A survey of 2,000 U.S. physicians released in September found that roughly half believed they had met criteria for a mental health disorder in the past but had not sought treatment. The doctors listed a number of reasons they had shunned care, including worries that they'd be stigmatized and an inability to find the time.
But they also voiced a troubling reason for avoiding treatment: medical licensing applications.
After graduating from medical school, doctors must complete residency training and apply for state medical licenses to practice medicine. According to a study that appeared in 2008, about 90 percent of state medical boards have licensing forms that include questions about an applicant's mental health.
Such questions are intended to protect the public, based on the idea that impaired or distressed physicians could endanger patients. A physician having hallucinations, for example, might not be able to focus or practice safely.
Yet because applications can be used by medical boards to restrict licensing or mandate treatment, these questions may actually encourage silence.
Disclosing mental health issues can have dire consequences. In the words of one physician interviewed for the new study, “all of my fears were realized when I did report it. I was placed in a very strict and punitive [program] that didn’t allow me to take meds written by my doctor for anxiety and insomnia. I am now not practicing at all because of this.”
Given such professional risks, many doctors who need it are terrified about getting mental health care. A 2011 study found that more than 60 percent of surgeons who had experienced suicidal thoughts were reluctant to get help because of licensing concerns; a 2008 survey also found that nearly 20 percent of physicians with moderate to severe depression would not seek care out of fear of losing their medical licenses.
A mark on my record
When I was a medical student, I suffered an episode of depression and refused to seek treatment for weeks. My fears about licensing applications were a major reason I kept quiet. I didn’t want a mark on my record. I didn’t want to check “yes” on those forms.
Did that delay exacerbate my symptoms? Did it plunge me further into darkness? It’s hard to know for sure, but I do know it was wrong to have to worry about application forms when I should have been taking care of myself.
Even if brave enough to seek treatment, many doctors won’t report this during licensure. According to the September survey, just 6 percent of physicians who received a mental health diagnosis or treatment had disclosed this to state medical boards. Physicians who didn’t disclose mental health histories most commonly held back because they didn’t believe they posed any safety risks to patients.
Indeed, it's debatable how relevant — or even legal — these questions from medical boards are. According to several court cases, asking about past illness rather than current functional impairment may violate the Americans With Disabilities Act. In a study published in 2009, researchers examined state medical board applications and estimated that 69 percent had health questions that were "impermissible" or "likely impermissible" under federal law.
Whether focusing on past or present, the phrasing of these questions matters. Fortunately, some states now focus more on impairment related to mental health rather than broadly screening for any history of mental health diagnoses or treatment. Moving the focus away from the past is an important nuance: A doctor who had mild anxiety as a teenager isn't the same as a physician with multiple recent hospitalizations for suicide attempts.
State medical boards are tasked with protecting the public from impaired medical professionals, and it’s difficult to predict who might put patients at risk in the future. Yet sweeping questions about mental health past and present aren’t the answer. I’ve seen little evidence to suggest that broad screenings make patients safer, and studies tell us these questions deter doctors from getting help.
Every year, as many as 400 doctors kill themselves in this country. Physician suicide has been called a crisis and a plague. Mental health care can be a lifeline for struggling doctors and, as with anyone grappling with mental illness, there are many reasons that doctors might not seek care. The questions on medical licensing forms should not be one of those deterrents.
In my case, after years of school and training, I’m preparing to apply for my medical license. The other day, I downloaded the lengthy application. Most of the forms are straightforward. They ask for proof of medical school graduation, test scores, addresses and the like.
Then, there’s a question about mental disorders. I pause.
Should I have kept quiet?
Morris, a graduate of Harvard Medical School, is a resident physician in psychiatry at the Stanford University School of Medicine.