Nearly 40% of physicians surveyed about medical licensing questions (2,325 of 5,829) indicated they would be reluctant to seek formal medical care for a mental health condition because of potential repercussions, Liselotte N. Dyrbye, MD, and coauthors reported in 2017 in the Mayo Clinic Proceedings.
“You’re sort of stuck. You recognize you have a problem and you want to seek care so that you can get better, but if you do that, you might have to tell the board,” Dr. Dyrbye said in an interview. “You could be mandated potentially to have an outside psychiatric evaluation, to have your personal medical records reviewed by people other than your personal physician.”
Rising levels of burnout among physicians make it critical to remove obstacles to care, said Arthur S. Hengerer, MD, a former chair of the FSMB who has been a leader in efforts to revise medical licensing questions.
Dr. Arthur S. Hengerer
“The only thing that really brings joy to medicine are the relationships you develop with patients, the trust that comes from that, and when you can’t develop relationships because you can’t spend the time, because you are clicking and documenting, it hurts,” said Andrew Lamb, MD, who aided in successful efforts to change North Carolina’s licensing questions.
North Carolina approached this issue in steps. In 2017, it removed a question about mental health from its annual physician license renewal form. In 2018, the North Carolina Medical Board voted to drop questions about mental and physical health from physician license applications.
“It’s hoped that removing this question will encourage clinicians to get the help they need, without fear it will compromise their chances to obtain a professional license,” the board said in an annual report.
Other states are retaining these questions, but allowing physicians to check “no” if they are in an approved program for mental health treatment. The North Dakota Board of Medicine took this approach.
“Because our mission is protection of the public, we didn’t feel that we could eliminate that question,” Bonnie Storbakken, JD, executive secretary of the North Dakota Board of Medicine, said in an interview.
The North Dakota board voted in March 2018 to change its question on mental health after the FSMB spurred a national dialogue on this issue, she said. The North Dakota board opted to allow physicians to check ‘no’ on the question about current mental health and or substance issues if they had voluntarily sought assistance from the North Dakota Professional Health Program or a professional health program in another state. The approach preserves anonymity. The question as previously phrased made some physicians feel they had to report their treatment, she said.
In Alabama, physicians also have the option to check “no” on questions about whether they are undergoing mental health treatment if they are participating in a professional assistance program. Mark Jackson, executive director of the Medical Association of Alabama, said he hopes more states give physicians this option for seeking help not only with mental health issues, but with addiction as well.
“You need to get people in and get them help and not jeopardize their career in the process. Society in general has got that problem going on and physicians are not immune from that,” Mr. Jackson said. “Hopefully other states will see that we need to do something to make sure that the physician population is taken care of.”
Pamela Wible, MD, an advocate for physicians’ mental health, did her own review of state board’s licensing questions. In an assessment posted on her website, Dr. Wible, who practices family medicine, gives 13 states an “A” grade for having no mental health questions or one or two straightforward current questions about impairment that do not mention mental health. “Connecticut, Hawaii, Michigan, and New York are the most physician-friendly of all states with no mental health or impairment questions,” Dr. Wible wrote.
The Texas Medical Board earned a “C” grade in Dr. Wible’s survey. In May 2019, that board’s chairman, Sherif Zaafran, MD, wrote about how his organization had taken a new look at the licensing questions, which were last revised in 2014. While the board has not decided on any immediate changes, it is “maintaining an open dialogue to address future concerns,” Dr. Zaafran wrote in the board’s bulletin.
The Texas Medical Board’s physician licensing form, as posted on its website, includes a broadly phrased question on mental health: “Within the past five (5) years, have you been diagnosed with or treated for any: psychotic disorder, delusional disorder, mood disorder, major depression, personality disorder, or any other mental condition which impaired or does impair your behavior, judgment, or ability to function in school or work?”
Physicians who have had treatment for mental health conditions then must submit another form. They may have to provide details on diagnosis, prognosis, and medications prescribed. Compliance requirements include counseling records, contracts with impairment support groups, and records on file with law enforcement agencies and licensing agencies.
State officials are trying to figure out how best to learn of potential impairments that could pose a risk for patients, without scaring physicians away from getting the care they themselves need said Stephen ‘Brint’ Carlton, JD, executive director of the Texas Medical Board.