Physician Health

Why Minnesota changed key query to promote physician well-being

Andis Robeznieks , Senior News Writer

The Minnesota Board of Medical Practice (BMP) revised a key question asked of doctors applying for or renewing their license regarding their health and fitness for practice. Minnesota is one of 20 states that have taken action as part of an encouraging trend to eliminate barriers to medical students' and physicians' ability to seek the health care they need—including care for mental health or substance-use disorders.

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The AMA considers the changes in Minnesota a best practice all medical boards can emulate to support physician wellness.

The change was made after an advocacy push from the Minnesota Medical Association (MMA). And former BMP President Kathryn D. Lombardo, MD, recalled in an interview that the intrusive language used on the application—along with requirements to hand over medical records—were instituted in the early 2000s and probably had the opposite effect of what was intended.

“We were contributing to physicians from either not self-reporting illnesses or not seeking treatment, and that wasn't the goal,” said Dr. Lombardo, a psychiatrist with Rochester-based Olmsted Medical Center. “If we have clinicians that aren't seeking care for themselves, they may not be able to provide good care to patients, and that potentially can contribute to unsafe care for patients.”

Dr. Lombardo was part of an AMA State Advocacy Summit panel that discussed how intrusive and inappropriate questions on state licensing applications and those used for hospital, medical group and health plan credentialing deter physicians from getting the care they need.

Olmsted Medical Center 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.

Previously, Minnesota’s licensing application included a requirement for the release of medical records for “applicants who have a medical condition during the last five years which, if untreated, would be likely to impair their ability to practice with reasonable skill and safety must have their treating physician complete this form.”

The application now appropriately focuses on current impairment and asks:

“Do you currently have any condition that is not being appropriately treated which is likely to impair or adversely affect your ability to practice medicine with reasonable skill and safety in a competent, ethical and professional manner?”

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As part of its “Debunking Regulatory Myths” series, the AMA has set the facts straight on licensing and credentialing bodies’ inquiries about physician mental health.

The AMA also developed an issue brief (PDF) to provide specific regulatory, legislative and other actions a medical society can take to help support physicians’ mental health and wellness.

Survey research shows that such questions contributed to about 40% of physicians being reluctant to seek formal medical care for treatment of a mental health condition. Find out why reducing physician burnout is a critical component of the AMA Recovery Plan for America’s Physicians.

J. Corey Feist, co-founder of the Dr. Lorna Breen Heroes’ Foundation, moderated the AMA State Advocacy Summit panel discussion. He noted that Minnesota was one of 20 states that have revised their licensing applications in line with the foundation’s three recommended options:

  • Ask one question with language that addresses all mental and physical health conditions as one, with no added explanations, asterisks or fine print on mental health.
  • Refrain from asking probing questions about an applicant’s health altogether.
  • Implement an attestation model that uses supportive language around mental health and offers “safe haven” non-reporting options to physicians who are receiving care.”

For information, consult the foundation’s toolkit, “Remove Intrusive Mental Health Questions from Licensure and Credentialing Applications A Toolkit to Audit, Change, and Communicate,” which is available for download at the organization’s website.

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MMA Advocacy Director Dave Renner said medical students first raised the issue in the state after some of their peers—including a classmate of Renner’s daughter—died by suicide in a short period.

“Medical students were expressing concerns about the way that the license application question was formed,” Renner said, adding that some worried if they could harm their careers by seeking help when they needed it.

There were “concerns about whether they should even go and get treatment because they were worried that they would then have to report that, ‘In the past, I got treatment for depression or for anxiety,’” he said.

The board, led by Dr. Lombardo, voted in 2021 to revise the application language and the change took effect for physicians and the seven other professions regulated by the Minnesota BMP in January 2022.

Dr. Lombardo said there is a need to provide physicians “with a better place to practice and reduce the stigma and acknowledge that at times we need to take care of ourselves and focus on our own health.”