In a win for physician mental health, 21 states have opted to remove broad mental health or substance abuse questions from medical licensure applications, according to data gathered by the Dr. Lorna Breen Heroes Foundation.
Among these 21 states, the licensing application language is consistent with one of three options: it asks one question that addresses all mental and physical health conditions (consistent with the Federation of State Medical Board’s (FSMB) recommended language), does not ask about applicant health at all, or implements an attestation model with supportive language around mental health and “safe haven” non-reporting options for physicians who are receiving care.
The Dr. Lorna Breen Heroes Foundation, whose namesake died by suicide after experiencing severe burnout while working in emergency medicine during the early period of the covid pandemic in NYC, advocates for better mental health practices for physicians and policies that reduce physician burnout. Two components of the Foundation’s mission include working with state medical boards to remove mental health and substance abuse questions from credentialing applications, and increasing transparency around states’ policies.
The mission is personal for the foundation. Shortly before Dr. Breen’s death, she had shared her reluctance to seek help with family members. She feared that she would no longer be able to practice medicine if she did so. And, Dr. Breen’s hesitance is reflective of the physician population. According to Medscape’s 2023 Physician Burnout & Depression Report, 40 percent of physicians said that they would not seek help for burnout or depression out of fear of repercussions from their employer or state medical board.
The Foundation is not alone in advocating for changes that support clinician wellbeing. Other organizations within the medical community have also voiced support for reform. In 2020, over 40 professional medical organizations, including the AMA, the American Academy of Family Physicians and the American Psychiatric Association, signed a joint statement in support of changing disclosure practices about mental health. And, the AMA and FSMB recommendations support questions that focus only on current impairments rather than historical struggles.
According to the FSMB, "Application questions must focus only on current impairment and not on illness, diagnosis, or previous treatment in order to be compliant with the Americans with Disabilities Act." Similarly, the AMA recommends that any questions required of physicians be restricted to “conditions that currently impair the clinician’s ability to perform their job." And the Joint Commission, an organization that accredits hospitals, removed the requirement for hospitals to question applicants on their mental health history. “We strongly encourage organizations to not ask about past history of mental health conditions or treatment," they wrote in a statement. "It is critical that we ensure health care workers can feel free to access mental health resources."
Stay up-to-date on state policy using the Dr. Lorna Breen Heroes Foundation tracker, here.