Compared with just a few years ago, state medical board officials and an increasing number of hospital executives are more keenly aware of the barriers physicians face in seeking mental health care or treatment for a substance use disorder for themselves and the dangers that arise when physicians don’t get help.
About three-quarters of state medical boards have now adopted policy to back up that knowledge and hospitals and health systems are beginning to follow that lead.
So, as doctors and health care organizations mark National Suicide Prevention Month this month and National Physician Suicide Awareness Day Sept. 17, it’s critical that physicians and other licensed health professionals become familiar with what has changed. Doctors should know whether their state medical board, credentialing body or health care organization has removed stigmatizing language from regulations or applications to ensure that they won’t face questions about past treatment related to mental health or substance use.
“The message still needs to get out to health care workers and they need to believe that the change makes things safer for them,” said Stefanie Simmons, MD, chief medical officer of the Dr. Lorna Breen Heroes’ Foundation. “When health care workers don’t know the status of their licensing questions, they will assume the worst. So, it’s important to communicate what the rules are.”
How can that be done? Letters from the health system’s president, town halls, newsletters, updates at department meetings, conversations with colleagues, integration into new staff orientation, or placing the Wellbeing First Champion Badge on email signatures are all ones worth considering to help communicate the changes taking place within a state or organization.
“Communicate often and do not assume that the message has already been heard,” Dr. Simmons said.
The AMA wants to ensure that physicians are practicing safely, and it also wants to ensure physicians are well and don’t fear getting treatment for themselves when they need it.
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 had overly board questions about mental health history were 20% likelier to be reluctant about seeking help.
Meanwhile, an American Hospital Association (AHA) 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.
The AMA’s goal is 100% change to inappropriate questions and its work will continue until that is achieved. It is reported that physicians have higher rates of depression and suicide than the general public.
Learn more from the AMA about preventing physician suicide and read this AMA issue brief on the campaign to support the health and well-being of medical students, residents and physicians (PDF).
Rapidly changing prognosis
When the Dr. Lorna Breen Heroes’ Foundation began tracking states and hospitals in 2022, just 19 states met the best practice standards and no hospital credentialing standards met the bar.
The AMA believes that if a physician has a current impairment, that should be disclosed. The AMA and the Dr. Lorna Breen Heroes’ Foundation are focused on removing stigmatizing and inappropriate questions on physician licensing and credentialing applications and anywhere else a physician is asked to answer the questions of whether they have ever received treatment for a mental health condition. The Federation of State Medical Boards (FSMB), AHA, Federation of State Physician Health Programs, The Joint Commission and many other organizations are also on the same page as the AMA when it comes to physician well-being.
In just a few short years, 37 state medical licensing boards and more than 600 hospitals—10% of all hospitals in the country—have been verified to now follow the best practices around the questions asked on licensing and credentialing applications.
Dr. Simmons, an emergency physician, compares the satisfaction with this progress to what she feels when she is able to quickly help a patient who presents at the emergency department.
“So much in policy and health care leadership and culture change is slower, but in this area, we are seeing change that is rapid. Sometimes it feels a bit more like a shoulder reduction and less like blood pressure management,” she said.
She credits the reason for being able to make progress quickly with groundwork that the AMA, the FSMB and others made before the Dr. Lorna Breen Heroes’ Foundation began its work in the wake of Dr. Breen’s tragic suicide.
Dr. Simmons said the continued alliance between the AMA, state medical societies, the FSMB and AHA has also been key to moving the work forward.
Physicians once listed state licensure concerns as the top reason for not seeking mental health care. As states have changed their questions, physicians’ top concern has shifted to hospital credentialing. Dr. Simmons said that is why it is important to ensure that intrusive, inappropriate questions are changed at all levels—in state, hospital and insurance applications.
The AMA has included the physician well-being work in its Joy in Medicine Health System Recognition Program (PDF) and leadership in the AMA’s state advocacy team has helped develop best practice standards used in awarding states and organizations the Wellbeing First Champion Badge that they can display as a sign that they prioritize the health care workforces’ mental health and wellbeing.
“It’s really been critical in developing our team’s ability to review these with nuance and consistency,” Dr. Simmons said.
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®.
