Now, in an effort to combat stigma and burnout among medical professionals, Massachusetts has become the first state to eliminate questions about mental illness and addiction from providers throughout the health care system. In nearly two dozen other states, the professional boards that license doctors have shut down the practice. Yet Massachusetts has gone further: removing probing questions from the credentialing forms used by nearly every hospital, health system, insurer and medical licensing board in the state.
It’s an important step forward, said Dr. James Baker, president of the Massachusetts Society of Addiction Medicine and a physician at a hospice care facility in Haverhill. The strength of this new policy is that it opens the door for physicians who are struggling with depression, anxiety, and substance abuse disorders to seek help without fear.
The questions stem from the idea that medical professionals should be held to a higher standard, and because lives hang in the balance if they are under the influence of alcohol or drugs on the job.
Yet studies have shown that questions about mental health history and past drug use have long had a chilling effect on doctors seeking professional help. In a 2017 survey, nearly 40 percent of American physicians said they would be reluctant to provide treatment for a mental health condition due to concerns about the impact on their medical license. In a separate study, nearly half of female doctors said they met criteria for mental illness but did not seek treatment for fear of being reported to a medical licensing board.
The campaign to root out questions about drug use and mental health has gained momentum amid rising rates of burnout and mental distress among physicians during the pandemic. Forty-six percent of healthcare workers nationwide reported feeling frequently burned out in 2022, up from 32 percent in 2018, according to a survey published last fall by the Centers for Disease Control and Prevention. According to an analysis by the American Psychiatry Association, an estimated 300 to 400 physicians commit suicide each year, and the suicide rate within the profession is more than twice that of the general population.
Yet it was the high-profile death of a New York physician in the early days of the pandemic that prompted hospital and medical professional associations to address the issue.
In April of 2020, Dr. Lorna Breen, an emergency room physician at New York Presbyterian Hospital in Manhattan, became overwhelmed by the constant number of sick patients, many of whom were dying in the hospital’s waiting rooms and hallways, her family said. After working 12-hour shifts, Breen called her sister to say she couldn’t get up from her chair at home. Concerned, family and friends took Breen to his childhood home in Charlottesville, Washington, where he checked into an inpatient psychiatric unit.
According to family members, while in the psychiatric unit, Breen repeatedly told relatives that she feared losing her medical license and hospital certificate because she sought mental health treatment.
A few days after expressing those fears, Breen took his own life.
Those questions absolutely contributed [Breens] Death, J. said Corey Feist, Breens’ brother-in-law and co-founder of a national foundation that advocates removing stigmatizing questions from the medical credentialing and licensing process. Much of his self-identity was inextricably linked with being a doctor. …When you threaten to have that lifelong goal taken away, it may result in suicide.
In recent years, medical boards in at least 26 states changed the language of their licensure applications to remove questions related to physicians’ mental health transitions, affecting 673,000 doctors nationwide, according to the Dr. Lorna Breen Heroes Foundation. Has given.
It took over a year of careful work to find and remove the language. The Massachusetts Health and Hospital Association began collecting credential forms from every hospital, health insurer, and medical licensing board in the state. Association staff carefully screened many of the forms, numbering 20 pages or more, to identify potentially stigmatizing questions about past treatment or diagnosis of mental illness or substance abuse disorder.
The association found that many of the forms had not been updated for decades and reflected outdated views on the nature of addiction and mental illness. Some placed questions about past mental health and substance use treatment in the same category as questions about criminal convictions. Many hospitals and health insurance plans were using a standard form that had not been updated since 2004.
Dr. Steve DeFosse, a neuroradiologist at Tufts Medical Center and vice president of clinical integration at the state hospital association, said these questions were a major disincentive for doctors seeking help for mental health and substance use problems. At hospitals, such credentialing forms are shared with three dozen hospital staff and administrators, from the hospital credentialing committee to the board of trustees, DeFosses said.
If someone has a condition that’s still stigmatized, they have no reason to expose it to dozens of strangers and coworkers they work with, Defosse said. The alternative for doctors is to hide it and not get them the help they need.
According to physician groups, high stress levels, long work hours and repeated exposure to trauma may make health care workers particularly vulnerable to burnout. Across the state, there are confidential peer support groups designed for health care workers; And the Massachusetts Medical Society offers a program, known as Physician Health Services, which provides therapy and monitoring to doctors with substance use and mental health problems.
Baker is not ashamed of the fact that she sought psychiatric counseling for her grief after losing her 23-year-old son, Max, to a heroin overdose seven years ago. But he resents having to disclose this fact when renewing his credentials every two years. Typically, he writes an asterisk next to the question and writes in a brief explanation, noting that he sought psychiatric care because of a family tragedy.
“What happened to my son was a terrible tragedy, but the fact that I sought his care should be my personal matter,” Baker said. Those questions do not improve patient care. They simply prevent physicians from taking care of themselves.
Chris Serres can be reached at email@example.com. chase him @chrisceres,
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