Mental Health Support for Clinicians: Where's the Privacy?

John Whyte, MD, MPH

Disclosures

May 24, 2021

Doctor-patient confidentiality is an expected pillar of our healthcare system. Not so, however, for doctors and other healthcare workers. Many state medicine boards require clinicians to answer intrusive questions about past mental health problems, leaving them without psychological safety and fearful of losing their jobs. WebMD Chief Medical Officer John Whyte, MD, MPH, recently spoke with Melina Davis, CEO of the Medical Society of Virginia, about what steps her state is taking to ensure adequate and confidential mental health support for healthcare providers. 

Tell us why clinician privacy is so important to discuss. Don't all patients have an expectation of confidentiality?

Yes, the general public has an expectation of confidentiality between themselves and their caregivers. If a healthcare provider were to break that confidentiality, patients have the right to report it and take legal action.

However, physicians and other clinicians do not have this same expectation when it comes to seeking care for behavioral health concerns. We already know that burnout and behavioral health issues are extremely high among frontline workers, especially physicians. More than half of U.S. physicians experience burnout, but even knowing this, many state boards of medicine (BOMs) are still asking too many questions about previous mental health problems.

What makes the questions asked by state BOMs problematic?

Currently, nine state BOMs ask "have-you-ever" questions related to mental health, mental health questions beyond 5 years, or a requirement for peer reference on applicant's mental health. Seven states have highly invasive mental health questions unlinked to current impairment that contain confusing, punitive, or adversarial language. These questions are not productive and leave physicians feeling unprotected and at risk of losing their career when they need to address personal burnout concerns, which normally means they will go without asking for help even if they really need it.

Why do you think it is so important that we change this?

Knowing that physicians and other healthcare workers see tragedy and death, it seems unfathomable that we aren't more supportive of them receiving mental health services. We have made it so that our caregivers are afraid of repercussions to their career and livelihood if they seek support for their mental health, which is something we encourage the general population to seek regularly. Why not our frontline workers?

To give our caregivers the ability to seek mental health help, we must give them psychological safety. For example, Virginia's BOM has worked extremely hard to provide physicians with this by only asking about current mental health conditions or impairments that may affect their ability to practice medicine. By doing this, physicians have a larger sense of trust in the BOM's oversight and are more willing to be honest when they are struggling. Nationally, we should begin taking this approach, so that we give our physicians the same opportunity for confidential treatment that they provide their patients.

Why can't physicians and other clinicians just use their employer's traditional employee assistance program (EAP)?

It is well known that many physicians, physician assistants (PAs), and nurses are offered an EAP, but studies show that these are barely being used by medical employees. Only 6% of the nonphysician workforce use the EAP offered to them. This number is even lower in the physician community. The physician workforce only has a 1%-2% utilization rate for EAPs.

Although employers are doing this with the best intentions, healthcare workers are concerned about participating in these programs and their information and data being shared with their human resources department. Physicians and PAs worry that the information collected and shared will be used to alter their employment. This has created an element of fear for our medical workers when they need support the most.

How does the mental well-being of healthcare workers affect patient outcomes and the US healthcare system?

Mental well-being in healthcare workers also has a large link to patient safety. Burnout is shown to increase the risk for medical errors by 200%. It is important for patients that their caregivers are taken care of, so that they can give their patients the best care possible.

We also know that burnout is a large financial stressor on the US healthcare system. The annual economic cost associated with burnout related to turnover and reduced clinical hours is approximately $7600 per employed physician each year, with a range of $4100 to $10,200.

Without changing the law and offering legal protections to medical workers, those suffering will continue to isolate vs seeking help. This will not only our hurt medical employees but will also affect patients and the entire healthcare system.

Do you think there is a solution for healthcare workers to this barrier in seeking mental health support?

It seems easier said than done to provide a program that offers these protections, and it is a large undertaking, especially for BOMs and employers who already have a lot on their plate. The Commonwealth of Virginia and the Medical Society of Virginia (MSV) have taken a large step toward this and are offering these protections to physicians, PAs, and other healthcare workers across the state. During the 2020 Virginia General Assembly Session, MSV focused on changing the law to allow physicians to seek professional support to address burnout without fear of undue repercussions in terms of their medical license. Virginia's governor signed the legislation on March 8, 2020, which led to the creation of MSV's physician wellness program, SafeHaven. During the 2021 General Assembly session, the safe haven legislation was expanded to include nurses and pharmacists as well as medical, nursing, PA, and pharmacy students. Virginia is the first state in the nation to have legislation providing such a resource to support clinicians, but it is important that this program expands nationwide.

In addition to the legal safeguards built into the SafeHaven program, it also offers several well-being resources to its members. In partnership with VITAL WorkLife, SafeHaven offers unlimited in-the-moment telephonic counseling 24/7; up to six confidential counseling sessions with a licensed counselor, therapist, or social worker; up to six confidential peer-coaching sessions with a physician or executive coach; and unlimited use of an all-purpose, virtual concierge offering first-class service 24/7.

Has this program made a difference in clinician comfort in seeking mental health support?

In the first 6 months, SafeHaven saw a utilization rate of 35%. This means that these clinicians are getting the support they need when they need it, and they do not have to fear their information being shared with their employer. We as a country have a responsibility to our providers to ensure they can seek confidential support in the same way that their patients can. Now is the time to come together and fight for this change for all healthcare workers across the United States.

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