MDs Don't Seek Psychiatric Care Because of Licensing Fears

Megan Brooks

October 06, 2017

Medical licensing boards continue to ask about current and past mental health conditions on initial and renewal applications, a practice that creates a major barrier to physicians seeking mental health care, new research shows.

Nearly 40% of physicians surveyed said they would be reluctant to seek formal medical care for treatment of a mental health problem because of concern that this may put their medical license in jeopardy.

The study was published in the October issue of Mayo Clinic Proceedings.

Against the Law

The Federation of State Medical Boards has advised medical licensing boards not to ask physicians about a history of mental illness, because doing so could violate the Americans with Disabilities Act of 1990. The American Psychiatric Association (APA) has also stated that impairment and potential risk for harm to patients cannot be inferred from a diagnosis or treatment alone.

There is a push to have medical licensure applications include only questions about current functional impairment of professional performance and for decisions regarding licensure to be based solely on professional performance, the investigators, led by Liselotte Dyrbye, MD, Mayo Clinic Program on Physician Well-Being, Rochester, New York, note.

As a result, some state licensing boards have modified questions about mental health. "However, many may remain in violation of the Americans with Disabilities Act, and the prevalence of licensure questions about physicians' history of mental illness appears to be increasing," the authors write.

"It remains unknown whether physicians who are licensed by medical boards that inquire about current or past diagnosis or treatment of a mental health condition are more reluctant to seek care for a mental health concern than those who are licensed by medical boards that inquire only about current impairment," they add.

To investigate, the researchers obtained initial medical licensure application forms from 50 states and the District of Columbia and renewal application forms from 48 states. They coded medical licensure application questions related to physicians' mental health as "consistent" if they inquired only about current (within the past 12 months) impairment from a medical condition or mental health condition or did not ask about mental health conditions.

Applications that asked about history of impairment (ie, whether the applicant has ever experienced impairment) or whether the applicant had a mental health condition that could affect competency, could possibly impair ability to practice medicine, or could lead to impairment if left untreated were not considered consistent.

The researchers also obtained data on care-seeking attitudes for a mental health problem from a nationally representative sample of 5829 physicians (66% men; mean age, 54 years).

20,000 Go Without Mental Health Care

"In this national study of nearly all (94.1%) medical licensure board applications, only one-third of states (16 of 48 [33.3%]) had questions on initial and renewal application forms that were congruent with the American Medical Association, American Psychiatric Association, and Federation of State Medical Boards polices and recommendations or in clear compliance with the Americans with Disabilities Act of 1990," the authors report. This is "disappointing," Dr Dyrbye told Medscape Medical News.

Previous large national studies have estimated that 6% of the more than 800,000 US physicians have had suicidal thoughts in the past 12 months and that 40% did not seek care because of concerns that doing so may have repercussions for their medical licensure. This would imply that licensure concerns may be a factor in 20,000 US physicians not receiving the professional help they need for mental health concerns, the investigators note.

The investigators point out that their findings support continued efforts to develop regulations and policies that encourage physicians to seek help. They also support universal use of consistent licensure questions across states. "Medical license boards are often controlled by the state legislature, so they are the ones that need to step up and get these questions fixed," said Dr Dyrbye.

The APA has developed and recommended the following language for state licensing boards to use on licensure applications: "Are you currently suffering from any condition that impairs your judgment or that would otherwise adversely affect your ability to practice medicine in a competent, ethical and professional manner? (Yes/No)."

"Such a question encourages physicians to consider any physical or mental health issue that could impair their performance and helps to destigmatize mental illness. In addition, it also enables state medical boards and their members to protect the public while being consistent with the Americans with Disabilities Act of 1990," the researchers write.

Changing medical licensure application questions so as to ask only about current functional impairment appears to be a "simple but potentially meaningful step to reduce barriers to physicians seeking help for mental health conditions," they conclude.

Doctors Are "Terrified"

Commenting on the findings for Medscape Medical News, Louise B. Andrew, MD, JD, from Victoria, British Columbia, Canada, who has an interest in physician suicide and who was not involved in the study, said: "It is just so sad that this population that is so susceptible to suicide is feeling that they can't get help or their licenses may be in trouble, and it is a reasonable fear, given some of the stories out there."

Also commenting, Michael F. Myers, MD, professor of clinical psychiatry, SUNY Downstate Medical Center, New York City, noted that the Federation of State Medical Boards is looking into making uniform the questions that states ask. "In their deliberations, I'd really want them to see a paper like this, so they know why so many doctors are not going for mental health care. If boards are going to ask, it must be restricted to current condition. Asking about something in the past has no relevance today."

Dr Myers said he recently renewed his New York medical license and was "delighted to see that there were no questions asked at all about the applicants' mental health (current or history)."

Dr Myers is author of the book, Why Physicians Die by Suicide: Lessons Learned From Their Families and Others Who Cared. He noted that in his research for the book, "10% to 15% of bereaved families of doctors who died by suicide told me that their loved one, the doctor who died by suicide, didn't receive any treatment at all and wouldn't go for help. They went from wellness to mental illness to death," Dr Myers said.

"Doctors are terrified of what could happen to their license if they go for mental health care. I don't want any barriers that prevent doctors from going for lifesaving care," Dr Myers added.

A related study published last year in General Hospital Psychiatry and reported by Medscape Medical News showed that female physicians frequently do not report seeking care for depression or other mental health problems because they are afraid of losing their medical license or of having to undergo intense scrutiny from medical licensing boards.

Funding for the study was provided by the Mayo Clinic Department of Medicine Program on Physician Well-Being. The authors, Dr Myers, and Dr Andrew have disclosed no relevant financial relationships.

Mayo Clin Proc. 2017;92:1486-1493. Full text

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