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State Medical Licensing Board Questions May Discourage Physicians From Addressing Their Mental Health

Medical license application questions are still not treating mental and physical illness the same, and this could be impacting a physician’s decision to seek treatment for mental disorders, according to findings recently published in Family Medicine.

“There had been some studies many years ago that also looked at how states treat mental health and physical health. I expected that there would be quite a bit of change since our study was done quite a number of years later,” Katherine J. Gold, MD, MSW, MS, department of family medicine, University of Michigan, told Healio Family Medicine in an interview.

Katherine J. Gold

Researchers wrote that those earlier studies found that the licensure questions regarding mental health or substance abuse questions were “overbroad.”

To see if anything changed since those previous studies, Gold and colleagues examined physician medical licensing applications for U.S. physicians seeking licensing for the first time in 2013 in the 50 states and Washington, D.C. Questions about mental and physical health, as well as substance abuse, were identified and coded as to whether they asked about diagnosis and/or treatment or limited the questions to conditions causing physician impairment.

Researchers found that states were more likely to ask for history of treatment and prior hospitalization for mental health and substance use, compared with physical health disorders. In addition, states were significantly more likely to ask about past or current treatment for mental health or substance abuse (28 vs. 16, P = .0005; and 33 vs. 16, P = .0002) vs. physical health disorders, and hospitalization for mental health problems was queried more often than for physical problems (10 vs. 4; P = .031). Researchers also found that many of the questions violated Americans with Disabilities Act standards. Of the applications examined, 43 asked questions about mental health, 47 queried on substance use, and 43 asked about physical health.

“The results were surprising [and] worrisome,” Gold said in the interview. “There’s been a big push to address physician well-being, particularly mental health and physician suicide. Part of addressing that is making it easier for physicians to seek health care if they need it. [But] if a physician thinks his or her license is on the line if they so much as disclose that there’s a mental health problem, then they’re not going to go get treatment.”

In light of the findings, Gold had a few suggestions for the Federation of State Medical Boards.

“My first recommendation would be to not ask specific mental health questions because these questions don’t identify physicians who are not fit to practice. My second [recommendation] would be that if you ask questions about mental health, make them about current impairment, current time and have them be equal in detail to the physical health questions because if they’re not similar, then you’re getting into violations of the Americans with Disabilities Act. You’re basically saying someone with a mental health disorder has to undergo a lot more investigation or otherwise prove that everything’s fine compared to someone with a physical health disorder.

“These questions really have a powerful impact on physicians,” Gold continued. “This kind of fear is real ... We know from my other research that as a result [of that fear] most people don’t report, or don’t get help, and that’s really sad when you have someone who has a condition that’s very treatable but the person don’t feel it’s safe to get help. To me, that poses more risks for patients.”

The AMA announced last week that delegates at its annual meeting adopted a policy that calls on state medical boards to evaluate a physician’s mental and physical health similarly to help ensure that a previously diagnosed mental health illness is not automatically considered a current impairment to practice, and lower the stigma connected to mental health illness that could impact a physician’s ability to obtain a medical license and impede physicians and medical students from receiving care. - by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.