Spotlight on provider mental health: can the credentialing process play a role?

Healthcare providers are expected to be superhuman; however, just like the rest of us, they are not immune from mental health challenges, and unfortunately, barriers to seeking care remain high. The nature of being a clinician itself is not an easy road — long hours and pressure cooker situations, not to mention sector-wide challenges such as provider burnout, staffing shortages, and, of course, the COVID-19 pandemic, heightening an already stressful job.

Thankfully, there is a growing awareness of provider burnout and a better understanding around the importance of work-life balance for providers and the need to destigmatize mental health challenges in the healthcare workplace.

Northwell Health is an example of a healthcare organization that has taken big steps to remove a major barrier that discourages providers from reaching out for mental health care by changing the questionnaire that physicians, PAs, NPs, and midwives must complete to be credentialed for hospital privileges. Innovate LI explains specific questions such as, “Do you have a physical, mental or emotional condition, or substance abuse issue, that would affect your ability to practice or provide safe patient care?” would discourage providers from answering the questions truthfully. “In some states, like New Hampshire and West Virginia, medical credentialing boards even ask medical professionals if they’ve ‘ever’ had such issues — asking them to admit to physical, mental, or substance problems that could have occurred long before they became licensed. Answering ‘yes’ to such questions could prevent licensing or subject the already-licensed to intimidating scrutiny from review and assessment boards.”

Challenges such as mental illness or substance abuse, no matter how common among human beings, are still stigmatized in the healthcare sector for those providing care, and because of this, many providers feel backed into a corner when it comes to answering these questions truthfully. Modern Healthcare reported, “While there is no published evidence that these questions improve patient safety, there is ample evidence that asking such questions on medical license applications can deter physicians from seeking care due to risks to their privacy, reputation and employment.” However, despite the growing evidence for the negative implications of these kinds of questions, healthcare organizations continue to use them, often doing more harm than good for the physicians that take them.

Credentialing and licensing questionnaires have been under scrutiny for years because of the often intrusive questioning regarding a provider’s psychiatric history. Northwell Senior Vice President of Medical Affairs said, “Why were we calling out mental health, as opposed to any other disease? If you have diabetes that’s not properly controlled, you’re just as dangerous as someone with a mental-health condition.”

Northwell implemented pivotal changes to their credentialing questionnaire to encourage healthcare workers to be open and honest about their medical status. The new questionnaire includes questions, such as “Do you have a current condition, or are you taking medication, that would affect your ability to practice or provide safe patient care?” as well as “asking medical professionals if they require ‘accommodations’ that would enable them to address an underlying health issue — opening the door to seeking help without fear of repercussions.”

So what can healthcare organizations do to destigmatize credentialing applications? Tips from experts in the field include:  

  • Be nonjudgmental and only include language that does not stigmatize mental health care or mental health diagnoses.
  • Avoid distinguishing between physical and mental health conditions.
  • Focus on present abilities, such as since the last application or within the past two years.
  • Include only questions asking about impairment or effect on practice, not merely the presence of a condition or diagnosis.
  • Clearly differentiate content related to an individual’s physical and mental health conditions and content related to criminal or unethical activity.

Additionally, the team outlines five concrete actions leaders can take today to better support physicians, including:

  • Determine how your organization asks questions related to physician mental health on credentialing applications.
  • Identify how your state medical board presently asks questions related to physician mental health on licensing applications.
  • Advocate for the recommended non-stigmatizing questions and supportive language to be used among healthcare organizations, state medical boards, and insurers.
  • Identify and mitigate barriers to physicians seeking mental health care.
  • Encourage investments in evidence-based research and interventions that promote and protect physician mental health.

The credentialing process for providers in general is arduous. It can be complex and long, filled with delays, and costly for healthcare organizations that are still doing things manually. Ensuring a provider is highly qualified and safe is of course essential; however, credentialing should not isolate providers who are in need of mental health care nor discourage providers from accessing care just like the rest of us. By making subtle yet effective tweaks in credentialing applications, healthcare organizations can help providers feel more comfortable and supported wherever they may be in their mental health journey.

Start streamlining the credentialing process for your team of providers today. Learn more here

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