What licensure and insurance concerns contribute to depression and physician suicide?

Updated: Aug 01, 2018
  • Author: Louise B Andrew, MD, JD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Licensure concerns

Medical licensure applications and renewal applications frequently require answers to broad-based, time-unlimited questions regarding the physician’s mental health history without regard to current impairment, and courts have determined that they are impermissible, because the resultant examinations and restrictions constitute discrimination under Title II of the Americans with Disabilities Act (ADA) based on stereotypes. [44, 45, 46, 47, 48, 42, 49] However, impermissibly broad parameters still persist in almost half of all licensure applications' mental health questions. [50]

Most states have physician health programs that may or may not be associated with the medical licensing authority, and many have regulations that allow a physician enrolled in a physician health program who is compliant with treatment to check “no” on the mental health questions on licensure applications. However, physicians who are contemplating or in need of treatment are almost universally unaware of such "safe harbor" provisions.

Most physicians assume that any state agency or treating physician will share confidential information about them to the licensing authority. [51] Additionally, any lack of disclosure on an employment or credentialing application can be cited as grounds for termination or decredentialing.

Insurance concerns

Discrimination in obtaining insurance coverage is a common, but little publicized problem for physicians with mental illness. Health, disability, life, and liability insurance may all be denied to a physician who admits to depression.

Even if disability insurance has previously been procured, its use may subject physicians to repeated humiliating and invasive examinations by detached and dubious “independent medical examiners” for the insurer, whose motivation is to cut company losses. Many physicians affected by mental illness feel that insurers expect them to adhere to the standard prescription “physician, heal thyself.”

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