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Physicians' Medical Licensing Forms Tougher on Mental Health than Physical Health

News  |  By Alexandra Wilson Pecci  
   June 21, 2017

Questions posed by state medical boards about physicians' mental health and substance abuse are specific and sometimes intrusive, study finds.

State medical boards ask physicians much more extensive and intrusive questions about mental health conditions than for physical health conditions, and many of those questions violated the Americans with Disabilities Act, according to a study published in the Society of Teachers of Family Medicine.

Researchers, led by Katherine J. Gold, MD, assistant professor in the University of Michigan's Department of Family Medicine, examined how state medical licensing boards across the 50 states and Washington, D.C. evaluated mental illnesses compared to physical illnesses or substance use on state licensing forms.

"The differences were really quite striking," Gold said in a statement. "States were significantly more likely to ask if physicians had been diagnosed, treated or hospitalized for mental health or substance abuse verses for physical health disorders, often asking about many years in the past."

Up to 15% of Physician Suicides Do Not Receive Mental Health Care

A similar number of states asked about both physical and mental health, but the content and nature of the questions varied. Physical health questions tended to be much more lenient and vague while questions about mental health and substance abuse were much more specific and sometimes intrusive.

"The problem is that states don't ask, 'Do you have a problem right now that affects your ability to provide good care for patients?'" Gold said. "(Instead) they ask broad questions that intrude on physician privacy and prevent doctors from seeking care, but don't necessarily pick up on impaired physicians."

Gold also published research last year showing that physicians fear stigma and possible sanctions for revealing their diagnosis. Nearly half of the surveyed physicians—all of whom were mothers—in the study believed they had met the definition for a mental illness at some point during their career, but had not sought treatment. Only 6% who had ever been diagnosed had reported it to their state licensing board, as most felt their condition didn't affect the care they gave.

To this point, the AMA last year called on state medical boards to refrain from asking applicants for licensure about a history of mental illness and substance abuse treatment and to focus only on current impairment by mental illness or addiction.

In addition to the fear of stigma or punishment, the pressure for physicians to stay quiet about their mental health also has a darker side: Up to 15% of physician suicide victims did not receive mental health care, HealthLeaders reported earlier this month.

"We're not going to improve physician health until we can take away some of the barriers to seeking help," Gold said. "We know that reporting this level of detail to state licensing boards is a huge barrier for physicians because of self-stigma and fears about their license and not being able to practice."

Alexandra Wilson Pecci is an editor for HealthLeaders.

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