Massachusetts hospitals and health insurance companies have agreed to stop asking doctors and other clinicians about their history of mental illness and addiction, joining an effort to erase stigma and reduce the widespread burnout among health care workers.
Every two to three years, clinicians fill out forms to maintain their medical credentials with hospitals and insurers. These forms commonly included questions about past mental health conditions and drug use to help determine whether a clinician could safely do their job.
But a growing number of state and national health care organizations argue such questions violate privacy and deter people from getting much-needed treatment for mental illness and substance use.
The state’s hospitals and insurers now say they won’t focus on a person's past behavioral health conditions. Instead, they will ask about current medical issues that may impair a clinician’s ability to take care of patients.
The changes mean that a physician will no longer have to disclose if they’ve been treated for depression, or if they’re recovering from drug or alcohol addiction.
“If you're currently able to practice medicine, and you’re taking care of yourself, that's what we should be interested in — not what you did previously,” said Dr. Barbara Spivak, president of the Massachusetts Medical Society. “That's a huge step forward.
“It's particularly important in today's world,” she said, “where we're seeing so many physicians suffering from various levels of burnout, where the stresses of medicine are really interfering with the joy of medicine, and maybe even the joy of life.”
Physicians who admit to mental health or addiction issues on their credentialing forms are typically required to share more details and submit to scrutiny such as monitoring or periodic drug tests.
Many doctors also fear they will lose their ability to practice medicine altogether if they admit to mental illness or drug use. More than 40% of physicians in a recent survey said they didn’t seek help for burnout or depression because they were afraid their medical board or employer would find out.
“The perception is that their livelihood is at risk,” said Dr. Steven Defossez, vice president of clinical integration at the Massachusetts Health & Hospital Association.
The culture of medicine traditionally has held doctors to unrealistic standards — to be “super men and super women,” Defossez said. “It means you don’t get hurt, you don’t have emotions. When you’re cut, you don’t bleed. And none of that is true.”
“It's much healthier if clinicians can obtain the behavioral health care they need,” he said, “whether it's psychological care for stress or anxiety or depression … or whether it's care for substance use disorder. And we're removing barriers so that clinicians can do that.”
Medical licensing boards in more than two dozen states, including Massachusetts, have stopped asking broad questions about mental health on their licensing forms. All Massachusetts hospitals and insurers committed to do the same for their credentialing forms, and some have already done so.
“This is a huge step in the right direction,” said Dr. Peter Grinspoon, a primary care physician at Massachusetts General Hospital, who was not involved in the decision to change hospital and insurance forms. “It allows doctors to be human beings. It allows them to deal with their problems without adding a whole layer of punishment.”
Grinspoon suffered from opioid addiction, temporarily losing his medical license, and has been in recovery for 15 years. He said physicians with addiction and mental illness deserve empathy.
“People who are in recovery are great doctors,” he said. “They are people who have made it to the other side. They are doctors who are really humble and connected and mindful, and they listen to their patients.”
Burnout among health care workers has been growing for years, and the COVID pandemic exacerbated the crisis by forcing medical professionals to contend with surging numbers of patients, longer work hours, supply shortages and increased harassment and violence.
Nearly half of health care workers reported feeling burned out often in 2022, compared with 32% who felt that way in 2018, according to the U.S. Centers for Disease Control and Prevention. And surveys show that burnout rates are even higher among doctors. To cope, some health care professionals are leaving their jobs or reducing their hours.
Health care workers, especially female doctors, are at disproportionately higher risk of suicide, compared to other workers. An estimated 300 to 400 doctors die by suicide each year.
Dr. Lorna Breen was an emergency room physician in New York City in the early days of the pandemic, when hospitals were overwhelmed with severely ill COVID patients. She was stresssed working long hours and realized she was struggling — becoming so despondent she could no longer move. She confided in her sister, who helped her get psychiatric treatment in another state. But Breen was afraid of what others would think. She was afraid she would lose her job.
“She was not well,” said her brother-in-law, J. Corey Feist. “Once we got her stabilized, she said, ‘Now my career’s over. Now I’m done.’ “
Breen died by suicide in April 2020.
Feist is chief executive of a foundation named in Breen’s memory, which works to improve the wellbeing of health care professionals. The Dr. Lorna Breen Heroes’ Foundation has been pushing state medical boards and hospital leaders to update their licensing and credentialing forms.
For example, instead of asking clinicians: “Have you ever been treated for or do you have a diagnosis for any mental health condition?” Feist said hospitals should ask whether they are currently suffering from any untreated condition that impairs their ability to practice medicine.
“Any organization we share this information with, they go back and look at their questions and are often horrified by what they’re asking,” Feist said. “Change is actually happening at quite a fast pace.”
The local health care groups that support updating forms include the state's medical society, the hospital association, the Massachusetts Association of Health Plans and Blue Cross Blue Shield of Massachusetts.
Several national groups, such as the American Medical Association, as well as state and federal health officials, also have called for an end to questions they say contribute to the stigma around seeking behavioral health care.
These changes are happening amid a broader shift toward treating mental illness and addiction more like other medical conditions. There doesn't appear to be any significant opposition to the movement to update forms.
The National Committee for Quality Assurance, which accredits health plans, recently removed its requirement that plans ask clinicians about prior drug use. This change allows Massachusetts insurers to update their forms.
“It is our hope that NCQA’s elimination of this outdated question … will reduce stigma for providers and patients alike,” Liz Leahy, senior vice president at the association of health plans, said in a statement.