Getting invasive questions about past mental health diagnosis or treatment removed from licensing and credentialing applications can be an effective way of supporting well-being and removing a barrier to physicians getting the help they need. But even when these changes are made, the impact can be blunted if doctors are unaware of them.
“The stigma is real. The fear is real,” said psychiatrist Lisa MacLean, MD. “It’s hard-wired in many physicians—this idea that they don’t have the time or that it’s a sign of weakness to seek care.”
Dr. MacLean led the effort to change the question on the credentialing application at Henry Ford Health, where she is the chief clinical wellness officer of the Henry Ford Medical Group.
Henry Ford Health is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Dr. MacLean spoke at an AMA Insight Network Meeting highlighting how her system implemented the changes on its credentialling forms and continues to educate staff on why the changes were made. The AMA Insight Network helps AMA Health System Program members gain early access to innovative ideas, get feedback from their peers, network, and learn about pilot opportunities.
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Moves in the right direction
To implement the changes, Henry Ford Health followed the three-step toolkit that can be found in the “Take Action” section of the Dr. Lorna Breen Heroes’ Foundation website.
The three steps are:
- Audit.
- Change.
- Communicate.
Regarding the audit process, Henry Ford recommends the following to-do list:
- Review every single application your organization issues, including training, renewal, initial, educational, supplemental or addendum, peer reference and peer-review forms.
- Look for questions that contain invasive or stigmatizing language and disclosure requests about a physician’s health and well-being.
This includes:
- Questions that ask about a physician’s history of “time off” or “breaks in practice.”
- Language that references mental health explicitly in any way that is not supportive.
- Questions that ask about usage or past experience of treatment.
Peer-reference forms often contain outdated language that may not be immediately noticed as other changes are being made on more high-profile forms, noted Corey Feist. He is president and co-founder of the Dr. Lorna Breen Heroes’ Foundation and also spoke at the AMA Insight Network event.
The AMA advocates to support the mental health of medical students, residents and physicians. This includes ensuring that state licensing, credentialing, employment and other related applications do not contain stigmatizing language that inappropriately asks about past diagnoses or treatment for mental health or a substance-use disorder.
Twenty-six states have removed or modified such questions on their licensing applications and so have 12 health systems that represent more than 127,000 health professionals. Another 21 health systems are in the process of doing the same—often with the effort led by chief wellness officers such as Dr. MacLean.
A few words make a big difference
Originally, the Henry Ford credentialing application included this question: “Have you ever been diagnosed with and/or received treatment for a physical, mental, chemical dependency or emotional condition which could impair your ability to practice medicine?”
That question has been revised and now asks: “Are you diagnosed with or receiving treatment for any condition (physical, mental, emotional or substance dependence related) that currently impairs your ability to practice medicine?”
Dr. MacLean also recommended that “someone needs to own the process end to end” to ensure that the logistical process of updating relevant documentation is executed and goes live.
After the change is made, she said the next step is to “communicate, communicate, keep communicating, recommunicate.”
A young surgical resident recently told Dr. MacLean that he was feeling as though he should seek help, but he was afraid it would affect his medical licensure.
“You can’t communicate enough, and you have to continue to tell people on a regular basis,” she said.
Feist agreed.
“We have got to let the workforce know what the rules are—at every level,” he said. “They can get the same mental health treatment that they prescribe for their patients.”
