Removing barriers to physician mental health care in 3 steps

Across the nation, 17 states have taken steps to eliminate physician licensing questions that create barriers to physicians seeking mental health care.

The Dr. Lorna Breen Heroes’ Foundation, in conjunction with The Physicians Foundation and the #FirstRespondersFirst Initiative, has launched a campaign to change the way physicians, other health care workers and executives think about mental health and its effects in the medical field.

At least 80% of physicians said they support eliminating credentialing questions about mental health care that effectively become barriers to physicians seeking that care, while 47% said their practices, health systems never or rarely took action on those questions, according to the latest survey by The Physicians Foundation, published Sept. 15.

The issue

J. Corey Feist, JD, MBA
_{Dr. Lorna Breen Heroes' Foundation}

Physicians are trained that “you’re supposed to be perfect all the time,” said J. Corey Feist, JD, MBA, brother-in-law to Lorna Breen, MD, and cofounder of the foundation that bears her name. Breen was a New York City emergency room physician who died by suicide in April 2020, physically and mentally exhausted from caring for COVID-19 patients and dealing with the illness herself.

State and specialty licensing boards, hospital leaders, and insurers ask physicians about their mental health histories. Acknowledging mental health care could be perceived as an impairment that jeopardizes physicians’ professional status, one that is deeply tied to their personal identities.

“So they just don’t get help,” Feist told Medical Economics.

The Dr. Lorna Breen Heroes’ Foundation has developed the Licensure & Credentialing Strategy Tool Kit, which outlines a three-step process to change the licensing and credentialing questions:

• Audit credentialing applications and peer review forms.
• Change invasive or stigmatizing language around mental health.
• Communicate the changes to physicians.

Communication is key

That final step is crucial “because if we make the changes and the consequences of getting mental health treatment are still opaque to doctors, they won’t go,” Feist said.

“So that third leg, communicate, is critical,” he said. “Doctors deserve to know what the rules are, it’s that plain and simple, particularly now more than ever.”

Many doctors – Breen included – believe if they seek mental health care, there will be ramifications for their professional licenses. Sometimes that is true, but in many cases, that is not correct, Feist said, citing conversations with family members of physicians lost to suicide in the last two years.

“No better example than, sadly, my sister-in-law, who truly believed that her license to practice medicine in New York state was at risk when she received the first and only mental health treatment of her career after she took care of patients during the pandemic,” Feist said. He credited New York as one of the 17 states that have taken measures to support physicians’ mental health.

State by state basis

As of Aug. 24, 2022, 17 states, including California, Hawaii, Illinois, Kansas, Maine, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New York, North Carolina, North Dakota, Texas, Utah and Washington, have aligned their applications to either:

• Ask one question consistent with the Federation of State Medical Board’s recommended language that addresses all mental and physical health conditions as one, with no added explanations, asterisks, or fine print.
• 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” nonreporting options to physicians who are receiving care.

With 33 other states, their medical boards, and thousands of insurers, hospitals and health systems, the work is far from over, Feist said. But the changes can be made quickly and with little cost if there is will to do so, he said.

Dr. Breen’s legacy

Lorna Breen, MD
_{Dr. Lorna Breen Heroes' Foundation}

Breen’s life, work, and death made national news as physicians, health care workers, and everyone dealt with the COVID-19 pandemic. The Physicians Foundation survey found 23% of physicians were familiar with her story, while 12% were aware of the federal Dr. Lorna Breen Healthcare Provider Protection Act. That legislation, now approved by Congress and President Joe Biden, aims to reduce and prevent suicide, burnout, and mental and behavioral health conditions among health care professionals.

In the past year, The Physicians Foundation survey reported 16% of physicians knew a physician who considered suicide, 4% knew of a physician who attempted suicide and 5% knew a physician who died by suicide. Expanding the time, 33% of physicians reported knowing another physician who died by suicide.

National Suicide Prevention Week is Sept. 4-10 and National Physician Suicide Awareness Day is Sept. 17, 2022. If you are in crisis, please call the National Suicide Prevention Lifeline at 988, or contact the Crisis Text Line by texting TALK to 741741.