National Physician Suicide Awareness Day (NPSA)—on Sept. 17—is a sobering reminder for physicians and others to ensure that we advocate for programs and initiatives to support physician health and wellness. Supporting physician wellness and reducing physician burnout are key elements of the AMA Recovery Plan for America’s Physicians.
Physicians have higher rates of death by suicide than the general population, and medical residents and students also experience depression at rates greater than the general population, according to the American Foundation for Suicide Prevention.
“AMA advocacy is focused on eliminating barriers that prevent physicians and medical students from seeking care for their own mental health,” said AMA President Jesse M. Ehrenfeld, MD, MPH. “National Physician Suicide Awareness Day is an important reminder of the tragedies in our profession—it is time, however, for licensing boards, health systems and credentialing organizations to take additional actions to ensure that we can support our physicians’ health and wellness and help prevent our colleagues from dying by suicide.”
Part of the AMA’s advocacy to support physician wellness has been direct engagement with state medical boards, hospitals and health systems to remove stigmatizing questions on applications related to mental health and substance use disorders. The AMA has worked with several dozen medical boards, hospitals and health systems alongside the Dr. Lorna Breen Heroes’ Foundation (PDF) and the Federation of State Medical Boards to urge boards and others to review, revise and/or remove all questions that may deter physicians from seeking treatment for mental illness or substance use disorder. In addition, the AMA has worked closely with the Medical Society of Virginia and Virginia Healthcare and Hospital Association to challenge all Virginia hospitals to ensure their credentialing applications are consistent with recommendations from the AMA, Federation of State Medical Boards and Dr. Lorna Breen Heroes’ Foundation.
In 2023, several dozen medical boards, hospitals and health systems have taken action based on these recommendations—but there is much more work to be done. This includes efforts to support medical students and residents by their training institutions to ensure that trainees do not suffer punitive consequences for seeking help for wellness. The AMA also has urged key stakeholders and credentialing organizations such as the American Hospital Association, ACGME, NCQA and others to take additional steps to support physician health and wellness.
The AMA also has developed resources to support physicians in their practices to take steps to identify and support at-risk physicians. AMA STEPS Forward resources include:
- Preventing Physician Suicide Toolkit
- After a Physician Suicide Toolkit
- Wellness-Centered Leadership Playbook
The Departments of Labor, Health and Human Services, and Treasury published a proposed rule in early August to help make meaningful progress on the path to mental health parity and improved access to substance use disorder care. The Mental Health Parity and Addiction Equity Act (MHPAEA) was enacted in 2008 and called for mental health care and substance use disorder benefits covered by health plans to be provided at the same level as physical health care benefits. The proposed rule reinforces MHPAEA’s fundamental goal and seeks to make it easier to get in-network mental health and substance use disorder care and eliminate barriers to access that keep people from getting the care they need.
The proposed rule would require health plans to conduct meaningful comparative analyses about access to their benefits and evaluate the outcomes of their coverage rules to make sure people have equivalent access between their mental health, substance use and medical benefits. This review includes evaluating the health plan’s actual provider network, how much it pays out-of-network providers, and how often prior authorization is required and the rate at which prior authorization requests are denied. The proposed rule provides specific examples that make clear that health plans cannot use more restrictive prior authorization, other medical management techniques or narrower networks that make it harder for people to access mental health and substance use disorder benefits than their medical benefits. The public comment period for this proposed rule ends Oct. 2, 2023.
The AMA strongly supports efforts to make naloxone available over-the-counter (OTC) but remains concerned that at reported pricing near $50 and with uncertainty over insurance coverage, access to the life-saving opioid overdose reversal medication may be out of reach for people during an emergency.
In a recent AMA Update episode on the current state of the overdose and death epidemic, Bobby Mukkamala, MD, chair of the AMA Substance Use and Pain Care Task Force, highlighted that while OTC naloxone is an important step in the right direction, there are key steps that can be taken to remove barriers and ensure affordable naloxone is widely available:
- Physicians should continue prescribing naloxone to patients at risk of a drug-related overdose.
- Health insurers should cover naloxone at no or low cost.
- Additional manufacturers should submit OTC applications and price naloxone affordably.
- Policymakers should support harm reduction organizations that distribute low-cost naloxone. Community-based naloxone distribution continues to save hundreds of thousands of lives each year.
- Retailers should stock naloxone in prominent locations and not behind the counter.
In addition to increasing access to naloxone, Dr. Mukkamala also discussed ways the AMA is working to save lives and help end the overdose and death epidemic. Efforts include:
- Working with states to help physicians who treat patients with pain provide individualized care by urging legislatures, pharmacy chains and payers to rescind policies based on arbitrary prescribing thresholds the CDC now says are inappropriate.
- Calling on health insurance companies to stop requiring prior authorizations for medications to treat opioid use disorder and remove quantity limits on buprenorphine.
- Urging state and federal regulators to increase meaningful enforcement and impose penalties for health plan violations of mental health and substance use disorder parity laws.
“This is a preventable epidemic. It’s getting worse, and it’s not going to get better until our patients have timely access to evidence-based care. We’ve got the tools to end this epidemic. It’s up to all of us to put them to good use.”