Working to improve the mental health of North Carolina clinicians

Healthcare leaders in North Carolina have made a new commitment to improve the mental health of clinicians.

The North Carolina Clinician and Physician Retention and Well-being Consortium has formed a partnership with the Dr. Lorna Breen Heroes’ Foundation, an organization focused on improving the mental health and well-being of healthcare workers. The effort is dubbed: “All IN: Caring for North Carolina’s Caregivers.”

The partnership aims to look at factors that impede clinicians from getting assistance with mental health needs. In addition, they will be pushing hospitals and health systems to drop invasive questions about their employees’ mental health, which can deter clinicians from seeking assistance.

Chip Baggett, executive vice president and CEO of the North Carolina Medical Society, says the society has been focusing more on mental health issues in recent years. A physician’s death by suicide in 2015 spurred more action, and the medical society helped lead a push to remove intrusive questions about mental health from North Carolina state licensing board applications. Now, the goal is to do more.

In North Carolina, Baggett tells Chief Healthcare Executive® that he and other leaders have been looking at “how the system itself is actually impacting clinicians, and changing not only the way they practice, but changing the way they feel about themselves.”

Stefanie Simmons, chief medical officer of the Dr. Lorna Breen Heroes’ Foundation, notes that North Carolina has already shown progress with the removal of mental health questions from state licensing applications.

“North Carolina's really expanding on the leadership and commitment they've already had to support the mental health and well being of their healthcare workforce,” Simmons tells Chief Healthcare Executive®.

(See part of our conversation with Chip Baggett and Stefanie Simmons in this video. The story continues below.)

Removing the questions

The Lorna Breen Foundation has successfully pushed for more federal aid to help healthcare organizations improve the mental health of clinicians. The foundation has also teamed with the National Institute for Occupational Safety and Health to produce a new guide for hospitals outlining steps to improve the wellness of their workers.

The Lorna Breen foundation has also been pushing state boards to remove invasive questions about mental health from credentialing applications, and the organization is pushing hospitals to drop those questions. As of April 2024, 27 state boards have removed intrusive language from their applications, the group says.

“We know that these invasive and stigmatizing questions and licensing and credentialing applications are really one of the most substantial causes for healthcare workers to not want to seek mental healthcare,” Simmons says.

In North Carolina, Baggett says spurring hospitals to drop such questions is an important step to help workers. Many North Carolina hospitals continue to ask intrusive mental health questions on their applications, he says.

Even some hospitals that are focusing on helping their workers have neglected to remove those questions.

“This is kind of a foundational piece,” Baggett says. “We feel like we have to start with these questions, get them out of the way so that we can open up a space to talk about, ‘OK, what are the other elements of the system that need to be adjusted?’”

The Lorna Breen Foundation will recognize those hospitals that drop intrusive questions as “Wellbeing First Champions.”

Participants in the North Carolina program will also engage in leadership training to recognize the causes of burnout and how to address those drivers.

• Read more: How smaller hospitals can improve the well-being of workers

Dealing with stigma

Many doctors and nurses say they are struggling with burnout and depression, but many also say they’re reluctant to seek assistance.

“Stigma is the number one reason why healthcare workers don't seek mental healthcare,” Simmons says.

Some clinicians are worried that getting assistance could be damaging to their career if they’re employers found out they were seeking treatment, according to a Medscape survey of physicians. Some doctors, nurses and other professionals won’t seek help because they are worried about how they’ll be perceived by colleagues, Simmons says.

And some caregivers grapple with internal stigma, and “what I think it says about me to seek mental healthcare,” Simmons says.

Doctors, nurses and other healthcare workers develop concerns about stigma and credentialing questions early in their careers, Baggett says. He says he hopes that making progress in North Carolina will have influence beyond the state, so other physicians aren’t burdened with those sentiments.

Many clinicians are still dealing with the lingering effects of working through the COVID-19 pandemic, and the stress of caring for so many patients.

“We never had the opportunity to decompress,” Baggett says. “From COVID, we just went straight on.”

Surveys of the North Carolina Medical Society have found an increase in suicide ideation among members, Baggett says. And he suspects other clinical fields are seeing similar increases. He’s hoping the “All In” effort will make a difference.

“We're hoping that by putting everybody together, all clinicians, all healthcare workers together, this is also a way where the community gets bigger, so you don't feel like you're isolated,” he says.

• Read more: Women in medicine suffer more burnout and anxiety

Administrative burdens

Many clinicians say the administrative burdens they face are the top contributor to stress and burnout. Those burdens can include prior authorization, the process of getting approval from insurers for treatments, along with the amount of time clinicians spend on documentation of visits with patients, Baggett notes. Plus, there are licensure renewals.

“This is the classic example of death by 1,000 paper cuts,” Baggett says.

Baggett and Simmons spoke with Chief Healthcare Executive in a joint conversation, and Simmons had a realization as Baggett recited some of the administrative burdens on clinicians.

“The thing that stands out to me the most is none of those were actual patient care issues,” Simmons says. “These are all of the things that get in between healthcare workers and their relationship and their ability to care for patients.”

“Some of those administrative burdens are inescapable, but some of them are changeable,” she says. “And some of them can be addressed by organizations and others can be addressed at the state level. And so where we can get those barriers out of the way of a healthcare worker and their patient, having that connection and that healing relationship, it has a huge impact on burnout and also ability to have effective, efficient patient care.”

Baggett says he’s encouraged by the North Carolina consortium’s enthusiasm to improve the well-being of workers and to remove barriers for clinicians.

“We’ve got the wind at our back right now, and we're just trying to take advantage of it and make some real progress,” Baggett says.

Getting help

988 Suicide & Crisis Lifeline: Dial or text 988 to connect with someone. Help is available 24/7.

The American Foundation for Suicide Prevention offers resources for healthcare professionals.

NAMI: The National Alliance for Mental Illness offers “frontline wellness” resources for healthcare workers and public safety employees.