Defending healthcare workers has become an essential part of our daily lives. In March, we were proud to see the Dr. Lorna Breen Healthcare Provider Protection Act signed into law to provide $135 million for programs to support the mental health and wellbeing of healthcare workers. . However, while this was a welcome first step, it is only the beginning of the work needed to protect our clinicians.
The critical next step falls on states to remove language from their licensing and credentialing processes that stigmatizes medical professionals who have sought treatment for mental health conditions.
Our research identified 31 states, plus the District of Columbia, that may still use invasive or stigmatizing language requiring applicants to disclose any history of mental health issues or explain why they took work breaks. Some require applicants to disclose any past psychiatric impairments, potentially dating back decades or even adolescence. These questions could violate the Americans with Disabilities Act. They certainly violate the privacy of candidates. And there is significant evidence that they deter clinicians from seeking the care they need – risking their well-being and their lives.
Indeed, a survey of more than 1,500 doctors this year found that 80% of them feel the stigma of doctors seeking mental health care. Nearly 40% said they or a colleague they know were afraid to seek mental health care because that treatment would have to be disclosed on their applications for licensure, certification or certification. insurance.
Mental health issues have often been added to applications for leave due to a misplaced desire to protect the public from clinicians who may not be fit to provide care. However, there is no evidence that these questions fulfill this function.
On the contrary, the public interest is harmed by these issues, because we know that when doctors, nurses and other clinicians are afraid to seek the care they need, they can find themselves unable to work due to a depression or burnout. Some may turn to drugs or alcohol. And tragically, some will turn to suicide. In fact, the stigma associated with seeking – or even discussing – behavioral health care is believed to be one of the main drivers of suicide among health care workers.
Law Dr. Lorna Breen is named after the sister-in-law of Corey Feist, co-author of this article. Emergency physician Lorna died by suicide in April 2020, after weeks of incredibly intense work caring for patients from the first wave of COVID-19. At one point during this wave, Lorna called her sister to confide that she was overwhelmed with exhaustion and grief – but she feared losing her medical license or being ostracized at work if she admitted that she needed help.
In the years since Lorna’s death, we have heard from many families who have lost loved ones to suicide. We recently contacted an emergency physician in Florida who reported that four of his fellow physicians committed suicide this summer. In too many of these cases, clinicians have admitted to friends or family that they are hesitant to seek treatment because of the stigma surrounding mental health issues.
One such tragedy involves Dr. Matthew Gall, a dedicated oncologist who practiced medicine for 16 years in Minnesota, one of the states that until recently used invasive questions on license applications. In 2019, Matthew moved to North Carolina with his wife and their three children. The transition to a new practice was difficult and Matthew struggled with depression, but he refused to ask for help. His wife, Betsy, told an interviewer that her husband felt “ashamed and embarrassed” about his depression and feared he would lose his medical license and livelihood if he sought treatment. “He honestly thought he wouldn’t be able to be a practicing oncologist anymore,” Betsy said. “The fear was real and being a doctor meant everything to him.” Matthew committed suicide on Thanksgiving Day 2019.
A terrible irony in this tragedy is the fact that North Carolina does not ask intrusive questions about mental health treatment in its licensing process. But having just moved to the state, Matthew was unaware of this fact. Lorna, too, didn’t know that New York didn’t use invasive questions.
These stories are painful. These are powerful reminders that we must work towards universal permit application reform, as our team in Minnesota did, updating their questions to be less stigmatizing after the testimony of the sister and Lorna’s brother-in-law. It is also clear that simply changing the language of apps is not enough. We also need to spread the message widely, so that no clinician has to worry about losing their job if they seek the help they need. Additionally, we must continue to change the culture within health care systems so that doctors, nurses, pharmacists and other health care workers feel comfortable talking openly about their mental health issues. and their need for support.
We fight for these reforms through our ALL IN: WellBeing First for Healthcare campaign, which brings together more than a dozen organizations, including the American Medical Association, American Hospital Association, American Nurses Foundation and Physicians Foundation. Thousands of people have joined us in contacting state medical boards to demand change.
We are also working to address clinician burnout through common-sense reforms that we hope will eliminate some of the bureaucracy that can take up so much of a clinician’s time and take away the joy of patient care.
Ensuring that healthcare workers can access needed mental health care is essential for their well-being and for the health of our entire country. Let’s do our part to support them. Together we can show our vital health workers that they are not alone in this fight for their lives.
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