COVID-19 ER Doctors Share What They Need for Better Mental Health

For Aaron Epstein, MD, the medical director of emergency medicine at Northwestern Medicine Lake Forest Hospital near Chicago, Illinois, time outside of the hospital was no reprieve from the early days of the COVID-19 pandemic. He'd find himself even more worried at home than at work, mentally preparing for what the next shift would be like for him and his staff.

“We all went into a field that is unpredictable, and we’re ready for anything that comes through the door. But I’ve been an emergency room doctor for 20 years and never anticipated working in a pandemic like this.” Epstein tells Verywell. "You go home and watch the news and not only worry about your patients, but about yourself, your family, your staff and colleagues."

COVID-19 is still taking a mental toll on physicians. And Epstein considers himself lucky that his hospital is willing to do something about it.

“The old school of medicine is that you suck it up," he says. "As time went on, I saw how important it was to take some time for myself. The hospital I’m affiliated with has a more modern attitude of medicine as mind, body, and soul—you have to take care of yourself so that you can take care of others. It’s now more OK to raise your hand and say 'I need help.'”

But that's not universally the case. A poll from the American College of Emergency Physicians (ACEP) shows most doctors have felt added stress since the pandemic began, most also say concern about stigma keeps them from seeking out help for their mental health.

Physicians Often Don’t Seek Mental Health Help 

The ACEP poll, published last fall with responses from 862 ER doctors, found that that most of them chose not to seek out mental health care during the pandemic. 

Among the poll’s findings: 

• 87% of emergency physicians said they were more stressed since the start of COVID-19 
• 72% reported experiencing more professional burnout
• 80% say the cause of their stress or burnout is concern about family, friends, and personal health.
• 60% say lack of personal protective equipment (PPE) or other essential resources was responsible for their stress

Of course, emergency room doctors were not the only healthcare professionals feeling the stress of the pandemic. A September survey released by the Physicians Foundation found that:

• 58% of doctors felt burnout during the pandemic compared with 40% in 2018
• Close to 80% said lack of patient compliance with social distancing or masking was a source of their frustration
• 8% of doctors had COVID-related thoughts of self-harm

Stigma Is a Blocker to Care

Mental health treatment is generally available as part of health insurance coverage or even as a benefit of working in a hospital. Yet nearly half of emergency physicians polled said they were not comfortable seeking mental health treatment. Close to three quarters said they feared consequences in the workplace, and more than half said they worried about professional consequences if they sought mental health care. 

“Physicians seeking mental health treatment in our current system are rightfully concerned about possibly losing their medical licenses or facing other professional setbacks,” Mark Rosenberg, DO, MBA, FACEP, president of ACEP and chair of emergency medicine at St. Joseph's Health in New Jersey, tells Verywell. “The pandemic emphatically underscores our need to change the status quo when it comes to physicians’ mental health.”

Mental Health Help Is on the Way

In early March, members of Congress reintroduced the Dr. Lorna Breen Health Care Provider Protection Act, named in honor of an emergency room doctor who cared for patients during the pandemic and took her own life in April 2020. Rosenberg says the bill carrying Dr. Breen’s name “will be a lifeline for emergency physicians who absorb extraordinary levels of grief, anxiety, and other stressors, but feel their only option is to struggle in silence.”

The bill, if passed, will authorize funding for:

• Mental and behavioral health training and services for health care professionals 
• Education campaigns to encourage healthier work conditions
• Research on causes of physician burnout and its impact

ACEP and other medical organizations are also calling for the removal of existing barriers to seeking treatment, including the fear of reprisal. ACEP encourages professional support and non-clinical mental health initiatives, such as peer support, for physicians. 

“Changes to the culture of medicine will not happen overnight,” Rosenberg says. “But the pandemic is shining a light on the urgent need to protect physician mental health and address contributing factors to burnout and stress that have been swept under the rug for too long.” 

More Staff and More Funding Matter Too

Bret Nicks, MD, a professor of emergency medicine at the Wake Forest School of Medicine in North Carolina, adds that more resources can alleviate the burden on physicians who feel like they must plow through patient care. Earlier in the pandemic, when SARS-CoV-2 was even less understood, ER doctors bore the brunt of care because nobody knew how to treat patients in other departments.

"We are not long-term care physicians, and leaving patients in the ER once diagnosed adds challenges for those patients and for the ones waiting to come in and be assessed," Nicks says. He adds this could happen again if new case surges occur and overwhelm hospitals.

The solution, Nicks says, is a renewed commitment to recommendations made in a 2006 report from the Institute of Medicine (now the National Academy of Medicine):

• Significant funds to ensure that America's emergency departments, trauma centers, and medical first responders are fully equipped and ready to provide prompt and appropriate care
• Actions to reduce crowding of emergency rooms, such as virtual triaging
• A boost in the number of specialists involved in emergency care

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.