Q’s Cut for mental health from MD-licensed apps in 21 states

Since May, doctors in 21 states are no longer asked general questions about mental health or substance abuse when applying for a medical license. This is an important change that could ease doctors’ concerns about seeking treatment, according to Dr. Lorna Breen Heroes’ Foundation, a medical burnout prevention group that tracks such changes.

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The foundation was named in honor of Lorna Breen, MD, an emergency medicine physician in New York City who died by suicide in April 2020 during the outbreak of the pandemic. The suicide rate among doctors is double that of the general population.

“The question isn’t whether a doctor might have had a severe or mild mental illness…it’s whether they have some disability that might affect their current work,” said Peter Yellowlees, MD, distinguished professor of psychiatry at the University of California. California. Davis. “Asking about past episodes of mental illness, which may have occurred years ago…is simply discriminatory and is an example of the stigma associated with mental disorders.”

The Breen Foundation has worked with medical boards and state hospitals to remove stigmatizing questions about mental health and substance abuse from license and credential applications.

Breen had told his sister and brother-in-law shortly before his suicide that he feared losing his license and the career he loved if the medical board found out he had received inpatient mental health treatment, said J. Corey Feist, JD. MBA, his brother-in-law and co-founder and president of the foundation.

She was unaware that New York was a state that didn’t ask doctors questions about their mental health, Feist said.

«That’s why we want to make it clear to doctors which states are still asking these questions and which are not,» Feist said.

Many doctors share Breen’s concern about professional consequences.

According to Medscape’s «I Cry but No One Cares»: Physician Burnout & Depression Report 2023, four out of 10 physicians said they did not seek help for burnout or depression because they feared their employer or state medical board would find out. .

An Oregon emergency room doctor said informing his state medical board about an episode of mania led to public disclosures, a 4-month investigation, loss of income and worse job ratings. Looking back on her decision to be transparent with the board, Susan Haney, MD, said she was naïve. «Advice is not your friend.»

Fearing for her career, midwife Robyn Alley-Hay, MD, now retired, never disclosed in her license applications that she had been hospitalized and treated for depression in the 1990s. She retired from practicing medicine in 2014 and now works as a life coach.

“I hated those questions because I felt like I could never tell the whole truth,” Alley-Hay said. «But I could always honestly answer ‘no’ to questions about the impairment. That was a line I wouldn’t cross if you’re impaired, you shouldn’t practice.»

Does attention to current impairment protect the public?

New York, Texas, California, Montana, Illinois and North Carolina are among 21 states that don’t ask health-related questions or ask only a single question to address physical and mental health, Feist said.

Most of these changes are in line with 2018 recommendations from the Federation of State Medical Boards (FSMB), said Joe Knickrehm, FSMB vice president of communications. “Application questions must focus only on the current impairment and not on prior disease, diagnosis, or treatment to be compliant with the Americans With Disabilities Act,” the FSMB says.

Mental health questions have often been added to licensure and credential questions out of a «misplaced desire to protect patients and families from physicians who may be unfit to provide care. Yet there is no evidence that they serve that function,» he said. stated Feist.

California patient safety advocate Marian Hollingsworth says medical boards have a responsibility to ensure that doctors pose no or negligible risk to the public. She questioned whether medical boards can adequately protect the public if they ask only for medical conditions rather than mental illness or substance abuse.

“There is a fine line between privacy and a right to know for the public protection. I would like the approving medical board to have assurance from a treatment professional that this doctor is stable and doing well with continued treatment «Hollingsworth said.

Legislation requires mental health questions to be removed

In March, Virginia became the first state to enact a law requiring all health professions regulatory committees, including physician committees, to remove or replace mental health questions on licensing, certification and registration applications.

The law requires committees to use the following wording if substituting questions about mental health: «Do you have reason to believe you would pose a risk to patient safety or well-being?» «Are you able to perform the essential functions of your job with or without reasonable accommodations?»

The Illinois General Assembly passed a more limited bill in May that requires medical boards to remove or replace mental health questions in its license applications. Governor JB Pritzker (D) is expected to sign the bill.

The Virginia Healthcare and Hospital Association, which represents more than 100 hospitals and health care systems in the state, has partnered with the Medical Society of Virginia and the Virginia Nurses Association to support the new legislation.

“The reason the Virginia coalition pushed for the law was because the state’s medical boards weren’t acting quickly enough. While state laws vary on what medical boards can do, the legislation isn’t necessary in most states to change licensing questions,” Feist said.

Virginia hospitals began working with the foundation last year to change their mental health applications to credential applications. About 20 percent of Virginia hospitals have completed the trial, including four major health systems: Inova, UVA Health, Centerra and Children’s Hospitals of King’s Daughters, Feist said.

The foundation also challenged Lisa MacLean, MD, a psychiatrist and clinical wellness manager at Henry Ford Medical Group in Detroit, to review their credential application for any stigmatizing mental health questions.

MacLean told the American Medical Association (AMA) that he found an application that needed to be changed, but that it took some time to pass the hospital’s approval process. Eventually, the wording was changed from «a diagnosis or treatment of a physically, mentally, chemically, or emotionally dependent condition» to «a diagnosis or treatment of any condition that could impair your ability to practice medicine.»

National medical organizations make changes

The Joint Commission, which accredits hospitals, has emphasized since 2020 that it does not require hospitals to inquire about an applicant’s mental health history.

«We strongly encourage organizations not to ask about past history of mental health conditions or treatments,» the Commission said in a statement. “It is crucial to ensure that healthcare professionals can feel free to access mental health resources.”

The Joint Commission said it supports the FSMB’s recommendations and the AMA’s recommendation that physicians’ mental health questions be limited to «conditions that currently impair physicians’ ability to do their jobs.»

More than 40 professional medical organizations, including the American Academy of Family Physicians and the American Psychiatric Association, signed a joint statement in 2020 calling for changes to mental health disclosure rules.

«Support from leading organizations is helpful because it’s changing the conversation going on inside and outside the house of medicine,» Feist said.

Should doctors answer questions about mental health?

Many states continue to ask questions about hospitalization and mental health diagnoses or treatment in their license and credential applications.

Yellowlees advises doctors to «be honest and not lie or deny past mental health issues, as medical boards tend to take a very serious view of doctors who don’t tell the truth.»

However, the questions asked by medical boards can vary by state. «If it’s possible, doctors can provide accurate but minimal information while trying to focus primarily on their current ability to work,» Yellowlees said.

He also suggested that doctors who are unsure of how to answer questions about mental health consider seeking advice from attorneys used to working with relevant medical boards.

Physicians who want to get involved in removing mental health care licensing and credential barriers can find resources here and here.

Christine Lehmann, MA, is a senior editor and writer for Medscape Business of Medicine based in the DC area. She has been featured in WebMD News, Psychiatric News and The Washington Post. Contact Christine at [email protected] or via Twitter @writing_health.

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