How credentialing fears harm physician mental health [PODCAST]

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Clinicians are treated as invincible, so when their own mental health suffers, many stay silent. Namit Choksi, a physician entrepreneur and health care executive, joins to explain how credentialing forms and a culture that treats wellbeing as a perk push doctors to hide depression, anxiety, and substance use until they reach a breaking point. You will hear why disclosing a behavioral health condition can threaten a clinician’s malpractice and life insurance and trigger a fit-for-duty review, why this fear creates a vicious circle that hospitals only notice once it is too late, and why losing a single clinician can cost more than a million dollars. Choksi also explains why legacy assistance programs fall short, with visit caps, long waits, and rotating counselors, and what confidential, barrier-free support looks like instead. This episode is based on his article “How credentialing and culture impact physician mental health,” published on KevinMD. You will come away understanding what institutions must change to keep their clinicians from suffering in silence.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Namit Choksi. He is a physician entrepreneur and a health care executive. Today’s KevinMD article is “How credentialing and culture impact physician mental health.” Namit, welcome to the show.

Namit Choksi: Thank you, Kevin. It’s a pleasure to be here.

Kevin Pho: All right. Why don’t you briefly tell us a little about yourself, and then why you decided to share this particular article on KevinMD.

Namit Choksi: Absolutely. So, I’m Namit, originally from Mumbai, India, and a physician by training. I started training in obstetrics and gynecology, but as my dad jokes, I gave up too early.

I went to Harvard, got a degree in public health, and launched my own startup in the postpartum hemorrhage space alongside my mentor, Thomas Burke. I did my postdoc at Mass General and Harvard Medical School, again with the focus of reducing the cost of treating reproductive tract infections in women. Throughout my life, my focus has really been on bridging gaps in health care access using innovation and capital reallocation.

That journey took me to China, where I did a wonderful program called Schwarzman Scholars. I was keen to understand how China lifted about 800 million people out of poverty and gave both life insurance and health insurance to everyone. Recently, I joined Asklepian Group, a small growth partnership organization that invests in health care founders.

I became the CEO of Tend Health, a highly specialized provider of mental health care services for health care professionals. So that’s a quick introduction. I decided to write this article because I have always thought that, so far, wellness is looked upon as a perk rather than a need, and I honestly think the need is dire.

As physicians, people often think of us as invincible, as if we cannot be touched by any harm. The reality is that we see so much grief every day that it is difficult to remain untouched by all of it. So I decided to write about it, talk about it, and bring it into public view.

Kevin Pho: All right. One of the things I talk about when it comes to behavioral health issues in the physician community is that physicians, from the very beginning, are trained not to show vulnerability. So I think being able to talk about these behavioral health issues is slowly, hopefully, turning the corner. And the work you do will certainly help with that.

In your article, you make a connection between credentialing and physician mental health. For those who did not get a chance to read your article, tell us a little bit about it.

Namit Choksi: Sure. To be candid, Kevin, this piece really came from a frustration that I think many clinicians quietly share: that we often wait until people are already burned out, exhausted, and considering leaving medicine before we acknowledge that they truly need support.

As I said, at Tend Health, we work closely with clinicians across the country, and one thing became very clear to me: mental health support in health care is still too reactive. In my view, clinicians should not have to reach that breaking point before confidential, high-quality care becomes accessible and available to them.

So the article was really an attempt to reframe clinician wellbeing not as a wellness initiative, but as essential infrastructure for a functioning health care system. I often say that happier clinicians lead to happier patients, and happier patients lead to a healthier bottom line in health care, if that is what you care about.

Kevin Pho: Absolutely. And I think that focusing on physician mental health will hopefully prevent them from leaving the workforce, because it is much more expensive to replace a physician than it is to keep one you already have.

Namit Choksi: Yes. The average cost of losing a resident is about $500,000, and the average cost of losing a clinician is about $1.2 million. But beyond all of these numbers, what I really want is for clinicians to feel seen, felt, and heard, for lack of a better phrase, and I think that is what we aspire to do by providing them that support.

Kevin Pho: Now, specifically with credentialing, and by that I assume you mean when you apply for hospital privileges and things like that, that becomes a barrier for clinicians seeking help. For those who are not familiar with the physician credentialing process, can you explain why that is?

Namit Choksi: Absolutely. Let’s say you have a history of substance use, or a history of significant depression or anxiety. If that is actually put on paper, it can take away your ability to get malpractice insurance or life insurance, or you may not meet the fitness-for-duty assessment. In my view, at least as the CEO of a mental health company, it is a vicious circle.

Because clinicians are scared this will happen, they do not seek mental health care support. They get worse, and nobody detects it. It reaches a point where there is a domino effect and things start to fall apart. By the time people look into it, it is too late. So I think the credentialing issue is real, and changes are needed.

We are like any other human beings. I understand that if you are unfit for duty, you should not be seeing a patient, but at the same time, I should not be penalized time and again for seeking help.

Kevin Pho: And from what I understand, and you are certainly much more familiar with this world, some of these credentialing forms are removing questions about behavioral health. Tell us what the situation is like today. Is that commonplace? Are you seeing more of these credentialing forms remove behavioral health questions? What is happening today?

Namit Choksi: Great question, Kevin. Again, it is state specific. There is a lot of advocacy work going on through physician health organizations and clinician groups that are trying to remove these questions.

To be candid, we are far from done. I do think there are a few states that are much friendlier. I would like to think Massachusetts and a couple of others are much friendlier compared to the rest, but there are states where you would be heavily penalized for disclosing. So I would say it has at least started, but we have a long way to go. As they say, a long journey begins with a single step, and I think this is at least a step in the right direction.

Kevin Pho: Now, to be clear, if a physician has a behavioral health condition and has to truthfully disclose it on that form, can that harm them professionally? Tell us about some of the different scenarios you have seen when clinicians truthfully answer those behavioral health questions on credentialing forms.

Namit Choksi: Yeah, the short answer is yes. Let’s say a clinician comes forward and says, “I suffer from significant depression.” Then five follow-up questions go out, and I am fairly sure that out of those five, you will answer yes to at least one or two, and that gets you into a rollover effect. So yes, if you actually declare it, you technically get penalized.

Now, you get penalized in different ways. There are states that are much friendlier, where the response is, “OK, you can practice, but you need supervision and check-ins every now and then,” which I think is the right approach. But there are other states where the response is, “OK, we are going to take a step back. You pause, you get yourself treated, and then we need a fitness-for-duty assessment, and unless you are fit for duty you will not be able to see patients.” And this is also their livelihood. Now imagine that you are not getting a single paycheck while carrying an overwhelming amount of medical student loans, like most of us. So again, it gets into that vicious circle I am talking about.

Kevin Pho: And I am sure that incentive prevents a lot of physicians not only from seeking help, but also from being truthful on these credentialing forms. One of the things you wrote about in your article was legacy employee assistance programs. Tell us about the current situation with those, and why they may or may not be lacking in terms of what is really needed.

Namit Choksi: Great question, Kevin. I think traditional EAP programs technically just check those boxes, and I say that for a couple of reasons.

First, a lot of those EAPs have visit limits. A clinician often cannot do more than six visits annually in many EAP programs, so there is a visit cap. Second, it usually takes about two to three weeks to reach someone and get an appointment, and once you have that first appointment, it is not the clinician who will stick with you for the rest of your journey. So you have a constant change in clinicians.

Third, EAPs are often built on the assumption that you do not use them. They want lower utilization so that, at the end of the day, the cost makes sense. A lot of these EAP programs cost a couple of dollars per employee per month, whereas a solution like Tend is much more expensive, but we are not there to just check boxes. We are there to create an impact and to genuinely help.

And last but not least, the other big issue we face with traditional EAPs is availability. We are available late at night, early in the morning, and most weekends, which a traditional EAP is not. So we try to remove all the barriers to accessing mental health care support that a traditional EAP could not address.

If you ask me, an ideal solution would be to couple an EAP with a solution like Tend and get the best of both worlds, to the extent that it is cost permissible. That is why traditional EAPs do not really solve the problem on their own, and why you need a system that supports them on top. That is why we exist.

Kevin Pho: And I know that the solution you are offering is a virtual-first mental health support system, which gives you that access. Walk us through an ideal scenario of how your solution helps with some of the behavioral health issues clinicians face today.

Namit Choksi: Sure. As I said, Tend removes all the barriers to accessing mental health support. First, we do not put any caps on visits, so you can have an unlimited number of them. Second, about 95 percent of our clinicians are PhDs or PsyDs with extensive experience in mental health support for clinicians, so they have a lot of contextual knowledge. They are not going to tell a resident to take five days off or tell a physician to take a break from surgeries. They understand the realities.

Third, we are available late at night, early in the morning, and on weekends. We are present in 45 states and expanding to all 50 soon. And finally, we do not trigger insurance, and the reason is that we do not have to put anything on record. So people feel comfortable coming to us. It does not affect your ability to get malpractice insurance, and it does not affect your ability to get life insurance. So people feel a lot more comfortable coming to Tend Health.

Finally, we do everything. We are, as I said, the Cadillac version of mental health care support, if such a thing exists. We do psychiatry and medication management. We do coaching, couples counseling, and individual counseling. So you do not have to step outside the Tend ecosystem to get mental health care support. Everything you need is within that ecosystem.

Kevin Pho: What does that say about the system? One of the things you mentioned is that your solution does not trigger an insurance request, which in turn does not affect your malpractice or life insurance. What does it say about the system that you are offering this as a feature of the service you provide?

Namit Choksi: Well, what I am really trying to say is that we want clinicians to seek mental health support. We exist for them. Our patients are at the heart of our decision-making, and we want them to use us and to feel comfortable when they come to us. We do not want to just check boxes. We want to be there for them as a partner by their side every single time they reach out to us.

Kevin Pho: Now, let’s say medical institutions are listening to you right now. What recommendations would you give them if they want to take physician wellbeing seriously? What should they do next?

Namit Choksi: Great question, Kevin. One of the first things I would say is that people often think of mental health care support as a vitamin rather than a painkiller, and the reality is often the opposite. It is not a nice-to-have; I think it is a must-have. Obviously, I come from a place of bias, since I am the CEO of a mental health care company and a clinician.

But there are a couple of things I want to tell them. If you invest in your workforce, you will see the returns, and those returns can show up directly in your P&L, but also in your patient satisfaction, your clinician satisfaction, and your turnover rates. So I would say reach out to an organization such as ours. I know a lot of CEOs in the same space, and I often tell them that we are not competitors, we are collaborators, because the more attention this space gets, the better it is for all of us. So I would tell institutions to reach out to us at [email protected], and we would love to have a conversation and see how we could fit your needs.

But really, if you want to be there for your people, do not just check the box. It is a basic necessity. It is not a vitamin, it is not a nice-to-have, it is a must-have.

Kevin Pho: And specifically going back to credentialing, are you recommending that institutions simply remove questions about behavioral health from their credentialing forms? Would that be the most direct solution?

Namit Choksi: I would say, look, figure out a way to be supportive. I do not think clinicians would refuse to answer a question, even if it existed, if they knew there would not be dire repercussions. I think all that many of us as clinicians are asking for is to be treated as you would treat anyone else. Give us that support. We are human, so view us with that in mind.

I would say that taking those questions off would be a great interim solution. But the longer-term solution is actually figuring out the structure, so that even with those questions in place and a clinician answering them truthfully, we create a systemic change where it is not a taboo, where it is not looked down upon, and where clinicians are not penalized. So there needs to be a system-level change, but the near-term solution could be taking those questions away in the right spirit, and then figuring out how to build policies and procedures around them.

Kevin Pho: We are talking to Namit Choksi. He is a physician entrepreneur and health care executive. Today’s KevinMD article is “How credentialing and culture impact physician mental health.” Namit, let’s end with some take-home messages you want to leave with the KevinMD audience.

Namit Choksi: Yeah. I am really hoping that the health care organizations that lead health care through the next decade will be the ones that understand this is a must-have and not a nice-to-have. And to all the clinicians out there, keep up the good work, and more power to you. We are here to support you all day, every day.

Kevin Pho: Namit, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.

Namit Choksi: Thank you, Kevin. It was a pleasure.

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