Stigmatizing questions removed from healthcare credentialing processes

Mass. joins other New England states with practice

In a move to reduce the stigma of seeking mental health treatment for physicians, Massachusetts hospitals and health insurers have committed to eliminate questions about prior mental illness and addiction from their credentialing processes.

“I think this is an important step in the right direction,” Barbara Spivak, M.D., president of the Massachusetts Medical Society. “What we should really care about is whether you are currently having mental health issues that could affect your ability to practice. That’s much more important than asking if you had a problem 10 or 20 years ago.”

The Massachusetts Health & Hospital Association’s Board of Trustees unanimously approved the credentialing process reform. In the past, health professionals have worried about revealing any history of drug or alcohol abuse, depression, and even stress, for fear someone might question their ability to practice medicine.

“While we will never know which clinicians will now choose to seek support, we are confident they and their patients will be far better off as a result of this united initiative,” said Steven Defossez, M.D., vice president of clinical integration at MHA in a statement. “We will celebrate the impact this effort will have, while knowing it is just one more step along the way to mitigate burnout and eliminate stigma from the healthcare profession.”

Elizabeth Austin Psy.D., president, Massachusetts Psychological Association, agreed, noting the changes will be better for not only physicians but patients, because doctors who care for themselves may be able to provide a higher standard of care.

“Physicians have traditionally underutilized mental health resources because of the reporting mandate,” Austin said. “There has always been a stigma and as a result, people feel their hands are tied when it comes to getting care.”

Spivak noted one of physicians’ biggest barriers to seeking help is time. It can be difficult to find a therapist who can work with their schedules.

Physicians are also challenged to find someone out of their network who doesn’t know them professionally or socially, particularly if they are in a small community. “The lack of [available] therapists impacts physicians just like everyone else,” she said.

Encouraging physicians to seek help when they need it should begin at the start of their careers. “We should be offering medical students, residents, and interns [the opportunity] to take time out of their day to get help,” Spivak said. “If we do that, it will set the tone and reduce the stigma.”

Younger professionals typically feel comfortable accessing mental health resources, said Austin. “It’s a cohort effect as much as anything. Millennials and younger people talk about their mental health as part of their everyday considerations, so they’re much more comfortable than people would have been 20 years ago.”

She noted many psychologists have mandates within their training programs to get therapy. “It’s part of the education process.”

There are numerous causes of stress for healthcare workers. Two major factors are the volume of work from employers and administrative burdens such as keeping electronic health records up to date.

Physicians are under more stress than ever before, said Spivak. One in five U.S. physicians report experiencing depression, with more than 60 percent citing job burnout as the cause, according to a 2023 Medscape survey.

And, an October 2023 CDC Vital Signs report revealed that poor mental health symptoms increased more for health workers than any other employment category.

“There is a mental health crisis among health workers,” said J. Corey Feist, a healthcare executive and founder/CEO of the Dr. Lorna Breen Heroes Foundation. “We’ve got to make sure they get the treatment they need so they can take care of patients. It’s that simple,” he said.

In 2020, Feist and his wife Jennifer co-founded the nonprofit, which works to improve the wellbeing and job satisfaction of healthcare workers. The inspiration was Jennifer’s sister, who died by suicide after becoming despondent over the potential stigma of her seeking mental health treatment for exhaustion and stress during the pandemic.

“It opened my eyes to a whole other world associated with our healthcare workers, which we couldn’t ignore,” he said. “It was clearly an unmet need. “These questions not only prohibit mental health care, they are a driver of suicide.”

The foundation’s 2023 year-end report shows that 26 states have made changes like Massachusetts to remove potentially invasive or stigmatizing language from their licensing requirements, including Maine, Vermont, and Connecticut.

New Hampshire was among the 33 states in the process of reevaluating its credentialing process, while Rhode Island is one of the 11 that has not yet reported changes.