you can, with clarity and with confidence, say this resident is finishing residency and is not impaired in the practice of medicine, then you should. And if you know that that resident had mental health care during residency, if you know that they, have a diagnosis of a mental health or mental illness during residency, but have not been impaired, are not impaired at graduation, to me, that’s the question you should be answering. Are they impaired now? And I do know of residency directors who are conscientious objectors to that question and say, at this time, this resident has no impairment. And, if they’ve had a formal leave, I think they still will, disclose that. But if it’s mental health care, just like physical healthcare, if it’s not impairing, it’s sort of just that person’s private business and really doesn’t belong on that answer. And so what I would love to see our program directors do is have some solidarity, with each other and with residents in how they answer, and really only answer the question to the extent that’s needed, which is about current impairment. that would make a big difference for residents willingness to care for themselves. And it also needs to be backed up with real access to resources during residency. Right. Can a resident actually access resources on their timeline? Right. And, when they are available to receive care, can they do that without it being part of their evaluation of their performance? Right. Because I think what everyone’s fear is, is, okay, I did great on the shelf. I did great clinically, but I had to take an hour at the end of every other Thursday to go see my doctor. And is that going to make me a bad resident in the eyes of my program? And so program directors really need to develop that culture among their faculty, some of whom may feel otherwise. So they need to develop that culture, and then they also need to push back if the questions that they’re being asked to answer at the end of residency are more invasive and stigmatizing than necessary to ensure competence and lack of impairment.

Dr. Frances Mei Hardin: I agree that often, or at least in what I’ve seen personally, a lot of the pushback is from faculty. And often the rhetoric is something like, my clinic can’t go uncovered, or, you know, like a, case is going uncovered, or something like that. And so, especially in a smaller residency program that does come up a lot. I do talk to or connect with different resident physicians who have personally, like, totally separate from the program, separate from residency training, because they are trying to keep things, you know, like, under wraps where they reach out to private therapists and they no show three visits. And that’s because the or runs later than expected. And so what’s really tough about that is that it’s not even a late cancellation. It’s a no show at times, because I can’t imagine, you know, super impractical, to be like, I gotta scrub out of this case to cancel therapy for tonight. Like, you know, you’d just be throwing yourself to the lion’s den saying something like that. And so. But then in that case, like, I spoke with a resident physician who then got fired from that practice. It was three no shows. Never even met the therapist because they’re a very busy, you know, on a demanding schedule. And so I know that there are programs out there. There are some, like, therapists who specifically, they do specialize in physician healthcare, you know, resident physician healthcare. So they have like, these evening weekend hours that could maybe work around the regular workday and call. But what options do you see as, ah, being very practical for these people?

Dr. Stefanie Simmons: So there’s a. There’s a couple of options. First is just know what your. What your institution offers, because you may assume that there aren’t resources and there may actually be some there. So I’m just gonna. I’m gonna talk, about a couple of different tiers of options for folks. Almost every organization has an employee assistance program, and, they will offer five visits, typically, these are typically like collegiate or master’s level trained counselors. And they are, focused on acute issue, for five. For five visits that will remain private, to you, that you access, that care, in most organizations. So, that’s one option. And they do offer, therapy over the phone and typically, at off hours. But again, make sure that you are asking about general information so you know, what is disclosed, what isn’t first. the second option that has helped some people are asynchronous app based therapy options like talkspace or betterhelp or meet Marvin. And I do not have any financial relationships with any of these, but I do know people who have found them helpful because it is a chance to meet and talk outside of ours. For all of these options, you are typically not, meeting with a, doctoral level prepared counselor, therapist, or psychiatrist. But there are, programs that do have that. So learn what’s available to you through your insurance and through your program. It’s probably a half an hour of research on the Internet, while you’re on call one night to figure that out, or if you do have a residency navigator for well being or a union rep, that would be a great place to go for those resources as well. After that, consider looking what else is available through your insurance that you are provided through your employer, because that may extend outside of your organization. So, it may not be, you know, the psychiatrist that you’re going to be rotating with. Three months later, there may be, an extended network available to you and I’d encourage, people to see what’s out there. There is a mental health care shortage in our country, so sometimes, regardless of ability to pay, the options are, a little sparse on the ground. Another option, is peer support programs. And so many hospitals and health systems will have a confidential peer support program where you can connect with a peer within the organization. And that peer support is maintained as confidential unless it reaches the level of harm to self or others. Right. Just like it would for any conversation, in mandated reporting environment. So those are other opportunities, within hospitals and residency programs to look for.

Dr. Frances Mei Hardin: That’s awesome.

Frances Mei learned interpersonal effectiveness skills as a chief resident

Thank you for sharing all that. And I had heard of like 75% of it, but it’s always good to hear from experts about everything and it’s really tough because, you know, it isn’t one size fits all. Like, not every institution is the same in terms of one thing that I learned only as a chief resident, but, found very helpful. I was recommended to check out the graduate school program, like associated with the big university and the big hospital because the grad school did have PhD students who ran their own DBT skills group. And that’s how. Yeah. Oh, it was awesome. It was once a week, $20 cash at the door like that, you know, to do very small group based, like a true DBT skills. And the leaders of the group, there were two of them. They were both phenomenal. Like, they were really brilliant. They. I personally think that they did an excellent job of like teaching DBT skills. And again, at what I thought was a fair price, it did not talk to the EMR at all, because when you’re a resident, like, you’re, you know, one of my first questions was, does this talk to our EMR? Like, is this documented anywhere? But, that skills group was just such a great experience and it’s what inspired a lot of, like, you know, the brand I created, rethinking residency, everything like that. Because what’s so funny is I was a fifth year when I heard all of that. And, you know, I hadn’t heard anything about, like, distress tolerance, emotional regulation, you know, interpersonal effectiveness. And even from day one, they were introducing these concepts, and I was looking around, I was like, where have you been this whole time?

Dr. Stefanie Simmons: Why isn’t this core curriculum? Why isn’t this core curriculum?

Dr. Frances Mei Hardin: Like, truly, it was going down the list of probably what I could have identified even years before, of M. Like, these would be a superpower to a resident. They certainly would have helped me handle things in a healthier way and process things in a healthier way and also just, you know, get through tougher situations, like kind of with aplomb. Like, they’re such incredible things to master. And I will say that I gave a, I traveled last week and gave a grand round. I gave several resident lectures on interpersonal effectiveness. And I just say, I’m giving this talk, you know, in my capacity as a surgeon who learned these skills. I think they’re very applicable, particularly in the or as I did many anesthesia resident lectures. And I’m not even kidding. At the end of my last talk, a chief raised her hand, and she was like, I really liked this. And she said, I wish you’d come here sooner. I wish I’d heard this sooner. I was like, you and I are of exactly the same mindset then, because she experienced the same. She would be almost graduating now, and she just was like, wow, wish I heard this a couple of years ago.

Dr. Stefanie Simmons: Yeah. But better late than never. And what I would say is, I learned those skills a few years after graduating residency. So, you know, head start. In some ways, I agree that we need to get this much earlier. Probably exposed to it the first time in medical school, and then booster shots right in residency. Frances Mei, there are two more resources that I forgot about that I want to mention. One is emotional PPE, which was an organization started, during the COVID pandemic, but that offers, counseling and therapy to, ah, physicians, across the country. And then the other is a physician helpline, which has trained psychiatrists. They do have more limited hours, but they do have, hours. They are free. They are anonymous, care options, for healthcare workers as well, and available via, a quick online search.

There’s another place to get some of this, um, coaching

There’s another place to get some of this, and that’s with coaching. Coaching can be very attractive to physicians because there are a lot of physician, peers doing coaching out there, and, it’s not mental health care. It is someone who is trained in helping you identify, some of your own, beliefs. Right. And ways of thinking about things. So coaches can be thought of as thinking partners who have some training and who are interested in helping. And for many people, that is a really great option, particularly if you’re sort of mired in a specific way of thought. In residency. Now, coaching is also not highly regulated. Right. and so it’s worth talking to a prospective coach about where and how they are trained and coaching they have, so that you know what sort of, training they have. And before you get into that relationship.

Dr. Frances Mei Hardin: Yeah, that makes sense. I’ve definitely seen some heterogeneity, across. Across that market.

If somebody lives in a state where intrusive questions are still on the applications

If somebody lives in a state where intrusive questions are still on the applications, like, let’s say that they’re not in the 27 where it’s changed, eleven where it’s pending, then what advice would you give that person who maybe has been thinking, oh, I want to seek mental health care, but, you know, I’m uncomfortable, I have hesitations. What would you advise them? Modern day?

Dr. Stefanie Simmons: That’s great, great question. I’ve got, four things.

Dr. Frances Mei Hardin: Boom.

Dr. Stefanie Simmons: that I would advise. The first thing is get help. Don’t let that dissuade you from getting help. Get the help you need, because, we don’t want to lose you and we don’t want to lose part of you either. Right. So, obviously we don’t. We don’t want to lose people to suicide, and that happens, but we also don’t want anyone to live a life that’s limited, that doesn’t have to be right. And so please, please, please get help. Once you’ve gotten help, think about how you are going to communicate that help. And if you have a very great program director, they may be able to help you with this as well. but you can also contact legal services. you can work with an employment lawyer and write up a paragraph about what your experience is. If you are not impaired by the help you are getting or, by the diagnosis you have, then you need to be able to communicate that you have engaged in self care to prevent impairment and that you are not impaired. the Americans with Disabilities act exists, right? So if you have a need to receive care, for a diagnosis, you have, you know, you should be able to get that care, and you should have reasonable accommodations made for you to receive that care. it can be helpful to write that up ahead of time, so that if you’re asked to communicate what care you received and how you received it, you know how you’re going to communicate that already. The third thing you can do is, you can write your state medical board and ask them to change their questions. We know of several states where medical students and residents have really led the way in asking for those changes and articulating the need for those changes. Minnesota, is one of those states, where, students are, they’re actually residents now, but students led the way, to get those questions changed. And your voice is very powerful. If, you know, if I’m a 47 year old physician with three kids living in a city, I’m probably not just going to up and move on a whim based on what state has which questions, right. if I’m just starting my career, that might be something I can consider. And if it is something you would consider, articulate that because we have a workforce shortage and, states do not want healthcare workers to go somewhere else because of something simple they could change. And this falls into that category of something simple they could change. So there’s a way, actually on our website, to write your state medical board for nurses to write your state nursing board, and you can also start state legislation to fix this problem for all licensed healthcare workers in your state. So we’ve been talking about physicians today, which makes sense, but all licensed healthcare workers actually face these questions. And so when states have taken this up as a state legislative issue, including all licensed healthcare workers, is the fair thing to do. Right. We want all of our teams to be safe, and feel comfortable seeking care. And there are several states that have laws currently in process. Delaware, Michigan, Iowa, Idaho, all have these in process. Virginia has passed theirs, to limit these questions. And so I just encourage you to seek care, think about how you communicate that and advocate for change.

Dr. Frances Mei Hardin: Well, that leads us very beautifully and very naturally, because I will say we will have the link, of course, to those resources at the bottom of the podcast and everything. And so definitely encourage people to check out what you’re describing, the ways in which people can get involved and advocate or write to their own legislatures. Especially if you live in one of those states where the change still needs to happen, the intrusive questions are still there. So they have a beautiful map on the website. We’ll get that all linked up for you guys.

Doctor Lorna Breen Heroes Foundation focuses on professional wellbeing for healthcare workers

I just wanted to kind of close out our discussion with a focus on Doctor Lorna Breen, heroes Foundation. Of course, I did a little introduction, but I think for people who haven’t heard about the conceptions, some of the major initiatives they can get into right now and ways that they can get involved, I’d love if you would share it with us.

Dr. Stefanie Simmons: Sure. A lot of people know Lorna’s story, but I think it’s worth hearing just as how the foundation started, Doctor Lorna Breen was an emergency medicine physician practicing as the department chair, at New York Presbyterian Hospital in Manhattan. Came, back from vacation with her family for the, first wave of pandemic to treat patients, and she led her department through those first several weeks, actually contracted COVID herself. Came back right away, as soon as she had been a febrile for 24 hours, and, couldn’t keep up when she came back because she was still suffering from the sequelae of her infection, she eventually had to be, removed from New York, and receive care in Manhattan for what likely was neuropsychiatric sequelae of COVID infection, and was so burdened by the concern that she may not be able to practice again, after her first ever treatment for mental health, as she died by suicide and, her cause of death. And her story was published in the New York Times less than 12 hours after her death, against the wishes of her family. And what happened after that, was an outpouring from healthcare workers across the country and even the world to her family, sharing their stories, sharing that Lorna’s concerns are not unique. Sharing that burnout and workplace challenges, including excessive administrative burden, difficulties in accessing care, existed before the pandemic actually were identified by the National Academy of Medicine as a pandemic. Before the pandemic, just a few months before, in sort of oppression. At the same time, their Virginia senator, Tim Kaine, contacted, Lorna’s sister and brother in law. She, was a Virginia native, and so were they, and offered his condolences, but also, asked what could be done. And, so that started, the foundation’s relationship with the doctor Lorna Breen Health Care provider Protection act, which, was passed in 2021, and funded projects and programs to address professional wellbeing for healthcare workers, including the workplace Change collaborative, which is 44 grantees for projects and programs around the country, and the Impact Wellbeing campaign, which was performed in partnership between NIOSH and the doctor Lorna Breen Heroes foundation. The Impact wellbeing campaign is six steps that hospitals and health systems can take to address professional well being. Step number three is fix your credentialing questions, like, don’t ask these questions of people. Let them seek care without being worried about having to disclose it when it’s not necessary. That law is actually up for reauthorization and refunding this year. So another thing you can do on our website is to write your legislator, your representative, to support that reauthorization and funding as a foundation, we advocate for reduction, of, institutional stigma, and for state and federal laws that support health workers. We raise awareness about mental health, and burnout, and we advance solutions. So we help advance the best practices and solutions that are evidence informed that have been shown to work, and we help promote those at the institutional, state, and federal level.

Dr. Frances Mei Hardin: Well, thank you so much for kind of the thorough explanation. You know, doctor Lorna Breen’s story is extremely powerful, of course, and what the foundation’s work is doing is very impactful. Like, I think that even as a person who is now early career, like, when I first learned of the foundation, saw the work it was doing, it did inspire hope because, you know, we could see the change happening. Obviously, your guys resources are like, extremely high quality, evidence based, and it just, it is such a large scale, incredible movement. So, you know, really appreciate you kind of going over all of that with us.

Do you believe in karma? Do you believe what we put out

I do want to close with our recurring segment, do you believe in karma?

Dr. Stefanie Simmons: Do I believe in karma? That’s a great question. I think I have a very rudimentary, understanding of what karma means. Probably more of a pop culture understanding than anything else. And so I’ll answer on that level. And you can take this answer for what it’s worth. I believe what we put out into the world comes back to us. And if you face the world, with an open attitude and optimism and, a sense of the goodness of people, that is often what you’ll experience, the world as. And so in that respect, I guess, yes, I do.

Dr. Frances Mei Hardin: I love that. Yeah, that’s my understanding as well. I’m certainly not an expert, nor like a, ah, then, guru.

Frances Mei discusses resident physician stories on Promising Young Surgeon

Thank you again for joining me today, and it’s been such a pleasure to chat with you and learn more about this incredibly important topic that affects so many physicians today.

Dr. Stefanie Simmons: Thank you.

Dr. Frances Mei Hardin: Follow me on Instagram at Francesmay, MD and rethinkingresidency. Visit my website, rethinkingresidency.com, to learn more about resident physician stories and ways that residents can most effectively navigate the game of residency. I cannot wait to connect with you on the next episode of Promising Young Surgeon.