ACP encourages members to advocate to have these questions removed so that those who need it seek help
Feb. 18, 2022 (ACP)—The American College of Physicians (ACP) is rolling out a new toolkit to help members encourage their state medical licensing and credentialing boards to remove questions about mental health on applications and add language that is supportive of receiving mental health care when needed.
In the past, such questions have been used in a punitive fashion that harms physicians who seek treatment for mental health issues, explained Dr. Eileen Barrett, an internist in Albuquerque, New Mexico, who spearheaded the effort to develop the new toolkit and has served as past governor of the ACP New Mexico Chapter and as a former ACP regent.
The stakes are higher now than ever before due to the stress that the ongoing COVID-19 pandemic is placing on the health care system, clinicians and physicians. “Physicians and medical students are enduring a great deal during the pandemic, and, quite naturally, many have wanted to seek mental health care to receive extra support,” said Barrett. “Unfortunately, many state medical boards and many institutions ask probing questions about mental health care that have never been shown to improve patient care or patient safety.”
Many medical professionals fear negative professional consequences if they seek mental health care and are deterred from doing so, Barrett said. “Physicians and medical students, like all people, deserve to receive mental health care when needed without fear it will affect their ability to work, get a license or get a job,” she said.
The way things are currently handled is damaging to the physician or medical student who is deterred from seeking mental health care due to the fear of negative effects on their licensure or credentialing, she said. Many physicians and students have reached out asking what to do for peers who are struggling but are afraid to seek help -- including some with passive suicidal ideation.
“There are also other cases of physicians experiencing invasive investigations and stigma despite their diagnosis having no effect on their medical practice or professionalism,” Barrett said.
To help members advocate to remove these barriers and encourage those who need it to seek help, ACP is providing a toolkit full of resources for physicians, medical students, practice administrators and leaders that includes background on this issue, sample letters for a credentialing committee and a state medical board, hyperlinks for how to contact the state medical board and how to reach elected officials, and references for further learning or teaching.
Change on the Horizon
As it stands, most states do not follow recommendations from the Federation of State Medical Boards on how to ask about physician mental health during the licensure process, Barrett said. In 2018, this federation adopted a policy recommending that state boards approach physician wellness and burnout from a nonpunitive perspective, which includes evaluating whether it is even necessary to include probing questions about an applicant's mental health, addiction or substance use and considering offering “safe haven nonreporting” to applicants for licensure who are receiving appropriate treatment for mental health or addiction, among other suggestions to state licensing boards.
The landscape on credentialing is not as well studied as that of licensure, but it appears to be problematic as well, Barrett said.
The good news is that times are changing. “Anecdotes show that some employers are changing credentialing applications as well,” she said.
The Lorna Breen Health Care Provider Protection Act, which ACP championed, is awaiting passage in the Senate. Named for a New York City emergency room physician who died by suicide in the early part of the COVID-19 pandemic, this act provides funding to reduce and prevent suicide, burnout and mental and behavioral health conditions among health care professionals. Some of the funds have already been made available.
“This is a step in the right direction,” Barrett said. “Hopefully, the work funded can help lead to meaningful changes and can help spur the deep work that is needed to reduce administrative burden, restore community and preserve our sense of purpose.”
The Advocacy Toolkit: Revising License and Credentialing Applications to Not Ask About Mental Health is available on the ACP website.