Leadership | 06.22.26
Making Changes Big and Small to Protect Physician Well-Being
By Tanya Albert Henry
Reprinted with permission from the American Medical Association.
Leaders at Northwell Health know that caring can’t just be focused on the more than 2 million patients they treat annually.
Physicians also need support for themselves so they can heal whatever ailments they may be personally facing, and that includes being able to, without fear, seek care for mental or behavioral health concerns.
Northwell Health — New York’s largest health system with more than 4,000 physicians and 900 hospitals and care centers — has worked to remove barriers that would stop its employees from accessing mental health care when they need it.
As part of that journey, Northwell Health replaced intrusive and irrelevant credentialing questions with questions that don’t impede physicians and other credentialed providers from seeking care, which is part of the support pillar of AMA Joy in Medicine® Health System Recognition Program.
It was during the COVID-19 public health emergency that Annabella V. Salvador, MD, an emergency physician, senior vice president of medical affairs, and deputy chief medical officer at Northwell Health, began spearheading an effort to change some of the credentialing questions the health system asked their credentialed providers, including the physicians.
She led the charge after she heard about the heartbreaking loss of New York City emergency physician Lorna Breen, MD, who died by suicide in the early days of the COVID-19 pandemic.
The effort started even before the Dr. Lorna Breen Heroes Foundation was created because Dr. Breen’s story was personal for Dr. Salvador, who was already very passionate about physician well-being. Dr. Breen completed her residency in emergency medicine and internal medicine at Northwell Health’s Long Island Jewish Medical Center, and Dr. Salvador collaborated with Dr. Breen on multiple regional meetings for the American College of Emergency Physicians.
Dr. Breen treated patients with COVID-19 at New York Presbyterian, working 12-hour shifts in the emergency department and frequently staying after her shift ended to take care of patients. She didn’t have a history of depression or anxiety, but the long hours and her own bout with COVID-19 took a toll. She feared seeking help, though, because she worried that she could lose her medical license or be ostracized in the medical community.
“I felt like it was our obligation to make changes to address the issues surrounding physician burnout and physician wellness,” Dr. Salvador says.
Some of those issues: A culture that looks at mental health care as a weakness and one where licensing boards often require physicians to disclose current or past mental health care and hospitals often require it for credentialing.
“When we heard about her loss and — having known her — it really left a mark on me. To honor her, I felt like it was our duty to make changes to the credentialing questions,” Dr. Salvador says.
Revamping Invasive Questions
Before the Dr. Lorna Breen Heroes Foundation was founded and created a toolkit to help organizations make changes, Dr. Salvador took a look at the credentialing questions with a team of people at Northwell Health and began editing to make them physician well-being friendly.
“We’re lucky that we live in New York where our questions of our licensing board and even our health system’s questions weren’t as intrusive as others,” Dr. Salvador says. “But we still felt there was an opportunity to make them even better, and that’s why we did that.”
It was a first step.
When the Dr. Lorna Breen Heroes Foundation created its badge recognition program, Dr. Salvador and her committee worked with representatives from the foundation as well as AMA experts to revamp the questions again and make them even better and even less intrusive.
“We were very proud of that. We did this across our entire health system. Not only at Northwell Health, but we also partnered with our Northwell Go Health Urgent Care,” Dr. Salvador notes.
Before changes were made, the question physicians were asked on the credentialing applications read like this: “Do you have a physical or mental condition that would affect your ability to exercise the clinical privileges requested?” (Yes/No).
“It called out mental condition, which is the part that bothered me because, as a physician, it doesn’t matter if it’s physical or mental — it should be do you have any conditions that affect your ability to carry out your privileges,” Dr. Salvador explains. “Because if you’re a surgeon and you have a tremor and you can’t operate, that’s going to affect your ability to carry out your privileges.”
She also didn’t like that it was specifically calling out any mental conditions, because these conditions can be temporary. For example, women who give birth and suffer from postpartum depression.
“If it resolves in a couple of months and they never have the issue again, why should they always have to mark yes?” Dr. Salvador questions.
To avoid those types of situations, the current question on the Northwell Health’s credentialing application reads like this: “Do you have a current condition or are you taking medication that would affect your ability to practice or provide safe patient care for the privileges you are requesting?” (Yes/No).
If a physician chooses “yes,” then they need to answer a second question that asks: “Do you require a reasonable accommodation to exercise your requested privileges safely and competently?” (Yes/No). If they answer “yes” to these questions, then they are referred to employee health services for further evaluation.
Overhauling Other Forms, Too
After making changes to the credentialing application, Northwell Health leaders came to a realization: Intrusive and stigmatizing language that created barriers for physicians to seek care appeared in other documents throughout the health system, too.
For example, intrusive questions were identified in their employee health services documentation.
“We said to our employee health service partners, ‘Hey, look at these questions. We are going to change our questions in the credentialing application. Do you want to partner with us and look at your questions and see how we can make them less intrusive?’ And they were willing and excited about changing them as well,” Dr. Salvador says.
Northwell Health has continued the hunt for intrusive language, changing language in the bylaws and rules and regulations of all the hospitals in the system.
Going beyond credentialing “was one of our biggest lessons that we learned,” Dr. Salvador says.
How They Made Changes
Once Dr. Salvador decided to make changes to the credentialing-application questions at Northwell Health, she says it became “probably one of the easiest initiatives” that she’s worked on, and that people were extremely supportive.
It still required work. They brought on their legal counsel and there were a few meetings to discuss changing the questions and how to do it, which was “why it was important for us to also meet with the AMA to get their support,” Dr. Salvador says. With all the stakeholders on board, “it was just a matter of having the team change the questions and then, operationally, beginning to roll it out.”
Her advice to others who may want to make changes in their organization is to get a senior leader to be your executive sponsor so that you can move the process along quickly and work with the AMA and Dr. Lorna Breen Heroes Foundation where experts understand how to make changes and are there to help you.
“They answered all of our questions immediately and were very, very helpful. We had a great experience,” Dr. Salvador said.
Changing Mental Health Culture
Altering credentialing questions and language in other documents removes a big hurdle holding physicians from seeking care for their mental health, but there are many other reasons that someone still may choose not to pursue help.
One large factor is the stigma that has swirled around mental health care for so many years. The pandemic helped alleviate some of those beliefs, but they are not entirely gone. Some physicians are hesitant to seek help because they don’t want their peers to know.
“They feel like they need to be resilient,” Dr. Salvador says.
She adds they have seen people want to go outside of the health system to seek help; they’ve heard stories of people paying cash for their care so it won’t be documented; and they’ve even heard of people in other states leaving that state because they didn’t want to answer licensing board questions.
“We didn’t want people to feel that way,” Dr. Salvador says.
In addition to changing credentialing questions, Northwell Health:
- Annually hosts an event for Physician Suicide Awareness Day.
- Provides Stress First Aid workshops in partnership with the health system’s Center for Traumatic Stress, Resilience and Recovery that help physicians create a plan to improve recovery from stress reactions for themselves and their colleagues.
- Gives physicians access to Team Well Physicians, a tool created by and for physicians that provides resources to help them take care of their well-being.
- Offers opportunities for physicians to meet up through the Connect the Docs program, where physicians across the health system host special meals for their colleagues. It gives them a place to discuss work life and daily stressors and helps them start friendships in a social setting.
Dr. Salvador says it’s important for their physicians to know that leadership is fighting for them. The badge they received from the Dr. Lorna Breen Heroes Foundation appears on their credentialing applications. She also gives updates to the staff on physician-related well-being initiatives.
“We want to make it better. It’s our moral obligation to do that. We want people to get the help they need,” she said. “We want you to be able to get help when and where you need it. You shouldn’t have to drive miles away to get help, or you shouldn’t have to even go outside our own organization.”
Keep Making Important Changes
This work is important, and Northwell Health and others across the nation need to keep pushing to make changes that promote physician well-being, says Dr. Salvador.
“It’s important when you’re making these changes to find the right leader to push it along. It’s important to have follow through to ensure that it is getting done because sometimes everyone is busy and it can get lost,” she said.
It’s also important to be speaking about the changes — be enthusiastic about them and proud, she says.
“One of the facts that always sticks in my mind is that we lose about 400 physicians a year to suicide. We're not even talking about all the other mental health illnesses that they face,” Dr. Salvador says. “Our Hofstra Medical School is 100 students per class, so the entire school is 400 students. So, if you think about it, every year we lose a similar number of physicians as an entire school of medicine.”
It’s important that physicians and health system leaders do anything that can be done to prevent that: “It’s important for all of us to take action and to be spokespeople because we need to change.”