Iowa’s top medical officials are exploring changes to its licensing process that advocates say could encourage more doctors to seek treatment for mental health and substance use disorders.

The Iowa Board of Medicine is reviewing its licensing applications for physicians, making Iowa one of a nearly dozen states working to determine whether the questions asked may stigmatize those seeking treatment, according to the Dr. Lorna Breen Heroes’ Foundation, a group that advocates for greater mental health support for health care workers.

“In an effort to reduce any stigma or fear associated with licensees seeking mental health treatment, our team has been involved in a number of conversations over the last year related to questions on licensing applications,” according to a statement from the Iowa Board of Medicine.

The board is reviewing quality-control questions on its license application, which include inquiries on medical conditions that may “impair or limit” an individual’s ability to practice medicine. The application also includes questions on participation in treatment or monitoring programs for their medical condition or their use of alcohol or drugs.

The Iowa Board of Medicine has received feedback on those questions, according to the foundation. However, it’s unclear what changes may be made because officials wouldn’t share what feedback the licensing board has received.

“Iowa is coming into best practices on medical licensing,” said Corey Feist, co-founder and CEO of the Dr. Lorna Breen Heroes’ Foundation.

How does reducing stigma for doctors affect their patients?

The foundation was founded by the family of Dr. Lorna Breen, a prominent emergency room physician in Manhattan who died by suicide in the early days of the coronavirus pandemic.

Since 2020, the organization has been leading the effort to change states’ credentialing paperwork nationwide.

When credentialing medical professionals, Feist said the foundation found that most state licensing boards ask questions that “create structural stigma that prevents and in some ways penalize licensed health care workers from obtaining the same mental health treatment that they can prescribe to their patients.”

Any untreated condition, whether it’s a physical condition or a mental health condition, in a physician can have a direct impact on the care they provide to patients, Feist said.

“If a health care worker has untreated diabetes or untreated eye disorder and they’re operating on a patient, there’s an opportunity for medical error,” Feist said. “And it’s the same with an untreated mental health condition. The idea is that we want your care team to be cared for so they can care for you.”

This move also could help rural states like Iowa, which have long struggled with a physician workforce shortage, to better recruit and retain providers. Feist argued that if prospective applicants see that the health system is supportive of their employees’ overall well-being, they may be more likely to apply for positions there.

Survey results published earlier this year by The Physicians Foundation, a nonprofit that advocates for practicing physicians, found that a majority of physicians, residents and medical students nationwide believe there is a stigma surrounding those who seek mental health care among their peers.

In addition, an estimated four in 10 physicians were afraid to seek help for burnout or depression because of questions asked in applications for medical licensure or hospital credentials, according to the survey.

That, in turn, increases the risk of suicide among these medical professionals, experts say.

“The primary driver of suicide of health care workers is the structural stigma and concerns around losing your license,” Feist said.

The Dr. Lorna Breen Heroes’ Foundation said the next step is to encourage individual hospitals and health care systems to change questions on their paperwork for physicians to be credentialed to care within their facilities.

That, Feist said, will help push broader support for mental health treatment at a local level and will have a greater impact on individual providers.

“Iowa has a model credentialing form for all hospitals in Iowa, and their form looks great, but each organization gets to ask their own peer reference questions,” Feist said. “There’s wide variability in Iowa hospitals on what they asked peer references, and many of them are asking overly intrusive questions.”

Michaela Ramm covers health care for the Des Moines Register. She can be reached at [email protected], at (319) 339-7354 or on Twitter at @Michaela_Ramm