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This CPPPH newsletter aims to keep readers abreast of current developments and relevant information about physician health and wellbeing in California.
All past issues are available from the CPPPH website: www.CPPPH.org.
Definitions
Wellness activities address quality of life and professional satisfaction for all physicians.
Wellbeing activities focus on an individual physician and provide resources for identifying, evaluating, referring, treating, and monitoring for physicians when addiction, mental health, behavioral issues, and the effects of aging are a concern.
Confidential Assistance Over the Phone
The Physicans’ and Dentists’ Confidential Assistance Line is a 24-hour phone service providing completely confidential doctor-to-doctor assistance for physicians experiencing substance use or mental health issues. Call:
Send Us Your Comments
We want to hear from you. Send comments to gjara@cppph.org.
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Questions about Mental and Physical Health on the MBC Licensing Application
The Medical Board of California is considering whether it should change the way its licensing application asks about “conditions that impair your ability to practice medicine safely.” Should the questions ask whether you have a diagnosis or a condition or a past history of treatment? Or should the question ask only if you currently have the ability to practice medicine safely?
The purpose of a change would be to remove the fear frequently expressed by physicians that getting help could adversely affect their career. The Physicians’ Foundation 2023 Survey of America’s Current and Future Physicians reports that nearly eight in 10 physicians (78%), agree that there is stigma surrounding mental health and seeking mental health care among physicians. [See the full report HERE]
The MBC licensing application currently uses this statement and these three questions:
An affirmative answer to any of the questions below will not automatically disqualify you from licensure. The Board will make an individualized assessment of the nature, the severity and the duration of the risks associated with an ongoing medical condition to determine whether an unrestricted license should be issued, whether conditions should be imposed, or whether you are eligible for licensure. Please note that a limited practice license may be available.
- Are you currently enrolled in, or participating in any drug, alcohol, or substance abuse recovery program or impaired practitioner program?
- Do you currently have any condition (including, but not limited to emotional, mental, neurological or other physical, addictive, or behavioral disorder) that impairs your ability to practice medicine safely?
- Do you currently have any other condition that impairs or limits your ability to practice medicine safely?
The Need to Know
There are concerns that the questions deter physicians from seeking help in a timely manner, and the same concerns apply also to the questions on the credentialing applications used by medical staff/medical groups for appointment and reappointment. At the same time that we consider these concerns, we see areas where the “need to know” comes into conflict with the need to remove barriers from seeking treatment. The organizations with the obligation, and the mandate, to protect patients and provide safe and effective medical care must carry out the due diligence required of them in ways that avoid any patient harm and avoid liability for “negligent credentialing.”
MBC Meeting for Interested Parties July 30
On July 30th, at a meeting of interested parties, the MBC heard expert testimony on these concerns from three persons: the Chief Learning Officer at the Federation of State Medical Boards; the Director of Innovation, Policy, and Strategy for the North Carolina Medical Board; and the Executive Director of the State Medical Board of Ohio. [You can see the slides they presented HERE under Materials.]
The “Safe Haven” Link to a Physician Health Program
Regarding the MBC’s question “Do you currently have any condition (including, but not limited to emotional, mental, neurological or other physical, addictive, or behavioral disorder) that impairs your ability to practice medicine safely?”, some advocate for allowing a “no” answer if the applicant was enrolled in a Physician Health Program.
The Federation of State Medical Boards (FSMB) recommends that state medical boards consider offering “safe haven non-reporting” to applicants for licensure who are receiving appropriate treatment for mental health or addiction. “While it is up to medical boards to determine what constitutes appropriate treatment, the FSMB recommends that physicians who are monitored by, and in good standing with, the recommendations of a state or territorial Physician Health Program (PHP) be permitted to apply for medical licensure or license renewal without having to disclose their diagnosis or treatment to the board. The option of safe haven non-reporting should only be offered when treatment received is commensurate with the illness being treated and has a reasonable chance of avoiding any resultant impairment.” – [Excerpt from FSMB 2018 Policy Statement on Physician Wellness and Burnout. See the full 22-page document HERE]
The Lorna Breen Foundation
The Lorna Breen Foundation website [https://drlornabreen.org/] publishes a tool kit for hospitals and health systems titled “Remove Intrusive Mental Health Questions from Credentialing Applications” that defines six “Structural Barriers” that a hospital or health system can address in efforts to remove barriers. [A copy of the 16-page Tool Kit is HERE.]
The tool kit describes options such as asking just one question: “Are you currently suffering from any condition for which you are not being appropriately treated that impairs your judgment or that would otherwise adversely affect your ability to practice medicine in a competent, ethical, and professional manner? (Yes/No)”. And they suggest the “safe haven” option– answering “no” to that question for those “who are under treatment and in good standing with a recognized physician health program (PHP) or other appropriate care provider. “
Legislative Approach in California
California Medical Association, along with SEIU, has sponsored AB2164 which would prohibit the MBC from requiring an applicant to disclose personal medical information that does not impact their ability to practice medicine. AB2164 is now moving through the 2023-2024 session of the legislature.
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