Nearly two dozen state medical boards have made changes to their licensing applications to help support physicians who seek care for mental health or a substance-use disorder.
States have changed their licensure applications as organizations such as the Dr. Lorna Breen Heroes’ Foundation, the AMA and the Federation of State Medical Boards (FSMB) have pushed for officials to take a look at the questions they ask physicians seeking licensure and to eliminate or reword intrusive questions.
Officials in at least a dozen other states are working to make changes to questions on their licensure applications so that physicians don’t feel like they cannot seek help, said J. Corey Feist, president and co-founder of the Dr. Lorna Breen Heroes’ Foundation.
“We are really thrilled at the progress we are making,” Feist said. “If we can get those organizations over the goal line, it would be a huge accomplishment. We are going to be pushing over the summer to get these boards over the line by the fall.”
This work is important because research has found that physicians working in a state where the initial licensing application or the renewal application probes overly broadly about mental health history were 20% likelier to be reluctant about seeking help. Overall, about 40% of physicians reported reluctance to seek formal medical care for treatment of a mental health condition.
An American Hospital Association report lists stigma associated with talking about and seeking behavioral health care, including fear of losing hospital privileges via the credentialing process, as a key driver of suicide in the health care workforce.
Reducing physician burnout is a critical component of the AMA Recovery Plan for America’s Physicians.
Far too many American physicians experience burnout. That’s why the AMA develops resources that prioritize well-being and highlight workflow changes so physicians can focus on what matters—patient care.
As of May 1, 21 states had met the criteria for the Dr. Lorna Breen Heroes’ Foundation to name them “ALL IN Wellbeing First Champions” were: California, Connecticut, Georgia, Hawaii, Idaho, Illinois, Kansas, Maine, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New York, North Carolina, North Dakota, Texas, Utah and Washington.
To receive the honor, state licensing questions needed to meet one of three criteria:
- Ask one question consistent with the FSMB’s recommended language that it approved in 2018 that addresses all mental and physical health conditions as one, with no added explanations, asterisks or fine print.
- Ask no probing questions about an applicant’s health.
- Implement an attestation Model that uses supportive language around mental health and offers “safe haven,” nonreporting options to physicians who are receiving care.
The FSMB’s recommended language is: “Are you currently suffering from any condition for which you are not being appropriately treated that impairs your judgment or that would otherwise adversely affect your ability to practice medicine in a competent, ethical and professional manner? (Yes/No).”
Two more state boards—Oregon and South Dakota—also have revised their physician licensure applications in this positive direction for a total of 23.
The AMA is advocating in many ways to support the mental health of medical students, residents and physicians, including ensuring that state licensing, credentialing, employment and other related applications do not contain stigmatizing language that inappropriately asks about past diagnoses or treatment for mental health or a substance-use disorder.
To help foster change in state licensing questions and elsewhere, the AMA has worked with the Dr. Lorna Breen Heroes’ Foundation, which was created after the New York emergency medicine physician died by suicide at the height of the COVID-19 pandemic.
State licensing board application questions are not always readily available and the AMA used Freedom of Information Act and open-records requests to get copies of questions and determine which states need to make changes to their applications. In February, Feist and an AMA representative held a workshop for FSMB members to explain why the questions they ask physicians are important, to show them how to change language that exists on their applications and to challenge officials to revamp applications to better support physician well-being.
“Most state medical boards have made positive changes to their licensing application questions, including removing probing questions, providing safe haven nonreporting options, and including compassionate statements about the importance of seeking treatment. Boards are working to proactively communicate these changes to their licensees and encourage them to seek the care they need and deserve to address mental health or substance use disorder,” said FSMB President and CEO Humayun Chaudhry, DO.
Arizona, Colorado, Louisiana, Maryland, New Hampshire, New Mexico, Oklahoma, Oregon, South Dakota, Vermont, Virginia are among the states now working toward making changes outlined in the step-by-step Dr. Lorna Breen Heroes’ Foundation toolkit.
“These changes can take hours to days to make, not weeks or months,” Feist said. “The low-effort changes have an incredibly high impact.”
Feist said the foundation plans to issue another state report in September, in conjunction with National Physician Suicide Awareness Day.
Feist said that physicians’ concern that they will face professional ramifications if they seek mental health care begins in medical school and that it’s reinforced throughout physicians’ careers; this includes his late sister-in-law Dr. Breen. With a lot of misinformation about seeking help, Feist hopes their organization’s “ALL IN Wellbeing First Champions” badge will become a symbol that it is safe for physicians to seek the same care that they are prescribing for their patients’ wellbeing.
“We want this to be viewed as a badge of psychological safety that says to physicians that you can get your own mental health care taken care of without fear of repercussions,” Feist said.
The Dr. Lorna Breen Heroes’ Foundation and the AMA are also working with hospitals, payers and liability insurers to remove intrusive, damaging questions. The foundation in May made a joint statement with the National Institute for Occupational Safety and Health on the importance of removing intrusive mental health questions from hospital credentialing applications.