Richard Payerchin

Physicians and their staff should beware a 

 that is targeting health care providers.

 was published Sept. 19 by the Health Sector Cybersecurity Coordination Center (HC3), within the U.S. Department of Health and Human Services. The campaign uses official-sounding language to convince recipients to click on a bogus download that is really a program that attempts to steal email credentials.

The sector alert stated: “The campaign has a subject of: “Data from (Victim Organization Abbreviation): "Important read about - Monkey Pox – (Victim Organization) (Reference Number) and utilizes an “Important read about Monkey Pox” theme.

“Inside of the email is a PDF with a malicious link which lures the recipient to a Lark Docs site. “The site is Adobe Doc cloud themed and offers a secure fax Monkey Pox PDF download.

"Clicking the download attempts to harvest Outlook, O365, or other mail credentials.”

HC3 recommends the following actions to help protect 

Protect each account with complex, unique passwords. Use a passphrase and/or a complex combination of letters, numbers, and symbols.

In general, avoid opening unsolicited emails from senders you do not know.

Do not open a link or an attachment in an email unless you’re confident it comes from a legitimate source.

Do not download or install programs if you do not have complete trust in the publisher.

Do not visit unsafe websites and do not click on pop-up windows that promise free programs that perform useful tasks.

This aricle originally appeared on Medcical Economics®.

Articles

Don’t click on links or attachments unless you’re sure they are legitimate.

Feds warn of monkeypox-themed malicious email campaign targeting health care providers

Across the nation, 17 states have taken steps to eliminate physician licensing questions that create barriers to physicians seeking mental health care.

 to change the way physicians, other health care workers and executives think about mental health and its effects in the medical field.

At least 80% of physicians said they support eliminating credentialing questions about mental health care that effectively become barriers to physicians seeking that care, while 47% said their practices, health systems never or rarely took action on those questions, according to the latest survey by The Physicians Foundation, published Sept. 15.

J. Corey Feist, JD, MBA
Dr. Lorna Breen Heroes' Foundation

Physicians are trained that “you’re supposed to be perfect all the time,” said J. Corey Feist, JD, MBA, brother-in-law to 

 and cofounder of the foundation that bears her name. Breen was a New York City emergency room physician who died by suicide in April 2020, physically and mentally exhausted from caring for COVID-19 patients and dealing with the illness herself.

State and specialty licensing boards, hospital leaders, and insurers ask physicians about their mental health histories. Acknowledging mental health care could be perceived as an impairment that jeopardizes physicians’ professional status, one that is deeply tied to their personal identities.

“So they just don’t get help,” Feist told 

The Dr. Lorna Breen Heroes’ Foundation has developed the 

Licensure & Credentialing Strategy Tool Kit

 to change the licensing and credentialing questions:

Audit credentialing applications and peer review forms.

Change invasive or stigmatizing language around mental health.

That final step is crucial “because if we make the changes and the consequences of getting mental health treatment are still opaque to doctors, they won’t go,” Feist said.

“So that third leg, communicate, is critical,” he said. “Doctors deserve to know what the rules are, it’s that plain and simple, particularly now more than ever.”

Many doctors – Breen included – believe if they seek mental health care, there will be ramifications for their professional licenses. Sometimes that is true, but in many cases, that is not correct, Feist said, citing conversations with family members of physicians lost to suicide in the last two years.

“No better example than, sadly, my sister-in-law, who truly believed that her license to practice medicine in New York state was at risk when she received the first and only mental health treatment of her career after she took care of patients during the pandemic,” Feist said. He credited New York as one of the 17 states that have taken measures to support physicians’ mental health.

As of Aug. 24, 2022, 17 states, including California, Hawaii, Illinois, Kansas, Maine, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New York, North Carolina, North Dakota, Texas, Utah and Washington, have aligned their applications to either:

Ask one question consistent with the Federation of State Medical Board’s recommended language that addresses all mental and physical health conditions as one, with no added explanations, asterisks, or fine print.

Refrain from asking probing questions about an applicant’s health altogether.

Implement an attestation model that uses supportive language around mental health and offers “safe haven” nonreporting options to physicians who are receiving care.

With 33 other states, their medical boards, and thousands of insurers, hospitals and health systems, the work is far from over, Feist said. But the changes can be made quickly and with little cost if there is will to do so, he said.

Lorna Breen, MD
Dr. Lorna Breen Heroes' Foundation

Breen’s life, work, and death made national news as physicians, health care workers, and everyone dealt with the COVID-19 pandemic. The Physicians Foundation survey found 23% of 

Dr. Lorna Breen Healthcare Provider Protection Act

. That legislation, now approved by Congress and President Joe Biden, aims to reduce and prevent suicide, burnout, and mental and behavioral health conditions among health care professionals.

In the past year, The Physicians Foundation survey reported 16% of physicians knew a physician who considered suicide, 4% knew of a physician who attempted suicide and 5% knew a physician who died by suicide. Expanding the time, 33% of physicians reported knowing another physician who died by suicide.

National Suicide Prevention Week is Sept. 4-10 and

is Sept. 17, 2022. If you are in crisis, please call the

National Suicide Prevention Lifeline at 988

, or contact the Crisis Text Line by texting TALK to 741741.

This article originally appeared on Medical Economics®.

Dr. Lorna Breen Heroes' Foundation teams with Physicians Foundation to define problem, propose solutions.

Removing barriers to physician mental health care in 3 steps

Physician burnout and suicide are serious issues that need addressing — but dealing with them can call for very different approaches.

Sept. 17 is National Physician Suicide Awareness Day, billed as a reminder and a call to action. Last year the awareness campaign reached 1.2 million people and received support from 54 medical and other organizations, resulting in 26,000 actions taken to prevent suicide, according to sponsors The Physicians Foundation, the Dr. Lorna Breen Heroes’ Foundation and FirstRespondersFirst.

Although there may be overlap between the two in symptoms and distress that people feel, focusing solely on burnout can create a risk of missing depression, a serious medical illness with potentially life-threatening consequences if left unaddressed, says Christine Yu Moutier, M.D., chief medical officer of the American Foundation for Suicide Prevention (AFSP).

Moutier was co-author of a study on feelings of depression and burnout in 2,281 medical trainees, staff and faculty at University of California San Diego Health, where the Healer Education and Assessment and Referral Program has been heralded as a model system for physician and medical staff suicide prevention efforts. The findings “suggest depression is a much more serious condition” with indicators of distress and suicide risk, including intense affective states, alcohol and drug use and suicidal thoughts and behaviors. Burnout without cooccurring depression was not associated with higher rates of suicidal thoughts or behaviors or with substance use, compared with respondents who screened negative for burnout and depression.

Yet burnout and depression are real problems that must be addressed with systemic change in medicine, say Moutier and Kristen Kim, M.D., corresponding author of a recent study on contributing factors to physician suicides across the country from 2003 to 2018.

Burnout is characterized by chronic workplace stress that can lead to a sense of emotional exhaustion, depersonalization or difficulty seeing others as human, and a low sense of personal accomplishment. Depression and suicide are clinical diagnoses requiring therapy and medications if appropriate, Kim says.

Solutions start with recognizing physician suicide is a serious problem and physicians must prioritize self-care in their everyday practices, Kim says. “I think medicine still, as a field, embraces this outdated sense that we need to sacrifice everything as a physician, including our own well-being,” she says. “And that is just simply wrong. At this point, it’s time to move beyond that and to really prioritize our own well-being in order to best care for our patients.”

In the study of physician suicides, one stressor was incapacity to work due to deteriorating physical health. Physicians tell their patients to stay healthy and they need to do the same, Kim says.

When scheduling appointments, physicians face the same barriers patients do. Primary care and specialist physicians often have office hours that overlap with work schedules, so physicians as patients sometimes must wait days, weeks or months for appointments. Flexibility in scheduling and telehealth could offer solutions, although telehealth limits physical examinations, Kim says.

AFSP notes primary care providers are “in a unique position to identify patients at risk of suicide and enact appropriate intervention methods,” including for fellow physicians. The foundation advocates increased training for physicians to better understand suicide assessment, treatment or risk management.

Even without added training, talking and listening can be a start. Physicians must be on the lookout for colleagues who are struggling and embrace the mindset that, as a community, “we can make a difference,” Moutier says.

“We don’t need to be their doctor or therapist; we’re being a colleague and a friend,” she says.

If physicians sought therapy or psychiatric treatment, Moutier suggests sharing that information with a colleague in distress.

“Give them permission to take those steps themselves by showing and modeling that that can be done safely and without any negative repercussions on your career,” Moutier says. “I’ve seen it happen innumerable times; there is so much more fear about that harm that will come from seeking treatment than there is. And the truth is that the true source of fear, and sort of danger, is actually from unaddressed mental health conditions when they’re left to go unaddressed because of the barriers that are in the way.”


This article originally appeared on Medical Economics®. 

Physician burnout, depression, and suicide

 to represent the COVID-19 updated booster shots announced Aug. 31 by the U.S. Food and Drug Administration (FDA).

The American Medical Association (AMA) announced the editorial update to Current Procedural Terminology. The updated bivalent vaccine boosters, made by Moderna and BioNTech, have mRNA for the original virus strain and the BA.4 and BA.5 omicron variants, in a single dose.

“Across the nation, 108 million Americans – or more than half of those eligible to be boosted – have yet to receive their first booster dose despite evidence that they are safe and highly effective against severe disease outcomes,” AMA President Jack Resneck Jr., MD, said in the AMA announcement.

The U.S. Centers for Disease Control’s Advisory Committee on Immunization Practices (ACIP) is scheduled to meet starting Sept. 1 to review the updated boosters. AMA looks forward to the analysis and pending recommendations, Resneck said.

“As we prepare for potential fall and winter surges of COVID-19, the AMA encourages all who are eligible to get a booster and review the available options with a physician," he said in the AMA announcement.

The AMA announcement stated: “CPT codes distinguish the type and dose of a COVID-19 vaccine and booster provided to each patient and allows for data-driven reporting and analysis that supports effective monitoring of vaccine administration, vaccine safety, as well as other critical aspects of the public health response to the COVID-19 pandemic.”

Four of the codes are effective for use immediately. They are:

Moderna bivalent booster for patients aged 18 years and older

Code 91313: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use.

Code 0134A: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, booster dose.

Pfizer-BioNTech bivalent booster for patients aged 12 years and older.

Code 91312: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use.

Code 0124A: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, booster dose.

Four CPT codes will be effective for use on the condition that the FDA authorizes Moderna’s new COVID-19 booster in patients aged 6 through 11 years of age and Pfizer-BioNTech’s new COVID-19 booster in individuals 5 years through 11 years of age.

Moderna bivalent booster – 6 through 11 years

91314: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 25 mcg/0.25 mL dosage, for intramuscular use.

0144A: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 25 mcg/0.25 mL dosage, booster dose.

Pfizer-BioNTech bivalent booster – aged 5 through 11 years

91315: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use.

0154A: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, booster dose.

Four for adult vaccines effective immediately, four pending approval for youths.

AMA publishes new codes for updated COVID-19 vaccines, boosters

One out of seven physicians admitted to consuming alcohol or controlled substances while on the job to cope with stresses of work, according to a new survey.

 “State of Mental Health: American Healthcare Workers Report,” commissioned by Edwards, Colorado-based All Points North (APN), a recovery and rehabilitation firm that specializes in treating health care workers. The survey of 1,000 health care workers found 21% of physicians, or more than one in five, consume alcohol or controlled substances multiple times a day and 17% reported using at least once a day.

The results indicate “high levels of substance abuse, an acute mental health crisis, and stigma within the healthcare industry,” APN founder and CEO Noah Nordheimer said in the report.

The survey, conducted in July, examined the prior three months. Among the respondents, one in five (20%) had checked into a rehab or detox facility in the last three months, but 14% said they did not want to admit they had a problem. In not seeking help:

32% said they are too overworked or don’t have the time.

23% said they were concerned colleagues or family would judge them.

23% said they were afraid of getting their licenses revoked.

20% said they did not know where to begin or the system was too difficult to navigate.

The study found a difference between male and female workers, with 58% of male health care workers reporting they were at their breaking point or were looking for a new job due to stress, burnout and trauma, compared to 45% of women. It appeared male health care workers were struggling with substance misuse more than female workers. Men were more likely to use positions in health care to acquire controlled substances, than women (21% compared to 4%).

Men were more likely to consume alcohol or controlled substances while at work (18%, compared to 4% of women) and men were more likely to consume alcohol or controlled substances up to 12 hours before their shifts (44%, compared to 17% of women).

Health care experts generally agreed workers were facing dangerous levels of burnout before COVID-19 spread and the pandemic made things worse. In the APN survey:

40% of workers said they feel anxiety or dread about going to work.

49% said they are at their breaking point or looking for new work due to job stress and trauma.

64% said the Supreme Court decision overturning the Roe v. Wade abortion rights case increased their stress levels or made them feel betrayed.

“The wellbeing and mental health of health care workers has been dramatically impacted by the pandemic, with many of them seeing more pain and death than ever before,” Nordheimer said in a news release. “This frequency and intensity of exposure is causing an unprecedented amount of trauma and stress, leading to high levels of burnout. The behavioral health care industry has been slow to innovate to meet the growing need for mental health care, oftentimes treating it as an accessory to health care. We must put mental health on par with physical health and make it a basic human right, indicator of overall health, and an industry standard.”

Peer and family judgment, and possible license loss, deter some from seeking help.

Survey says 1 in 7 physicians use alcohol, drugs while on the job to cope with stress

Public money covered the majority of costs of developing 

 and therapeutics for more than 18 months in the 

There were 1,977 clinical trials addressing COVID-19 therapeutics and vaccines from Jan. 1, 2020, to Aug. 31, 2021, according to the 

, “Funding Sources of Therapeutic and Vaccine Clinical Trials for COVID-19 vs Non-COVID-10 Indications, 2020-2021,” published Aug. 16 in JAMA Network Open.

1,144, or 57.9%, were funded by public sources

293, or 14.8%, were funded by public-private partnerships (PPPs)

Most of the studies (1,680, or 85%) focused on developing anti-COVID-19 therapeutics instead of vaccines (297, or 15%), according to the study. For therapeutics, the public sector paid for 1,039, or 61.8%, of the studies, with 413, or 24.6%, funded by the private sector and 228, or 13.6%, paid for by PPPs.

For vaccines, the pharmaceutical industry paid for 127, or 42.8%, of the studies. Public funding covered costs of 105, or 35.4%, clinical trials, while PPPs paid for 297, or 15%, of clinical trials.

“New vaccines reached the market within the first year of the pandemic and numerous repurposed drugs were in the late stages of clinical development, representing an unprecedented historical achievement,” the researchers wrote. Public-private partnerships, or joint efforts linking government, industry, academia, and nongovernmental organizations, helped, the study said. The authors cited the U.S. National Institutes of Health-led Accelerating COVID-19 Therapeutic Interventions and Vaccines partnership, and Operation Warp Speed, the program that coordinated efforts of the U.S. 

Even so, little was known about funding sources for COVID-19 clinical trials, the study said. It did not include an actual dollar amount spent to develop the vaccines and therapeutics, but 

 have put the figure in the billions of dollars.

“Taken together, our results indicate that the public sector was most likely instrumental in the development of COVID-19 vaccines and therapeutics,” the study said. “Thus, it would be critical to determine way to safeguard both the affordability and global access to these health-sustaining modalities. The public sector facilitated critical (research and development) investments and provided funding that extended beyond basic research to include late-state clinical development, notably during the early phases of the pandemic.”

COVID-19 studies may have received the most public attention during the study period, but during the same time, they were 13.9% of the 14,274 trials registered worldwide, the study said.

Study examines funding sources for 18 months of pandemic in 2020, 2021.