As a traveling emergency room doctor, I have spent years filling in for short-staffed hospitals and overwhelmed emergency departments. I know firsthand the challenges of practicing in a new facility. Each time I start a new assignment, I must obtain a new state license and receive hospital privileges to practice, which can take months.
This process is called "privileging" or "credentialing" and it is where hospitals thoroughly vet a clinician's ability to work in their facility by verifying current and past state licenses, past employment, malpractice history, references, education, residency, and any other issues they may want to know about.
(For new medical students heading into residency or doctors moving, the process can be even more lengthy.)
A particular question on state medical license application and hospital credentialing applications is a growing concern. (It's a question I had to answer last week.) The question asks: "Have you at any time during the last 10 years, been hospitalized or received any other type of institutional care for physical or mental problems?"
Why does an employer need to know your medical and mental health history? The answer is simple: they don't.
This question goes far beyond determining a clinician's ability to care for patients and invades their right to privacy, which is the bedrock of medical care. We're all familiar with the law Congress passed in 1996 called the Health Insurance Portability and Accountability Act (HIPAA), which prevents clinicians and hospitals from sharing private patient information. Yet, hospitals continue to ask physicians to detail their private medical and mental health history.
Why are physicians not afforded the same rights as their patients?
While some may believe a psychiatric history may be fair game for a hospital, we know that psychiatric conditions can be treated and managed, just like diabetes, hypertension, cardiac disease, orthopedic injuries, and many other medical conditions. If the condition is diagnosed and treated, why should a hospital concern themselves?
This matter extends beyond an infringement on privacy. These questions create a barrier for physicians needing mental healthcare. I was once told in residency that if I were to get HIV from a needle stick, I could never be a physician again. This is wrong, but for some time, it prevented me from wanting to ever get tested. Similarly, the question regarding mental health creates stigma and the perception that if a physician answers one of these questions in the affirmative, this may prevent them from obtaining or keeping a job.
Physicians are twice as likely to commit suicide compared to the general population and one-fifth suffer from depression. Physicians are also experiencing worsening "burnout" when compared to pre-pandemic times, with more than 63% experiencing symptoms of burnout.
Many clinicians battling these issues do not seek help. Fear of losing their job or career is certainly one reason why. This question creates a barrier to care.
These questions also reinforce the dangerous myth that physicians must be superhuman, immune to the same physical and emotional responses that other humans experience. Physicians witness some of the most vulnerable moments of human life, from birth to death, and it is only natural for them to experience a range of mental and physical responses. Suppressing these emotions leads to burnout and, ultimately, poorer patient outcomes.
Senators Ron Wyden (D-Ore.), Cory Booker (D-N.J.), and Jeff Merkley (D-Ore.) recently implored the U.S. Department of Justice (DOJ) to investigate state medical boards because of Title II Americans with Disabilities Act (ADA) violations where more than two-thirds of the states continue to ask "unnecessarily broad questions about doctors' psychiatric history."
The DOJ should act -- and Congress should exercise oversight.
States must act more quickly too.
Some states, like Virginia, have approved laws to reduce stigma. These measures prevent their state medical boards from asking questions about past psychiatric mental health or medical history. Instead of invasive questions about medical and mental health history, its medical board can now only ask doctors:
- Do you have any reason to believe that you would pose a risk to the safety or well-being of your patients or clients?
- Are you able to perform the essential functions of a practitioner in your area of practice with or without reasonable accommodation?
While these moves are a significant step forward, these laws only amend state licensing board questions, not employer questions. Virginia offers a strong model -- but other states must follow suit and then take these laws one step further.
The American Foundation for Suicide Prevention has said, "Unaddressed mental health conditions, in the long run, are more likely to have a negative impact on a physician's professional reputation and practice than reaching out for help early."
For the sake of doctors' privacy, and their mental health, it is time hospitals, hospital privileging applications, and other healthcare employers make a voluntary change too and prioritize their clinicians' mental health and well-being.
N. Adam Brown, MD, MBA, is a practicing emergency medicine physician, founder of ABIG Health, and a professor of practice at the University of North Carolina's Kenan-Flagler Business School. Previously he served as president of emergency medicine and chief impact officer for one of the nation's largest national medical groups.