Why Confidentiality Is Essential for Physician Wellness
In October 2023, American Medical Association Director of Product Management, Lauren Huchingson joined AMA Group Vice President, Michael Tutty, PhD, MHA, FACMPE and AMA Senior Attorney, Daniel Blaney-Koen, JD to discuss the problematic questions in medical licensing, employment, and credentialing applications pertaining to disclosure of mental illness or substance use disorder (SUD). We’ve captured some highlights from that conversation.
Physicians Face a Multitude of Pressures
Excessive documentation, lack of work autonomy, and increased patient communication, especially post-COVID, contribute to a burdensome work environment for physicians. To combat this, the AMA has introduced the Quadruple Aim to emphasize clinician wellness alongside better outcomes, lower costs, and improved patient experience.
Burnout vs. Mental Health Conditions
Burnout is defined as a workplace phenomenon characterized by emotional exhaustion, decreased sense of personal achievement, and depersonalization. This contrasts with mental health conditions like depression and anxiety. However, both burnout and mental health conditions can exacerbate each other.
The AMA has tracked physician burnout since 2011, noting fluctuations and a peak in 2014, a decrease in 2017, and another in 2020. Surprisingly, burnout decreased during the initial phase of COVID-19 but worsened in 2021 due to long-term fatigue and politicization of healthcare.
"One in three physicians are talking about reducing their work hours and one in five, leaving medicine altogether."
Michael Tutty, PhD, MHA, FACMPE
Challenges in Seeking Help
Systematic barriers make it difficult for physicians to seek help for burnout or mental health issues, which is critical for maintaining a healthy workforce. In particular, the stigma associated with mental health issues is a major barrier to healthcare professionals seeking care, made worse by the requirement to disclose mental health care to employers. The AMA is working with organizations to review and revise application questions to support physician health and reduce stigma.
Actions to Take
Several states have taken steps to audit their application questions to remove inquiries about past diagnoses or treatments of mental illness or substance use disorders, focusing instead on current impairments – Ohio, Georgia, and Minnesota are examples.
Questions with high subjectivity regarding past treatments or conditions should be avoided as they are not indicative of current or future performance. Further, questions about current medication usage should be scrutinized, as they may not be relevant unless there is a current impairment.
"The appropriate focus is on whether there is a current impairment that adversely affects healthcare professionals' ability to competently practice medicine."
Daniel Blaney-Koen, JD