A Change in Policy Regarding Physician Burnout by the NC Medical Board

December 19, 2016

Submitted by Bob Henderson, MD
Medical Director of WCMS’ Healthy Healer Program

Previously, I shared with you my experience of meeting with the widow of a North Carolina physician who committed suicide last year, a victim of burnout. As you recall I discussed three factors which contributed to his death. One of those was his fear of seeking assistance due to possible negative repercussions with the state licensing board.

At the time of that physician’s suicide the North Carolina Medical Board’s license renewal application, question 4, asked the applicant if he/she “was aware of any medical condition that impairs or limits your ability to practice medicine safely?”  Medical conditions included “… psychological conditions or disorders …” Such language was viewed as a deterrence against a physician reporting burnout and seeking help from therapists, coaches or the North Carolina Physician Health Program, which was designed to assist physicians with such problems. 

When Miriam and I began to structure the intervention arm of the WCMS physician burnout and wellness program, the Healthy Healer, we had been warned by Candice Barr-- CEO of the Lane County Medical Society in Eugene, Oregon-- that we must work with the state medical board to remove any barriers for physicians needing and voluntarily seeking assistance, such as question 4 of the North Carolina Medical board’s license renewal application, if our program was to be successful.  Ms. Barr has created one of the premier physician burnout programs in the nation and has become a model for others, including ours. 

The first stop, the North Carolina Medical Board. Having been a part of a state medical board for six years I was well versed on the bureaucratic red tape that dealing with these boards can involve. My premonitions were soon confirmed with one call after another to the state medical board, resulting in speaking to multiple secretaries or assistants and being transferred to yet another where I again had to restart the process. 

Finally, I was referred to Dr. Joe Jordon, Executive Director of the North Carolina Physician Health Program.  The NCPHP was created in collaboration with the state medical board and the state medical society to provide resources to advance the health and wellbeing of physicians across the state. Already Dr. Jordon had struggled with a growing awareness that the tenor and tone of the state’s medical board’s policy concerning psychological problems, including burnout, was deterrence against physicians seeking help. Through telephone conversations we shared ideas. Then, he invited Miriam and I to attend an upcoming NC Consortium for Physician Resilience and Retention meeting scheduled for May 13, 2016, and he suggested that I address the Consortium voicing our concerns and creating a clearer focus of this issue. 

The Consortium is composed of physicians and other health care representatives from across the state whose purpose it is to identify needs and opportunities to address mental health, wellness and burnout among medical professionals.  It seeks to identify medical individuals and groups who are engaged in addressing these issues, to open communication among these groups, to create a statewide network of care providers and to provide supportAt that meeting we underscored the necessity of change to the board’s policy (question 4 of the renewal application) concerning burnout, sharing with the group Ms. Barr’s experience in Oregon.  The change in policy was a prerequisite for any group striving to embark upon a successful physician burnout and resilience program.    Through the discussion among participants, commitment to action gained momentum.  The Consortium unanimously agreed to write and submit recommendations to the state medical board for their change in policy and wording.  At the end of that meeting Miriam and I were invited to join the consortium. 

Throughout the summer the discussion of changing language in the state board’s license applications, question 4, followed.  Drafts of change in language were floated among the group and considered.  At the following meeting September, 17, a proposed draft was considered but sent back for further revision.    Throughout the process Miriam and I stayed active, holding up the Oregon Medical Board policy that confirmed “participation in a Wellness Program including counseling and coaching services is not reportable to the state medical board physician license and applications/renewals”.

A final draft proposal was approved and submitted to the state medical board for their deliberations on the issue during the September board meeting.  Before that board meeting I had become acquainted with David Henderson, Executive Director of that board, at the state medical society and Consortium meeting in September.  Maybe it was the name, but we became fast acquainted.  Once getting behind us our possible family connection, we discussed, on several encounters, very openly and in depth the need for the state medical board to remove all language that dissuades physicians from seeking help when experiencing burnout and stress.  Beyond the language we also discussed the culture of the board that has cast a pall of fear and suspicion among physicians.  Dr. Henderson made his position quite clear, he wants to change that culture to one of support and encouragement so physicians seek the help, whatever it is, that they need in order to address any health need so that they may safely serve the health needs of their patients.

Recently, the North Carolina Medical Board announced its new policy.  While WCMS’ exact proposed wording was not adopted, the Board’s language recognizes and accepts that physicians may seek help for burnout or mental health without having to report it to the Board.  The Healthy Healer program of the WCMS welcomes that change, and we celebrate the fact that we were a part of it.

Now, we move forward with WCMS Healthy Healer.  The program’s services encompass prevention, intervention and education.  The intervention arm of the program is in the final phases of recruiting vetted psychiatrists, psychotherapists and professional coaches to address the needs of health care providers in western North Carolina.  Contracts are being written and are under legal review, policies of governance are being formulated, again, using the Eugene, Oregon and other successful programs across the nation as models.  New Healthy Healer Services will be rolled out to the WCMS membership in early 2017.  In addition, we will continue a leadership role in the state Consortium, promoting collaboration among other providers in the state.  Finally, we welcome and collaborate, when possible, with the North Carolina Physician Health Program to promote the health and wellbeing of health care providers in North Carolina.

A copy of the state medical board’s change in policy follows:

The Board voted in September to replace the current renewal question that asks licensees to state whether they are under treatment for a condition that may adversely affect their ability to practice with the following language:

Important: The Board recognizes that licensees encounter health conditions, including those involving mental health and substance use disorders, just as their patients and other health care providers do. The Board expects its licensees to address their health concerns and ensure patient safety.  Options include seeking medical care, self-limiting the licensee’s medical practice, and anonymously self-referring to the NC Physicians Health Program (www.ncphp.org), a physician advocacy organization dedicated to improving the health and wellness of medical professionals in a confidential manner.

The failure to adequately address a health condition, where the licensee is unable to practice medicine with reasonable skill and safety to patients, can result in the Board taking action against the license to practice medicine.