Doctors know the questions are coming.
Stephanie Simmons says, at some point, many doctors will ask about their mental health and whether they have a diagnosis or treatment for depression or another condition. Questions may come up with applications for state medical licenses or for hospital jobs.
“I’ve known, ever since I started medical school, that I had to answer that question,” Simmons said. “And that has a huge chilling effect on a physician’s willingness to provide care when needed.”
Simmons is the Chief Medical Officer of the Dr. Lorna Breen Heroes Foundation, which focuses on the mental health and well-being of healthcare workers.
The foundation is named in memory of Lorna Breen, a doctor who died by suicide almost three years ago amid the early pressures of the Covid-19 pandemic. Breen was hospitalized for his mental health, and he thought he would never be allowed to practice medicine again, Simmons said.
Today, the Foundation is working to bring about structural and cultural changes in federal and state laws and in the health care industry that will enable more people to receive help. Last year, President Biden signed the Dr. Lorna Breen Health Care Provider Protection Act, which directs federal support for educational efforts and research to improve mental health.
In an interview with Dr Chief Healthcare Executive®, Simmons discusses what hospitals should do to change the culture around mental health and some of the legislative changes needed. Simmons said 29 states — and many hospitals — are not adhering to best practices in mental health questionnaire credentials.
More than half of the nation’s physicians (63%) experienced burnout in 2021, according to a published study Proceedings of the Mayo Clinic. Simmons compared the healthcare workforce to a patient with a bleeding wound. While building personal resilience is important, she says, it mainly puts stress on the wound.
At some point, the source of the wound must be addressed.
“If we don’t address the systems and operational issues at the root of the problem, the patient will die,” Simmons said. “And patients are the health care system on which we all depend.”
(See part of our conversation with Stephanie Simmons. Story continues below.)
Change the question
In early 2020, Simmons, vice president of physician and clinical engagement at Envision Physician Services, was in the midst of launching a program aimed at improving physician wellness. The program involved training physicians on peer support and administrative issues that affected physicians’ well-being. Envision launched the program just before the start of the Covid-19 pandemic.
When Lorna Breen’s family launched the foundation in 2020, Simmons reached out to Corey Feist, the organization’s co-founder and Breen’s brother-in-law. He began working with the foundation and eventually joined the board of directors. In January 2023, Simmons became the foundation’s chief medical officer.
The foundation aims to change the culture of medicine to ensure that healthcare organizations are encouraging physicians to seek support. While many doctors admit they struggle with burnout, few are getting help to deal with it, according to a Medscape survey in January.
“You can create separate assets,” Simmons says. “But if you don’t create a culture where using those resources is not okay, but encouraged, then they will fall away. The resource cannot be used.”
A key change comes in changing questions for hospital positions as well as applications for state medical licenses. Simmons said it’s time to end the practice of asking applicants if they’ve been diagnosed or treated for a mental health condition.
Instead, hospital and state licensure questions should only be asked of applicants if they are impaired from practicing medicine due to physical health, mental health or substance abuse, Simmons said.
“The vulnerability can be different depending on what you’re doing and what you’re certified to do,” Simmons says. “If I’m doing microsurgery, and I’m taking medication that makes me shiver, that can be a handicap. If I’m a psychologist or a psychiatrist and I have tremors, it won’t affect my ability to care, right? So handicaps mean different things depending on what you’re doing.”
The foundation is focused on changing those certification questions because physicians often avoid seeking help because they fear professional repercussions.
“I can tell you from personal experience, I can tell you from literally hundreds of stories that I’ve heard from physicians who didn’t get the care they needed when they needed it,” Simmons said.
“And I can tell you that that was Lorna’s biggest concern after her mental health hospitalization, that she wouldn’t be able to practice medicine again because she’d had mental health care once in her life,” he added. “So that’s one of the reasons it’s such a big shock to us … his family thinks that was the biggest contributor to his death.”
Simmons said that if he were a patient, he would not be barred from seeking care from a physician seeking treatment for mental health problems.
“If my doctor had accepted treatment for depression, not only would I have cared for them, but given that they were my doctor, I would have felt more comfortable sharing my own struggles with that person,” she says. “I would feel that maybe they had some insight into what it was like to be a patient and need care. And I want to have that person as my physician.”
It’s time to remove questions that prevent people from expressing their need for help.
“Asking questions about diagnosis and treatment does not reduce the burden of mental health problems on health care workers,” says Simmons. “It only reduces the number of people being treated and puts doctors at risk and ultimately patients at risk as well.”
Four key steps
Health care leaders who want to create a culture where people get help and stay in their jobs longer can take four key steps, Simmons says.
1. Change the certificate question
Replace questions about past treatment with mental health and focus on any current impairments. It removes barriers to getting help, she says. It is also important to inform employees about those changes “If a hospital changes its credentialing questions, and they don’t tell a physician, has the change really made a difference? Not as much as there could be,” Simmons said.
2. Increase options for care
“We know that we lose physicians to suicide because their only option for mental health care was to seek care from their own colleagues at their own hospital,” Simmons said. “So make sure your physicians have care options outside of their personal peer group.”
3. Improve at work
Reduce administrative burdens, and let physicians have a voice in optimizing the workforce with key performance indicators. “Put physicians at the center of all quality initiatives,” she says
4. Put people at the center of leadership
Leaders need to get back to basics. Managers must “have a relationship with the people you’re managing, that you know what’s going on with them,” she says. He also says that leaders should “share what’s happening to you in a vulnerable and appropriate way to destigmatize sharing these stories and those struggles.” Leaders must invest in leadership training that focuses on emotional intelligence.
Some steps don’t require large expenditures, he notes.
“Certificate reform is free,” Simmons said. “And we changed their questions within 48 hours at the hospital. It’s fast, it’s free, and it makes a huge impact and sends a huge message.”
Hospitals also need to have someone who leads workforce improvement efforts. He says this could be a dedicated champion, such as a chief wellness officer, or a wellness committee.
“If a hospital or health center doesn’t already have a committee in place that includes frontline workers, executives, executive champions, representation from across the workforce, that’s the place to start,” Simmons says.
Some healthcare leaders are shifting their focus from building resilience among employees to solving workplace issues that are driving burnout and physicians out of medicine. Simmons says some measures of personal resilience, such as empowering employees to take time off, have some value.
Health systems need to see that their workforce resilience is not the problem, especially if they’ve made it through three years of the pandemic, she says.
“You can’t say people aren’t resilient enough when they’re just being asked to carry more and more, because even a granite pillar will break if enough weight is put on it,” Simmons says. “And so the key is to actually say, well, ‘How can we support the structure around you?'”
“Hospitals and health centers are getting the message loud and clear that pizza parties and ‘Hero’ T-shirts aren’t hacking it,” he added. “It’s always good to feel appreciated. But it’s much better to be complimented in a way that significantly changes your experience at work. And that’s what people want and demand.”
988 Suicide and Crisis Lifeline provides free, 24/7 support to those in distress. Call or text 988.