Programs and Resources to Alleviate Concerns with Mental Health Disclosures on Physician Licensing Applications

Abstract

This article considers concerns about the presence and phrasing of questions on physician licensing applications related to mental health, substance abuse, and leave from practice. These questions may discourage physicians from seeking appropriate treatment due to fear of stigmatization, public disclosure, and career effects related to licensing or credentialing concerns. Accessible and affordable resources and programs are needed to allow physicians to seek treatment in a non-punitive, confidential manner. The authors discuss how some state medical boards have taken steps to address barriers that prevent licensees from seeking help and review the work of the Federation of State Medical Boards Workgroup on Physician Wellness and Burnout, which addressed concerns about physician wellness, burnout, and suicide prevention. Physician health programs also have begun to intervene in areas related to mental and physical health and are providing confidential and professional support. Additionally, medical schools, hospitals, and medical societies have increased their focus on mental health by implementing programs and offering resources to help students and physicians improve their overall health. Raising awareness about the importance of physician wellness has inherent value to physicians and the public and ultimately contributes to patient safety and the health of our nation.

Questioning physicians about health conditions at medical licensure registration: How should policy evolve in Canada?

“…10 , 20 However, the presence of illness does not equal impairment; a physician may be ill while continuing to function at work. 12 , 19 , 21 Medical regulatory authorities are therefore tasked with identifying, first, circumstances in which physicians will be required to disclose illness on their licence application or renewal and, second, circumstances in which an illness will require monitoring to maintain licensure. 10 In this sense, medical regulatory authorities must balance the duty to protect patients with physicians’ right to privacy, with the ultimate goal of creating a nonstigmatizing environment in which physicians are encouraged to seek treatment for illness before it becomes impairing.…”

Mental Health Disclosure Questions on Medical Licensure Applications: Implications for Medical Students, Residents, and Physicians

“…23 Therefore, removal or refinement of these intrusive questions would serve to validate, normalize, and promote optimal health and well-being among physicians and trainees. 16…”

“…13 Such a distinction is supported by the Americans With Disabilities Act Amendments Act of 2008 (ADAAA) 15 and the American Psychological Association's 2019 recommendation that medical credentialing boards create application language that focuses on current impairment as opposed to previous diagnoses and treatment. 16 Some state boards have revised mental health history questions to differentiate between temporary and chronic impairments. 10 Additionally, because mental health history cannot accurately project the quality of care medical trainees will provide future patients, state boards that choose to continue requesting mental health data at initial licensure should emphasize these questions as nonpunitive.…”

“…13,22 Trainees and physicians have been known to seek informal or "off-thebooks" treatment, as an alternative to evidence-based therapies, to maintain anonymity or confidentiality. 16 Thus, licensure application question changes could lead to a reduction in the use of unprescribed stimulants or psychotropic medications. Trainees and physicians might also be more apt to seek services related to substance abuse if the number of licensure questions about substance abuse treatment were reduced.…”

“…23 Therefore, removal or refinement of these intrusive questions would serve to validate, normalize, and promote optimal health and well-being among physicians and trainees. 16 The Florida medical boards' decision to remove disclosure requirements for applicants with a history of counseling for "stress, mild anxiety, situational depression, [or] family or marital issues" 20 may expand the help-seeking behaviors of medical trainees. However, "mild anxiety" and "situational depression" are not formal diagnoses; therefore, it would be helpful for medical boards to provide operational definitions to reduce ambiguity regarding such terms.…”