Massachusetts has now become the first state to remove provider questions about mental illness and addiction from the entire health care system in an effort to combat stigma and burnout among medical professionals. In about two dozen other states, professional boards that license doctors have stopped the practice. Yet Massachusetts has gone further: cleaning up questions on power of attorney forms used by virtually every state hospital, health care system, insurance company and medical licensing board.
This is a huge step forward, said Dr. James Baker, president of the Massachusetts Society of Addiction Medicine and a physician at Haverhill Hospice. The power of this new policy is that it opens the door for doctors struggling with depression, anxiety and substance use disorders to get the help they need without fear.
The questions stem from the idea that medical professionals should be held to a higher standard, and because they are on the job under the influence of alcohol or drugs, they are at stake.
Yet research has 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 study, nearly 40 percent of American doctors said they would be reluctant to seek treatment for a mental health problem because they were worried about the consequences to their medical license. In a separate study, nearly half of female doctors said they met criteria for mental illness but hadn’t sought treatment, in part because they feared reporting to the medical licensing board.
The effort to eradicate drug use and mental health issues accelerated during the pandemic as doctors’ work burnout and mental anxieties increased. According to a study published last fall by the Centers for Disease Control and Prevention, 46 percent of healthcare workers nationwide reported feeling frequently burned out in 2022, up from 32 percent in 2018. Each year, an estimated 300 to 400 doctors kill themselves, and the suicide rate is more than double that of the general population, according to an analysis by the American Psychiatric Association.
Still, it was the widespread death of a New York doctor in the early days of the pandemic that made hospitals and medical associations take up the matter.
In April 2020, Dr. Lorna Breen, an emergency physician at New York Presbyterian Hospital in Manhattan, was overwhelmed by the relentless flow of sick patients, many of whom died in hospital waiting rooms and hallways, her family said. After working 12-hour shifts on the set, Breen called his sister and said he couldn’t get out of his chair at home. Concerned, family and friends drove Breen to his childhood home in Charlottesville, Va., where he checked into a psychiatric inpatient unit.
While at the psychiatric clinic, Breen repeatedly told relatives that he feared losing his medical license and hospital credentials because he sought mental health treatment, family members said.
Days after expressing these fears, Breen took her own life.
Those questions definitely helped [Breens] to death, said J. Corey Feist, Breens’ brother-in-law and 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 to being a doctor. … When you threaten to take away that lifelong practice, it can lead to suicide.
In recent years, medical boards in at least 26 states have changed the language of their licensing applications to remove questions about changes in doctors’ mental health, affecting 673,000 doctors nationwide, according to the Dr. Lorna Breen Heroes Foundation.
Finding and removing the language took more than a year of painstaking work. The Massachusetts Health & Hospital Association began collecting power of attorney forms from every hospital, health insurance company, and medical licensing board in the state. After that, the association’s employees carefully combed through several 20-page or more forms to find potentially stigmatizing questions about previous treatment or a diagnosis of mental illness or substance abuse disorder.
Many forms had not been updated for decades and reflected outdated views about the nature of addiction and mental illness, the association found. Some placed questions about past mental health and substance use in the same category as questions about criminal convictions. Many hospitals and health insurance plans had used a standard form that had not been updated since 2004.
Dr. Steve Defossez, a neuroradiologist at Tufts Medical Center and vice president of clinical integration for the state hospital association, said the questions were a huge deterrent for doctors seeking help for mental health and substance abuse problems. In hospitals, such credentialing forms are shared with as many as three dozen hospital staff and administrators, from the hospital’s credentialing committee to the board of directors, Defossez said.
If someone still has a stigmatized illness, there’s no reason for them to reveal it to the dozens and dozens of strangers and co-workers they work with, Defossez said. The alternative is that doctors hide it and don’t get the help they need.
According to medical groups, high stress levels, long working hours and repeated exposure to trauma can make healthcare workers particularly vulnerable to burnout. There are confidential peer support groups designed for healthcare workers across the state; and the Massachusetts Medical Society offers a program called Physician Health Services, which provides therapy and follow-up for physicians with substance use and mental health problems.
Baker is not ashamed that she sought psychiatric counseling to deal with her grief after losing her 23-year-old son Max to a heroin overdose seven years ago. But he has resented having to make that fact public every two years when he renews his credentials. Typically, he writes an asterisk next to the question and writes a brief explanation, noting that he sought psychiatric treatment because of a family tragedy.
“What happened to my son was a terrible tragedy, but the fact that I’m seeking treatment should be my private matter,” Baker said. These questions do not improve patient care. They just prevent doctors from seeking treatment for themselves.
Chris Serres can be reached at email@example.com. Follow him @ChrisSerres.
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