Do we really need to ask doctors about past drug use for hospital credentials?
Massachusetts is set to become the first state in the country where no doctor will be asked about past struggles with mental health or substance use as part of the credentialing process. This important move will remove a major barrier for doctors seeking treatment, and other states should follow Massachusetts’ lead. No physician should fear seeking potentially lifesaving treatment because it might impact their professional license.
“The stress of being a health care worker has increased dramatically over the years, and you want people to get the help they need,” Massachusetts Medical Society President Dr. Barbara Spivak said. Equally important, she added, when physicians are healthier, they provide better patient care.
Doctors undergo multiple credentialing processes. To practice in Massachusetts, they must be licensed by the Board of Registration in Medicine. They must then get credentialed by any hospital or health system they work for and by every insurance company whose network they join, with renewals every two or three years. All Massachusetts health plans and about half the state’s hospitals use the integrated Massachusetts application, a common application, for credentialing.
Over the last several years, a growing number of professional organizations have called for credentialing to avoid asking about mental health treatment or substance use that does not currently impair a person from practicing medicine. A 2020 joint statement co-signed by numerous medical professional associations, organized by the American College of Emergency Physicians, argued that in the postCOVID-19 era, “A provider’s history of mental illness or substance use disorder should not be used as any indication of their current or future ability to practice competently and without impairment.” Seeking care should be encouraged, not penalized, the statement said.
According to the Dr. Lorna Breen Heroes’ Foundation, an organization named after a physician who died by suicide that has advocated to change credentialing questions, as of October 2023, 26 state medical boards, including Massachusetts’, have language that is not overly intrusive about mental health or substance use, and another 11 states are in the process of making changes.
But until recently, the National Committee for Quality Assurance, which accredits insurance companies, required insurers to ask clinicians about prior drug use. As a result, the integrated Massachusetts application asks,
“Have you engaged in the illegal use of drugs within the past ten years?”
Additionally, the Massachusetts Health and Hospital Association reviewed every hospital’s credentialing application and found questions like “Are you now or have you ever engaged in the illegal use of controlled substances?” and “Are you currently participating in a supervised rehabilitation program or professional assistance program as a patient?” One application asks for dates and diagnoses related to medical treatment for the use of chemical substances.
“We looked at this with a lens of do any of these question represent a barrier to physicians obtaining behavioral health care?” said Steve Defossez, Massachusetts Health and Hospital Association’s vice president of clinical integration.
In August, the National Committee for Quality Assurance decided that insurers only have to ask about present, not past, drug use. The question on the integrated Massachusetts application asking about past drug use is now set to be eliminated in early 2024.
A number of health systems nationwide are similarly updating their credentialing forms. In December, the Massachusetts Health and Hospital Association announced that Massachusetts would become the first state where every hospital, health plan, and local insurance company has committed to removing credentialing questions about mental health history and past drug use. The principle will also apply to forms for advanced practice nurses and physician assistants. Defossez said institutions can still ask whether clinicians have any physical or mental health condition, including substance use disorder, that impairs their ability to do their job currently. But questions should be written in a way that if someone sought past treatment — or is currently receiving treatment in a way that does not impair their work — their license will not be negatively affected.
There are ways doctors can obtain treatment while ensuring their work performance is not affected. The Massachusetts Medical Society runs a physician health services program, through which doctors are referred for treatment for substance use or mental health issues and monitored throughout treatment, including with drug tests when relevant. Information is shared with the physician’s direct supervisors to ensure the person is properly supervised at work.
Studies suggest that physicians badly need access to treatment. A 2022 physician survey by Medscape, released in 2023, found that 53 percent of doctors reported feeling burned out and 23 percent reported being depressed. Few had sought professional help; when asked why, 41 percent cited fear that their medical board or employer would find out. Nearly half of physicians with depression said their depression affected patient interactions. Among physicians with burnout, 22 percent of those surveyed turned to alcohol to cope while 2 percent to 3 percent used drugs, either prescription medicine or cannabis. A Medscape survey released in 2019 found 14 percent of physicians polled had had suicidal thoughts and another 1 percent had attempted suicide.
Doctors are committed to caring for their patients. But they also need to care for themselves. Unnecessary credentialing questions incentivize physicians to deny having a problem rather than to seek help. Removing barriers to treatment is the right thing to do, and more states’ hospitals, insurers, and medical licensing boards should follow suit.