Momentum is growing for a nationwide effort to remove stigmatizing mental health questions from applications for state licensing and credentialing applications used by medical groups, hospitals and health plans.
The goal is to remove the barriers that have been shown to deter physicians from getting the care they need. Psychiatrist Lisa MacLean, MD, led the effort to change the question on the credentialing application at Henry Ford Health, where she is the chief clinical wellness officer of the Henry Ford Medical Group.
Henry Ford Health is part of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Previously, the credentialing application included a question asking physicians to disclose whether they ever received mental health care. These questions, according to Dr. MacLean, are not indicators of future competency. The question used to ask: “Have you been diagnosed with and/or received treatment for a physical, mental, chemical dependency or emotional condition which could impair your ability to practice medicine?”
The application now appropriately focuses on current impairment and asks: “Are you diagnosed with or receiving treatment for any condition (physical, mental, emotional or substance-dependence related) that currently impairs your ability to practice medicine?”
Getting it done
Dr. MacLean realized that a change was needed after a talk by Stefanie Simmons, MD, an emergency physician in Michigan who spoke at a Henry Ford Health grand rounds and is the chief medical officer of the Dr. Lorna Breen Heroes Foundation. The foundation was formed in honor of Lorna Breen, MD, an emergency physician who died by suicide in 2020.
Dr. MacLean immediately set out to do her due diligence, first contacting the chair of the credentialing committee who agreed with the proposed change as did the rest of the panel.
Next, the vice president of quality and safety was approached and then the medical executive committee and all agreed to make the change. The AMA and Dr. Lorna Breen Heroes’ Foundation also assisted in the process and continues to work with other interested health systems to audit questions and recommend changes.
For organizations seeking to make their own changes, Dr. MacLean recommends using “Remove Intrusive Mental Health Questions from Licensure and Credentialing Applications: A Toolkit to Audit, Change, and Communicate” that was developed by the Dr. Lorna Breen Heroes Foundation and is available for download at the organization’s website.
As part of its “Debunking Regulatory Myths” series, the AMA has set facts straight on licensing and credentialing bodies’ inquiries about physician mental health. The AMA also has developed an issue brief (PDF) to provide a wide range of advocacy and other resources to help support mental health and wellness.
The entry also points to survey research showing that such questions contributed to about 40% of physicians being reluctant to seek formal medical care for treatment of a mental health condition.
Change grounded in policy
“People feel supported, and they're really delighted that we've made these changes,” Dr. MacLean said. “Interestingly, when you start talking about it, they start talking about even more ways that we can break down those barriers.”
Dr. MacLean was a member of the American Psychiatric Association Assembly when it approved guidance in 2018 recommending that “general screening inquiries about past diagnosis and treatment of mental disorders are overbroad and discriminatory and should be avoided altogether.”
Similarly, AMA policy encourages state licensing boards to:
- Exclude from license application forms information that refers to psychoanalysis, counseling, or psychotherapy required or undertaken as part of medical training.
- Require disclosure of physical or mental health conditions only when a physician is suffering from any condition that currently impairs his/her judgment or that would otherwise adversely affect his/her ability to practice medicine in a competent, ethical, and professional manner, or when the physician presents a public health danger.
Georgia is the latest state whose medical board has taken steps in this direction. The Georgia Composite Medical Board has changed its licensure applications to ask:
“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?”
Previously, the state’s licensure application asked about “physical, psychiatric or substance-use disorder” going back seven years.
The move will help “address clinician burnout and encourage mental health care while still protecting patients from impaired professionals," said Matthew Norman, MD, the board’s chair. “Applicants should not fear loss of a license or denial of a licensure application for seeking mental health services.”
In an AMA policy focusing on physician well-being, hospitals and other stakeholders are encouraged to remove “intrusive questions regarding physician physical or mental health or related treatments on initial or renewal hospital credentialing applications.”
The AMA continues to advocate (PDF) the removal of questions regarding physician physical or mental health or related treatments on initial or renewal hospital credentialing applications.
Health systems that change their credentialing applications to focus only on current impairment rather than past diagnosis are encouraged to share that information with the AMA Advocacy Resource Center.