Q&A: Physicians call for changes to medical licensing applications

Research has shown that questions about physicians’ mental health on state licensing and credentialing applications often discourage them from seeking mental health treatment.

These questions frequently contain stigmatizing language that lead to concerns about potential repercussions to the physicians’ medical licensure if they acknowledge having mental health conditions, according to Saranya Loehrer, MD, MPH, the founder of C3 Collaboratives and a faculty member at the Institute for Healthcare Improvement, and Ankita Sagar, MD, MPH, FACP, the system vice president for Clinical Standards and Variation Reduction and Physician Enterprise at CommonSpirit Health.

To address this issue, Loehrer and Sagar are working with a national coalition to remove stigmatizing language regarding mental health on licensing and credentialing applications. Their work is part of the Dr. Lorna Breen Health Care Provider Protection Act, which was recently signed into law to address the stigma that health care professionals face when seeking mental health services.

Healio spoke with Loehrer and Sagar to learn more about the coalition’s goals and how stigma is affecting physicians’ access to mental health care at a time when they need it most.

Healio: What is the name of your coalition that is advocating for more supportive language in behavioral and mental health questions?

Saranya Loehrer

Loehrer: The Help Health Care Heal Coalition is convened by the Institute for Healthcare Improvement's Leadership Alliance and is comprised of physicians and health care leaders across the country.

Healio: What are the goals of the coalition?

Loehrer: The initial focus of the coalition is to ensure that every state and care setting in the country eliminates the use of stigmatizing language regarding mental health on licensure and credentialing applications. We believe this is a vital step towards protecting and promoting the health of the health care workforce.

Healio: Do you think that state medical boards should ask physicians questions about their mental health? Why or why not?

Sagar: Questions about mental health can be a barrier to seeking assistance. The questions currently do not serve their intended purpose: to ensure patient safety and the ability to practice medicine without being under the influence of substances. Furthermore, it is well established that early access to mental health services improves outcomes and health care costs for those seeking care, and for clinicians, this relates directly to improved patient safety. And so, crafting questions that are non-stigmatizing and address previous concerns about patient safety are more appropriate and should replace the current questions.

Healio: How might the current questions deter physicians from seeking therapy for mental health conditions?

Sagar: It is well known that seeking mental health assistance can be a difficult step for physicians and advanced practice providers for various reasons. And, reporting that we have accessed therapy for mental health concerns can be required in a few ways: state licensure, health system privileging and credentialing, commercial insurance credentialing, and malpractice insurance applications. However, there is great variation from application to application on the language and need (if any) to report. As Jennifer Breen Feist, JD, and J. Corey Feist, JD, MBA, stated, “many don't seek mental health care due to fear of negative consequences in the workplace, including retribution, exclusion, loss of license or even their job.”

Healio: What evidence is there to demonstrate that physicians are forgoing treatment due to concerns about these questions?

Sagar: There are many studies citing this data. Dyrbrye et al reported that “nearly 40% of physicians (2,325 of 5,829) reported that they would be reluctant to seek formal medical care for treatment of a mental health condition because of concerns about repercussions to their medical licensure.” Arnhart et al reported similar outcomes in their NY state-based study and further cite that “overly intrusive questions, though well-intentioned to protect the public, may run counter to current interpretations of federal law and may inhibit care-seeking among physicians.”

Healio: How should these questions be rephrased? What are some examples of more supportive language?

Loehrer: Our coalition recommends the following, if it is determined that such a question should be asked: “Do you currently have any condition that adversely affects your ability to practice medicine in a safe, competent, ethical and professional manner?”

Further, we recommend the following supportive language also be included: “It is common for clinicians to feel overwhelmed from time to time and to seek help when appropriate. We emphasize the importance of well-being and appropriate treatment and support for all health conditions.”

Healio: How can other physicians help support your efforts?

Loehrer: We welcome physicians to join our coalition and encourage their colleagues to do so as well. Physicians can also ask their local care settings and state medical boards to review their current applications and revise as appropriate. Finally, physicians should encourage the professional societies in which they belong to adopt formal resolutions and advocate for these changes on their behalf.

Healio: Do you have anything else to add?

Sagar: Clinician well-being is top of mind for patients as well. As Lemaire et al report, patients are aware and concerned about clinician well-being and its impact on the community. Furthermore, patients and communities are “focused on the shared responsibility of individual physicians, the medical profession, and health care organizations” to support clinician wellness.

It is important to realize that we have the ability to craft questions mindfully and compassionately, without stigmatizing or traumatizing our clinician workforce. And, moreover, encouraging them to seek assistance early.

For more information:

Saranya Loehrer, MD, MPH: saranya@c3c.org.

Ankita Sagar, MD, MPH, FACP: Ankita.Sagar@commonspirit.org.

References:

• Arnhart K, et al. L Leg Med. 2019;doi:10.1080/01947648.2019.1629364.
• Dyrbye LN, et al. Mayo Clin Proc. 2017;doi:10.1016/j.mayocp.2017.06.020.
• Lemaire JB, et al. PLoS One. 2018;doi:10.1371/journal.pone.0196888.