Do PA licensure questions violate the Americans with Disabilities Act?

Abstract

Objective: Negative stigma related to mental health diagnoses is common in both clinicians and the public. Questions about physical and mental conditions on licensure applications often are overly broad and may violate the Americans with Disabilities Act (ADA). This study investigated state physician assistant (PA) licensing applications relating to physical and mental health, and their consistency with the ADA. Methods: We collected PA state licensure applications from all 50 states and the District of Columbia. To be considered consistent with the ADA about physical conditions, an application had to only contain questions about a current (within the past year) physical health condition that impaired the applicant's ability to practice as a PA, or not include any questions about physical health. Questions that asked for speculation about possible future situations were considered inconsistent with the ADA. Results: Nearly 57% of state PA licensing applications were consistent with ADA guidelines on physical conditions; 51% were consistent for mental health conditions. Conclusions: Many state PA licensing boards include questions about physical and mental health conditions that are not limited to current impairment. These licensure questions could violate the ADA, and may reduce PAs' willingness to seek help for mental health issues. Balancing public safety with clinician health is a challenge. Further research and action are needed to optimize PA licensure questions on physical and mental health.

PA licensure questions, the Americans with Disabilities Act, and seeking medical care

“…Taken together with our previous data on initial applications (28 consistent for physical health, and 25 consistent for mental health), 18 states were consistent with the ADA with regard to licensure questions about physical and mental health for initial and renewal applications (Figure 2). 6 Thirty-two states were inconsistent with the ADA in at least one application and for at least one of physical and mental health questions; one state (Michigan) was consistent on its initial application but we were not able to obtain the renewal application. A one-way ANOVA confirmed that this difference between perceived risk of repercussions on licensure between physical and mental health issues was signifi cant (P < .05).…”

“…This survey included demographic information about the respondents, as well as two questions used in previous research about help-seeking behavior and licensure concerns for physicians and PAs. 5,6 Data were analyzed using SPSS Version 25. Descriptive statistics were collected and reviewed, followed by analyses to explore the relationship between various demographic (age, sex, specialty) or regulatory (state compliance with the ADA for initial application, renewal application, or both) factors and the likelihood to feel reluctance to seek help for physical or mental health issues due to concerns about unfavorable effects on licensure.…”

“…After obtaining exempt status from the Butler University institutional review board, we distributed an anonymous survey about attitudes on physical and mental health as a pass-through survey opportunity made available to all PAs who completed the AAPA Salary Survey during a 2-week period in March 2021. This survey included demographic information about the respondents, as well as two questions used in previous research about help-seeking behavior and licensure concerns for physicians and PAs 5,6…”

“…Recent work has found somewhat better rates of compliance for initial PA licensure applications: 26 states had MLAQs that were consistent with the ADA with regard to mental health conditions, and 29 were consistent with the ADA for physical conditions. 6 The present study seeks to expand our knowledge of MLAQs for PAs by assessing renewal applications, and also surveys a national sample of PAs to explore the relationship between MLAQs and likelihood to seek help for problems with physical illness, mental health, or substance use.…”

Healthcare owes us real mental health support

“…Research in the March 2021 issue of JAAPA highlighted the widespread practice of PA license applications asking deep, probing questions about mental health 7. These intrusive questions do real harm to clinicians and have a paradoxical effect on medical boards' mandate of public safety.…”