As the COVID-19 pandemic rages on, the mental health of the healthcare workforce is widely reported as worsening. Despite increased attention, barriers to seeking mental health care remain high. Physicians, for example, are often required to divulge details about their mental health history on medical license applications ostensibly in service of patient safety. While there is no published evidence that these questions improve patient safety, there is ample evidence that asking such questions on medical license applications can deter physicians from seeking care due to risks to their privacy, reputation and employment.
As a result, the Federation of State Medical Boards, a national organization that advises state medical boards, developed detailed recommendations regarding how medical boards should and should not ask questions about mental health on medical licensing applications. Despite widespread agreement with these recommendations, few states and territories have meaningfully adopted them. Further, unlike state medical boards—which receive guidance from the FSMB and are generally accountable to state governors or legislatures—health system and clinic employers have no oversight on questions they ask about mental health on their own credentialing documents.
In the spring and summer of 2021, representatives from health systems across the country were convened by the Institute for Healthcare Improvement's Leadership Alliance to identify opportunities for collective action to eliminate credentialing related barriers to seeking mental health services. While attending to the mental well-being of the entire healthcare workforce is of vital importance, and many of these same concerns impact all licensed health professionals, the focus of this foundational work was specific to physicians. After a review of the literature, presentations from published authors, legal consultations, and iterative discussions the group developed several design principles for non-stigmatizing credentialing application questions.
To reduce unnecessary harm to physicians seeking or receiving mental health care, credentialing applications should:
■ Be nonjudgmental and only include language that does not stigmatize mental health care or mental health diagnoses.
■ Avoid distinguishing between physical and mental health conditions.
■ Focus on present abilities, such as since the last application or within the past two years.
■ Include only questions asking about impairment or effect on practice, not merely the presence of a condition or diagnosis.
■ Clearly differentiate content related to an individual's physical and mental health conditions and content related to criminal or unethical activity.
Our team recommends the following language be used on credentialing applications, if it is decided a question on physician health must be included: "Do you currently have any condition that adversely affects your ability to practice medicine in a safe, competent, ethical and professional manner?" We also recommend revising credentialing applications to include supportive language on physicians seeking and receiving mental health care, such as: "It is common for clinicians to feel overwhelmed from time to time and to seek help when appropriate. We emphasize the importance of well-being and appropriate treatment and support for all health conditions."
While healthcare leaders continue to commend the ways in which physicians and the entire healthcare workforce have compassionately cared for the sick during the COVID-19 pandemic, here are five concrete actions leaders can take today to support physicians as they continue this vital work.
■ Determine how your organization asks questions related to physician mental health on credentialing applications.
■ Identify how your state medical board presently asks questions related to physician mental health on licensing applications.
■ Advocate for the recommended non-stigmatizing questions and supportive language to be used among healthcare organizations, state medical boards and insurers.
■ Identify and mitigate barriers to physicians seeking mental health care.
■ Encourage investments in evidence-based research and interventions that promote and protect physician mental health.
Greater attention than ever is being paid to the toll that the pandemic and its attendant moral injury have taken on the healthcare workforce. As we work through this collective grief, what are we willing to do for those who have sacrificed so much to care for us all?
Also contributing to this article: Dr. David Marcus, chair of the GME Physician Wellbeing Committee and residency director in the combined program in emergency medicine, internal medicine and critical care at Northwell Health; and Dr. Robin Motter-Mast, chief of staff and medical director of care transformation at GBMC Healthcare.