When slogging through a credentialing application that runs 50 pages or more, physicians often are just trying to get through it efficiently. But certain questions can give pause, particularly invasive ones that dig into a physician’s mental health history.
“It’s a hefty question that has the potential to impact your life, your livelihood and if you have a family, the ability to support your family. It definitely holds great weight,” said California anesthesiologist Jill Kacher Cobb, MD. She is the chief wellness officer at Sutter Health, which is a member 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.
“When there’s credentialing questions that ask if you’ve ever sought treatment, that’s a big barrier to reaching out for help,” Dr. Kacher Cobb told the AMA.
So that’s why there was an “Aha!” moment when Dr. Kacher Cobb and colleagues heard the CEO of the Dr. Lorna Breen Heroes’ Foundation speak at the International Conference on Physician Health about how those types of questions can—and should—be removed so that physicians feel more comfortable seeking the mental health care they may need.
“That’s really where it was brought to our attention that this was something we needed to do. We were very proud to learn at the time that the state of California already changed the language and we knew that as a health system, we needed to review our credentialing questions and make changes,” Dr. Kacher Cobb said, noting that it is important that physicians feel comfortable seeking care because of the unacceptably high rate of suicide among American doctors.
Sutter Health’s 28 acute care facilities and eight medical groups recently finished removing questions that asked about past mental and behavioral health issues and now the questions are focused on asking physicians if they currently are experiencing anything that could impair their ability to safely perform in their job. The change aligns with recommendations from the AMA (PDF) and the Dr. Lorna Breen Heroes’ Foundation to remove stigmatizing language that can be a barrier for physicians to seek care.
It is a first, fundamental step to setting the tone in a hospital or clinic that it is safe for physicians to access mental health care as appropriate.
“This is a foundational building block to destigmatize reaching out for help,” Dr. Kacher Cobb said, noting that it’s important to “help people understand that it’s safe to get help and to get care when you need it. As a physician, we experience many intense and potentially traumatic situations that deeply impact us. Ot’s normal to experience these feelings and emotions after, for example, an unexpected outcome or a lawsuit—and it’s OK to reach out and get professional help to process these and other situations.”
As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine.
Sutter Health’s experience
The Dr. Lorna Breen Heroes’ Foundation this fall recognized Sutter Health as a Wellbeing First Champion for the changes the hospitals and medical groups made to their credentialing questions. The AMA and Dr. Lorna Breen Heroes’ Foundation are able to help institutions identify stigmatizing language and offer suggested changes.
As of mid-September, 60 licensure boards and 1,850 health systems, hospitals, medical centers, clinics and other health care facilities have removed intrusive, stigmatizing mental health questions, including substance use, from their licensing and credentialing applications, according to ALL IN: Wellbeing First for Healthcare—a national coalition of health care organizations that the Dr. Lorna Breen Heroes’ Foundation leads and the AMA is an integral part of.
It took Sutter Health about a year for its 28 acute care facilities and eight medical groups to strip stigmatizing questions and implement the new ones.
Dr. Kacher Cobb said that they engaged their legal partners to align wording and credentialing colleagues to help shepherd the changes through each entity.
They did encounter one glitch along the way and encourage others to cross-check to make sure the right language is being used from the beginning. Sutter Health entities’ initial changes to questions asking about health conditions or impairments were missing one crucial word: “currently.”
An example of a nonstigmatizing question should read: “Do you currently have a health condition that requires an accommodation and/or could affect your ability to safely perform the privileges you are requesting?”
Sutter Health leaders have already spoken to physicians in their organization about the changes and they plan to continue letting their doctors know about it through their monthly newsletter, leadership meetings, LinkedIn posts and other staff meetings.
“We need to be able to take care of ourselves first before we are able to take care of others,” Dr. Kacher Cobb said.
Learn more with the AMA about seven things Sutter Health has done to turn the tide on physician burnout.
Other steps to boost physician support
With this change in place, Sutter Health is moving forward with additional steps to help physicians take care of their mental health, a practice that has been stigmatized for too many years.
For example, one Sutter Health ob-gyn group is piloting a program asking all of its physicians to call the employee-assistance program and set up appointments with a therapist or a coach and take advantage of the free therapy sessions their benefits include each month. It’s a form of preventive medicine for mental health.
“As a profession, we need to shift our thinking to mental health care not only being self-care, but also a part of regular health care in the same way we go in for annual visits with our primary care physicians,” she said.
Sutter Health’s new Office of Well-being is encouraging physicians to reach out to a peer supporter who can listen if they need to talk about an intense situation confidentially. They are also sharing support resources in an effort to make mental health care part of the physician culture.
Dr. Kacher Cobb would like, in the future, to embed support into Sutter Health’s systems and operations. For example, when a physician experiences an inevitable low point in their career—a lawsuit, a risk event, an intensive analysis, a peer review or other event—the aim is to build in a process to automatically share support resources.
Explore further with this AMA issue brief on the campaign to support the health and well-being medical students, residents and physicians (PDF).
