Physicians must be comfortable seeking help when they have a mental health concern or a substance-use disorder. But due to stigma and fear of adverse career consequences, far too many physicians are deterred from seeking the care they need.
In one study, four in 10 physicians told researchers they were reluctant to seek help. And physicians who lived in a state where the initial or renewal licensing application has overly board questions about mental health history were 20% likelier to be reluctant about seeking help.
Meanwhile, 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.
But the hope is that those numbers will trend downward with changes beginning to take place to some questions that physicians find on licensing and credentialing applications in a growing number of states, health systems and hospitals.
In a recent AMA webinar, physicians and experts explored why it is important to make these changes and detailed how to persuade state medical boards to eliminate or amend questions, and how their health care organizations have been able to move in the right direction in changing their credentialing applications.
“This is an opportunity for us to not just solve a problem, but actually enhance our profession and enhance our ability to come together, to work together and create an environment that will lead to increased quality of care, increased patient engagement and increased physician productivity,” said Willie Underwood III, MD, MPH, who chairs of the AMA Board of Trustees and moderated the discussion.
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The AMA, the Federation of State Medical Boards (FSMB) and the Dr. Lorna Breen Heroes’ Foundation—an organization created after the New York emergency medicine physician died by suicide early in the COVID-19 pandemic—have pushed officials to look at the questions they ask physicians seeing licensure or credentialing and to eliminate or reword intrusive questions.
One example of intrusive questions are ones that do an infinite look back into a person’s treatment history or history with a particular illness, experts explained.
“State medical boards don’t necessarily need to know if a physician suffers from a particular illness—it’s the impairment that may result that might put patients in jeopardy that they need to worry about,” explained Mark Staz, management consultant in regulatory policy at the FSMB.
The FSMB has been promoting an approach that the North Carolina Medical Board took: Rather than asking a licensee whether they have a condition that will result in an impairment or affect one’s medical practice, there is a statement about what the professional expectations are related to taking care of one’s self.
Licensees are asked if they understand what their professional expectations are, yes or no, and they can check a box.
That approach can help because “it continues the conversation,” Staz said. “It helps reduce the stigma because people are talking about burnout. It’s clear that the medical board understands that physicians face these issues just as members of the general public would.”
The FSMB also has recommended this language: “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).”
Joel Bundy, MD, vice president and chief quality and safety officer at Sentara Healthcare in Virginia, had been working on a number of wellness issues to create a better workplace. However, he said, credentialing questions weren’t on his radar until people from the Dr. Lorna Breen Foundation raised the possibility that queries put in place long ago could be contributing to the reasons why physicians don’t seek help for themselves.
What he found was surprising.
“I went back and looked myself and I said: ‘Oh my gosh, these are terrible questions. So, why are we asking these questions?’” They were questions that specifically asked whether a person had had a particular diagnosis.
“We realized that we could get to the same place by changing the questions,” Dr. Bundy said. “I’m not going to ask people: ‘Do you have diabetes? Do you have mental health issues? Do you have this or that?’ I want to know: Can you competently practice your profession today? Period.”
Based on what they found in the credentialing questions, Dr. Bundy said they then looked at peer review and employment agreements with a similar eye to see if changes needed to be made.
Valley Health, which serves the Northern Shenandoah Valley of Virginia, the Eastern Panhandle and Potomac Highlands of West Virginia and western Maryland, also recently revised its credentialing applications to remove stigmatizing questions about mental health and substance-use disorders. The changes happened after discussions with the AMA and the Dr. Lorna Breen Heroes’ Foundation.
The webinar also featured health care leaders from Virginia and South Dakota who shared how their organizations have advocated and successfully made changes in licensing and credentialling questions and they emphasized the importance of communicating the changes to physicians and other staff members.
In addition, experts offered tips on how others can make changes in these questions in their own states and organizations:
- Review the questions the state medical board or health care organization uses to determine what should be changed and focus on the mental health questions.
- Be very specific in the changes you would recommend.
- Look for a physician who can give a real-life story about the changes you want to make.
- Amplify your voice by finding partners who want to see the changes as well.
“Amplifying your voice just makes that advocacy road a little easier to travel,” said Barb Smith, CEO of the South Dakota State Medical Association, which successfully advocated changes to state medical board licensing questions in 2012 and 2020.
Abraham Segres, vice president of quality and patient safety at the Virginia Hospital & Health Care Association, said finding a champion who can be a champion for the issue is important.
“We are all in this work because we want to improve individuals’ experience of care. We want to improve the health of our communities. We want to reduce the cost of care,” he said. “We need satisfied, stable workforce participants in order to do that.”