States are redefining when medical professionals can receive mental health treatment without risking notifying the boards that regulate licensure.
Gene Branscum, CEO of the Montana Medical Association, a trade group representing doctors, said health care workers too often wait for counseling or addiction treatment, disrupting their work and patient care. He said that
“They’ve invested so much time into their careers,” Branscum said. “It’s a big worry for them that anything is at risk.”
Montana, like other states, has recovery programs for medical professionals with substance use disorders and mental illness. But medical associations say such programs often involve invasive monitoring, even for voluntary treatment. And ambiguity about when a mental illness should be disclosed creates fear that seeking care will jeopardize a career as a doctor.
Montana is among the states considering increasing confidential care for health care workers unless they are deemed a danger to themselves or their patients. In recent years, at least a dozen states have considered or created confidential health programs to provide clinicians with early help with career burnout and mental health issues. States have also reworked medical licensing issues to avoid oversight of health care workers who require mental health treatment. This change is modeled after Virginia law from 2020.
At a legislative committee meeting last month, advocates for Montana’s medical professionals called on the state Legislature to follow Virginia’s lead. They say they have two goals. One is to get clinicians to treat patients before they are at risk, and the other is to limit worker burnout, which is fueled in part by untreated stress.
Montana’s existing medical monitoring program, the Montana Recovery Program, is operated by the global company Maximus. Montana Professional Advocates had been helping another nonprofit run Montana’s program, but it was unable to win a state contract.
The Montana Recovery Program declined an interview request and instead referred KFF Health News to the Montana Department of Labor and Industries, which oversees the state’s medical licensing board. Ministry officials did not comment by deadline.
A Medscape survey released this year found that 20% of doctors said they felt depressed, and job burnout was the main contributing factor. The majority said it was not practical to confide in other doctors. Some said they might not tell anyone about their depression for fear that their abilities would be doubted or that their employer or medical board would find out.
Medical workers are quitting their jobs. They retire early, reduce their hours, or change jobs. In a situation where there are already not enough health care providers, patient care options become even more limited. The federal government estimates that 74 million people live in areas without adequate primary care services due to labor shortages.
In order to ensure patient safety, state medical boards may suspend or revoke a clinician’s right to practice medicine if drug use or psychological impairment impairs the clinician’s ability to practice medicine. can. Such cases are rare. One study found that from 2004 to 2020, there were approximately 4,400 lawsuits revoking the licenses of U.S. doctors for drug use or psychological disorders.
Nevertheless, workforce advocates say disclosure requirements have led some medical professionals to skirt questions about mental health history on licenses and insurance forms, or to forgo care altogether. It is claimed that there is. They worry that disclosing weaknesses will signal that they shouldn’t practice medicine.
The mental health questions asked of health care professionals vary by state and profession. For example, nurses renewing their licenses in Montana are asked whether they have had any psychological conditions or drug use in the past six months that limited their ability to practice medicine “with reasonable skill and safety.” In addition to being asked about drug use on the job, doctors are also asked to say whether they have experienced any mental conditions that “may adversely affect any aspect of their performance.”
“When I saw a question like that on an update, do I have to report that I was depressed because I was going through a very acrimonious divorce?” Branscombe cited as an example of worker anxiety. I mentioned it. “As you know, my life has changed forever. Am I obligated to report it?”
Selecting “Yes” does not immediately cause licensing issues. People who report mental health issues will be flagged by state officials as a potential concern. They could ultimately be brought before the same review panel of the commission, which will recommend whether their licenses be revoked or submitted to long-term monitoring with periodic reviews.
In addition, healthcare professionals must report when other clinicians exhibit unprofessional behavior or have potential problems that affect their performance. Branscombe said medical professionals are concerned that what they say in counseling sessions could be reported to licensing boards, or that colleagues could report them if they appear depressed at work. Ta.
Bob Theis, a Montana addiction psychiatrist and co-founder of the nonprofit 406 Recovery, told the state Legislature that job stressors, such as long hours and heavy patient workloads, are affecting workers’ mental health. He said it was affecting his health. And as health care costs soar, doctors routinely substitute optimal treatments for less than patients can afford, and they feel their efforts toward healing are being sacrificed.
Cissé said his clinic currently has about 20 medical professionals as patients.
“They were able to receive treatment before it was too late,” Cissé said. “But they are the exception.”
In Virginia, doctors, nurses, physician assistants, pharmacists, and students can participate in the state’s Safe Haven program. Melina Davis, CEO of the Medical Society of Virginia, said the service offers counseling and peer coaching, and staff are available to answer calls 24/7.
“If you only have time at 2 a.m., or when you have the first opportunity to process a patient’s death, you can talk to someone,” Davis said.
Program participants are assured that these conversations are privileged and cannot be used in litigation. The state is considering adding medical diagnoses to the program’s confidentiality this year.
While there are some differences among the states that have followed suit, most have created “safe havens” with two types of health management and reporting systems. People who seek care before an injury occurs at work have extensive privacy protections. The other defines a disciplinary tracking and monitoring system for people who pose a danger to themselves or others. Indiana and South Dakota followed Virginia in 2021.
States have also narrowed the time period during which licensing boards can ask about a person’s history of mental illness. The American Medical Association is encouraging states to require health care providers to disclose current physical or mental health conditions rather than past diagnoses.
Last year, Georgia updated its license renewal forms to ask doctors whether any current conditions that are “not receiving appropriate treatment” are impacting their ability to practice. This update replaces the seven-year mental health history requirement.
Even outside of the “safe haven,” some states are grappling with how to ensure doctor privacy while keeping patients safe.
The California Medical Board has created a program to treat and monitor physicians for alcohol and drug-related illnesses. But patient advocates argue that too much privacy, even for voluntary treatments, could jeopardize consumers’ well-being. They told the state medical board that patients have a right to know if their doctor is addicted.
Davis said states should discuss how to balance physician privacy with patient safety.
“We as health care workers should be saving lives,” she says. “Where is the line where it starts to drop? Where might their personal circumstances influence that? And how does the system know that?”
According to the Montana Recovery Program website, it is not a discipline program, but rather a “support, oversight and accountability” program. Participants may refer to the program themselves or by a licensing committee.
Branscombe, president of the Montana Medical Association, said the state needs a surveillance program when illnesses interfere with a clinician’s work. But she hopes such treatments will become the exception.
Vicki Byrd, CEO of the Montana Nursing Association, said nurses tend not to participate in programs unless forced to do so to maintain their licenses. That leaves many nurses struggling in silence until untreated illnesses show up at work, she says.
“Let’s get it addressed before it’s on the license,” Bird said.
She said that’s because it’s hard to recover after that.
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