Hats off to Massachusetts for becoming the first state to eliminate the long-sanding, widespread, and outdated practice of requiring physicians to disclose current or prior treatment for mental health issues as well as past drug use as part of state licensure, hospital privileging, and/or insurance plan credentialing. Writing in the December 26 issue of Becker's Review, Molly Gamble reports the comprehensive change was the result of a successful collaboration among and between the Massachusetts Health & Hospital Association, Massachusetts Medical Society, Massachusetts Association of Health Plans and Blue Cross Blue Shield of Massachusetts "to reduce stigma among health professionals" (for having sought or currently receiving treatment).
For those of us who are active in the clinician wellbeing/burnout prevention community, this is a landmark, welcomed development. For far too long, throughout society in general and, ironically, particularly among clinicians, there has been a pervasive, persistent reluctance to seek help or to acknowledge having received mental health treatment due in part to the unfortunate stigma associated with behavioral health issues as well as the not unrealistic fear that disclosing one's mental health history could adversely affect one's chances of professional advancement or even employment. Now with roughly 70% of all clinicians reporting burnout and a stunning number of nurses and physicians indicating they are strongly considering (or even actively planning) to leave the field, existing staffing shortages are likely to become even more severe unless the various barriers, real as well as perceived, to seeking help (or for having sought help) are removed.
Dr. Lorna Breen - Heroes Foundation
For those interested in learning more about how to create the case for and conditions to replicate the Massachusetts model, an excellent resource is the Dr, Lorna Breen Heroes Foundation co-founded by Jennifer Breen Feist, JD and Corey Feist, JD, MBA, respectively, the late Dr. Breen's sister and brother-in-law. A talented and compassionate physician, Dr. Breen was the director of emergency medicine at Allen Hospital, part of the New York Presbyterian Health System in Manhattan. Dr. Breen died by suicide at the height of the pandemic -- during the terrible period when hospitals were overflowing with COVID patients, treatments were limited or still evolving, supplies of PPE for caregivers were inadequate, and no vaccines were yet available. Beyond trying to cope with these difficult conditions, Dr. Breen, like many clinicians, was reluctant to seek professional help for fear that it would adversely affect her career.
Roughly half of the states have adjusted physician licensure applications to remove this category of questions, but Massachusetts is now the gold standard for removing the entire line of inquiry at hospitals and health plans alike. While Massachusetts' actions warrant our collective support and appreciation, it should be considered just the first step toward eliminating mental health queries for ALL clinicians: -- nurses, advanced practice providers, pharmacists, and therapists of all stripes -- in all states.
Removing this and other barriers to seeking mental health care is a key step but it is just one of several changes that are required of healthcare leaders to fundamentally alter the conditions in the hospital or medical group practice workplace that give rise to burnout.
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