The Challenges of "Intrusive Questions" and a Changing Landscape in Healthcare Credentialing

Hospitals and their medical staffs bear the critical responsibility of ensuring patient safety and the quality of care. Among their numerous obligations is the evaluation of medical staff members' qualifications and fitness for practice, including addressing impairments due to chemical dependency or mental illness. Federal mandates and standards, such as those set forth by The Joint Commission (TJC), require processes for identifying and managing individual health issues for licensed practitioners separate from disciplinary measures.

However, addressing the mental and physical well-being of healthcare providers has proven to be a complex and sensitive challenge, exacerbated by stigma and structural barriers within the medical profession. This article explores the reform efforts surrounding “intrusive questions” in licensing and credentialing processes and provides actionable recommendations for hospital medical staff to navigate this evolving landscape effectively.

The Mental Health Crisis Among Healthcare Providers

Physician burnout and mental health struggles were prevalent even before the COVID-19 pandemic, with alarming implications for both providers and patient safety. Studies such as the 2012 and 2015 research cited by the Federation of State Medical Boards (FSMB) highlighted significant increases in physician burnout and dissatisfaction. The toll on physicians' mental health is underscored by disproportionately high rates of suicide among healthcare professionals.

The pandemic intensified these issues, as exemplified by the tragic case of Dr. Lorna Breen, who died by suicide in 2020. Dr. Breen’s story sheds light on a systemic problem: the fear of professional repercussions often prevents healthcare workers from seeking necessary mental health care. A 2016 study revealed that nearly half of surveyed female physicians who met the criteria for mental illness avoided treatment due to stigma and fear of adverse career consequences.

This avoidance is compounded by licensing and credentialing processes that include overly broad and intrusive questions about past mental health diagnoses and treatments. Reform efforts, such as those spearheaded by the FSMB, TJC, and the Dr. Lorna Breen Heroes’ Foundation, are working to address these barriers.

Hospital Medical Staff Applications: Navigating a Complex Terrain

Current Practices in Credentialing and Oversight

Hospital medical staff applications often include broad inquiries about physical and mental health conditions, including chemical dependency. While these questions aim to mitigate risks to patient safety, their scope and nature have come under scrutiny. Common examples include queries about:

• Current impairments due to health conditions.
• History of mental health treatment.
• Participation in rehabilitation programs, with timelines spanning years or even decades.

While these questions are intended to fulfill quality oversight responsibilities, they can inadvertently discourage healthcare providers from seeking help, thereby undermining the intended goals of ensuring provider well-being and patient safety.

Balancing Confidentiality and Oversight Obligations

Medical staff are required to maintain confidentiality while addressing physician well-being. Mechanisms like Physician Wellbeing Committees, mandated by TJC, aim to provide non-disciplinary support. However, the requirement to act when patient safety is threatened creates tension between safeguarding practitioner privacy and fulfilling regulatory responsibilities.

For example, under the Americans with Disabilities Act (ADA), restrictions can be imposed on individuals if their condition creates a “direct threat” to public safety. Hospitals must balance this legal framework with their obligation to provide non-punitive support for providers.

The Legal Landscape: Disability Discrimination and Intrusive Questions

The Americans with Disabilities Act and Similar Laws

The ADA limits preemployment inquiries into disabilities, permitting questions only if they are directly related to job performance. For example:

• Employers may inquire about the ability to perform job-related functions.
• Medical examinations can only be required after a conditional job offer.

In healthcare credentialing, the tension lies in determining whether broad questions about mental health history comply with the ADA. The ADA allows inquiries tied to current impairments affecting job performance, but many applications extend far beyond this scope, raising legal and ethical concerns.

Notable Legal Challenges

Two prominent legal cases provide guidance:

1. Medical Society of New Jersey v. Jacobs (1993): A federal court found that overly broad mental health questions in medical licensing applications violated the ADA by imposing unnecessary burdens on individuals with disabilities. The court emphasized the need for targeted, behavior-based questions.
2. DOJ Settlement with the Louisiana Supreme Court (2014): The Department of Justice found that broad mental health inquiries for bar applicants violated the ADA. The DOJ noted that such questions deterred individuals from seeking mental health treatment and did not effectively predict future misconduct.

While these cases did not involve hospital medical staff directly, they highlight the potential legal risks and ethical dilemmas posed by intrusive questioning.

Reform Efforts: Addressing Barriers to Care

FSMB and TJC Recommendations

The FSMB’s 2018 report called for significant reforms in licensing and credentialing applications, recommending that questions focus solely on current impairments affecting professional competence. Similarly, TJC has urged hospitals to eliminate or significantly narrow questions about past mental health diagnoses and treatments.

The Dr. Lorna Breen Heroes’ Foundation

The Foundation’s advocacy has led to legislative and organizational changes, including:

• Passage of the Dr. Lorna Breen Health Care Provider Protection Act in 2022.
• Recognition of hospitals and licensing boards that adopt FSMB-aligned application reforms.
• Distribution of $103 million for initiatives aimed at reducing burnout and suicide among healthcare workers.

State and Organizational Initiatives

Several states have enacted or proposed legislation to limit intrusive health inquiries in licensing and credentialing processes. For example:

• Minnesota: Prohibits questions about past health conditions that do not affect a provider’s current ability to practice safely.
• Virginia: Requires amendments to application language to reduce stigmatization.

Leading health systems, including HCA Healthcare and Geisinger, have also revised their credentialing processes to align with best practices.

Practical Recommendations for Hospital Medical Staff

1. Revise Credentialing Applications: Limit questions to current impairments that directly affect clinical performance. Avoid inquiries into past mental health diagnoses or treatments unless directly relevant to patient safety.
2. Enhance Confidentiality Measures: Strengthen the confidentiality of Physician Wellbeing Committees. Clearly communicate that seeking help will not automatically lead to disciplinary action.
3. Implement Training Programs: Educate medical staff leaders on reducing stigma around mental health. Provide training on ADA compliance and best practices for application processes.
4. Foster a Culture of Support: Promote mental health resources and peer support programs. Recognize and celebrate efforts to improve provider well-being.
5. Collaborate with Advocacy Groups: Partner with organizations like the Dr. Lorna Breen Heroes’ Foundation to access toolkits and recognition programs. Stay informed about legislative changes and adapt policies accordingly.

The challenges posed by intrusive questions in healthcare credentialing underscore a critical need for reform. By revising application processes, enhancing confidentiality, and fostering a supportive culture, hospital medical staff can address provider well-being while ensuring patient safety.

At Axis HR Solutions, we specialize in helping healthcare organizations navigate complex HR and compliance challenges. Whether you need assistance revising credentialing policies, implementing training programs, or fostering a culture of support, our expert team is here to guide you every step of the way. Visit us at axishrky.com to learn more about how we can assist your organization in achieving its goals while prioritizing the well-being of your staff.