Efforts to support physician well-being have scored two big wins as 2024 gets underway.
The National Association of Medical Staff Services (NAMSS)—the nation’s largest national medical staff organization that includes more than 6,000 medical staff and credentialing services professionals from medical group practices, hospitals and elsewhere—removed stigmatizing questions from its standard credentialing application.
This includes questions about past diagnoses and treatment for mental illness and substance-use disorders that studies have shown make physicians less likely to seek help for fear of losing their license or credentials. They have also been shown to be a key driver of suicide in the health care workforce.
Meanwhile, in Massachusetts, leaders at every hospital, health system and local health plan have committed to eliminating potentially stigmatizing questions from their credentialing process.
AMA President Jesse M. Ehrenfeld, MD, MPH, commended the Massachusetts Health & Hospital Association, Massachusetts Medical Society and all the stakeholders in the state that “have made the commitment to support physicians’ health and wellness by removing stigmatizing questions about past treatment or diagnosis of a mental illness or substance use disorder on credentialing applications and peer review forms.”
The AMA is urging “all other state hospital associations to make the same commitment and join a growing number of leading state and national organizations that recognize the urgent need to make these changes,” Dr. Ehrenfeld said.
The AMA and the Dr. Lorna Breen Heroes’ Foundation worked closely with the state hospital and medical associations to identify areas where progress could be made on credentialing questions. The AMA has advocated for changes to the invasive questions that have been identified as a contributor to burnout. Slightly more than half of state medical boards have taken action to remove stigmatizing questions from their license application, when Ohio in late 2023 became the 26th state to do so.
An AMA issue brief, “Confidential care to support physician health and wellness” (PDF), provides model legislative language and other recommended policy actions for states as well as resources for physicians and state medical associations.
Reducing physician burnout is a critical component of the AMA Recovery Plan for America’s Physicians.
Far too many American physicians experience burnout. That's why the AMA develops resources that prioritize well-being and highlight workflow changes so physicians can focus on what matters—patient care.
Focusing on the here and now
NAMSS approved two questions that directly follow AMA recommendations that language focus on a physician’s current state and not ask about past diagnoses or treatments.
For “Health Status,” NAMSS now recommends that its members use a single question:
Are you currently suffering from any condition for which you are not being appropriately treated that impairs your judgment or that would otherwise adversely affect your ability to practice medicine in a competent, ethical, and professional manner? (Yes/No)
For peer references, NAMSS now recommends its members use this question:
To your actual knowledge, is the applicant currently suffering from or experiencing any condition or health issue that is not being treated and that impairs the applicant’s judgment or that would otherwise affect the applicant’s ability to practice medicine in a competent, ethical, and professional manner? (Yes/No) Responses to this question are confidential and used strictly for credentialing purposes. This question should not be answered if doing so would or could violate physician/patient obligations
“The AMA deeply appreciates and commends NAMSS for its national leadership and commitment to supporting physicians’ health and wellness through removing stigmatizing questions about past treatment of mental health and substance use disorders from the NAMSS credentialing standards,” Dr. Ehrenfeld said.
“The next step,” he added, “is for all hospitals and health systems to review their own credentialing questions and policies to ensure they are consistent with NAMSS national best practices. The AMA and Dr. Lorna Breen Heroes' Foundation stand ready to work with every hospital and health system in the nation to update their credentialing applications to ensure they support physicians' and all health care professionals' health and wellbeing.”
Massachusetts’ efforts mark the first statewide effort to eliminate stigmatizing questions from the credentialing process and support physician well-being, reduce stigma and connect doctors with the care they need.
The Bay State effort includes no longer asking physicians about prior drug use. The National Committee for Quality Assurance no longer requires health plans to ask doctors about their prior drug use, allowing Massachusetts to update its common credentialing application known as the Integrated Massachusetts Application. Local health plans have endorsed the change, which affects 38 hospitals that use the application form for their own credentialing practices.
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