How Virginia’s getting rid of obstacles to physician well-being

AMA News Wire

How Virginia’s getting rid of obstacles to physician well-being

Jan 23, 2023

A statewide initiative has been launched in Virginia that seeks to cut burnout levels among physicians and other health professionals, and it includes a call to remove a major barrier to their well-being—the stigmatizing of those who seek the help of mental health professionals.

As part of the “ALL IN: Caring for Virginia’s Caregivers” initiative, hospitals and health systems that remove overly broad or invasive mental health questions on credentialing applications will be recognized as well-being champions by the coalition supporting the effort.

The coalition includes the Medical Society of Virginia (MSV), the Virginia Hospital & Healthcare Association and the Virginia Nurses Association. It is being supported by ALL IN: WellBeing First for Healthcare—an organization co-founded by the Dr. Lorna Breen Heroes’ Foundation and #FirstRespondersFirst.

The effort builds on the medical society’s previous success in advocating with the state’s lawmakers. In 2020, the legislature unanimously approved creation of SafeHaven, an MSV-administered program in which physicians can seek confidential help 24/7 to address career fatigue or mental health issues. The law also guarantees that information originating in SafeHaven is privileged.

“MSV’s intention behind all our SafeHaven efforts has been to help strengthen physicians’ mental health and affect change within the profession,” said Melina Davis, the organization’s CEO.

“To effect meaningful and lasting change, it was of vital importance to look at every aspect of the drivers of physician burnout,” she added. “This included providing physicians legal protections to talk to a peer coach or counselor without fear of undue repercussions to their employment.”

More than 40% of physicians do not seek help for burnout or depression for fear of disclosing it to a state licensing board—even though 9% of physicians report they have had thoughts of suicide, according to “Confidential care to support physician health and wellness” (PDF), an AMA Advocacy Resource Center issue brief.

The AMA strongly supports the work of the Virginia initiative.

“We have helped build coalitions to remove some of those stigmatizing questions about mental illness or past substance-use disorder that appear on physician credentialing forums,” AMA President Jack Resneck Jr., MD, said during a recent episode of “AMA Update.”

“Asking about something that happened years in the past and is not a current concern discourages physicians and other health care professionals from getting the help they need.”

MSV has been working closely with the Virginia Board of Medicine and Department of Health Professions on implementing changes and removing barriers for physicians to address their personal mental health concerns, Davis explained. This includes an effort to remove unnecessary mental health-related questions. MSV is leading an effort in the state legislature to ensure these changes are made.

Virginia House Bill 1573 and Senate Bill 970 would “direct the state Department of Health Professions Department of Health Professions to amend its licensure, certification and registration applications to remove any existing questions pertaining to mental health conditions and impairment.” Instead, they would include these questions:

• Do you have any reason to believe that you would pose a risk to the safety or well-being of your patients or clients?
• Are you able to perform the essential functions of a practitioner in your area of practice with or without reasonable accommodation?

Dr. Lorna Breen Heroes’ Foundation Co-Founder J. Corey Feist provided highly persuasive testimony in the House Health, Welfare and Institutions Subcommittee, which reported out the bill unanimously. Similar progress is expected in the state Senate.

MSV has also been working to address these changes on credentialing applications used by medical groups, hospitals and health plans. This includes one large primary care group whose physicians have been leaders in SafeHaven efforts and who, Davis said, hadn’t even thought to look at their own credentialing application.

“When they did, they learned the application asked several unnecessary questions which didn’t match the culture of physician well-being the group’s leadership had instilled,” she added. “They changed their credentialling application questions that day.”

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.

Physicians say they don’t seek help for suicidal thoughts because of fear of judgment from colleagues or concern that they will gain a reputation as someone who cannot handle stress.

These fears and concerns are compounded by medical licensing applications, employment and credentialing applications, and professional liability insurance applications. These forms may include problematic and potentially illegal questions requiring physicians to disclose whether they have ever been diagnosed with a mental illness or substance-use disorder. Some of these applications also ask physicians if they ever sought counseling for a mental illness.

These questions about past diagnosis or treatment are strongly opposed by the AMA, the Dr. Lorna Breen Heroes’ Foundation, Federation of State Medical Boards and The Joint Commission, the AMA issue brief notes.

Lorna Breen, MD, died by suicide in April 2020 following an intense stretch treating COVID-19 patients at the onset of the pandemic.

After recovering from COVID-19 herself, she returned to her job in the busy emergency department of a Manhattan hospital and began struggling physically and mentally. But her chief concern wasn’t her failing health; it was the fear of losing her medical license or that she would get a reputation as someone who couldn’t handle pressure if she sought help.

Learn more with this AMA STEPS Forward™ toolkit, “Preventing Physician Suicide: Identify and Support At-Risk Physicians.”