Physician Licensing Questions Regarding Mental Health Ethical?
A recent study took a look at the extent to which state medical boards investigate the past and current mental health of practicing physicians, including the questions asked on licensing applications. This is what the application questions include and what the board members had to say.
The initial physician licensure application for Texas states: “Within the past 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.”
Texas’s medical license procedure follows the recommendations made by the Federation of State Medical Boards (FSMB) and other stakeholders. “There’s a reason why the questions are asked,” said Jared Schneider, communication’s officer for the Texas Medical Board. “We want to make sure that people are competent, that physicians are safe to practice and treat patients in Texas.”
Schneider insisted both the initial application and renewal forms had “undergone a very lengthy stakeholder process to arrive at” its current form, which was approved approximately ten years ago, and no revisions are currently planned. “Physicians can seek mental health treatment without having to report, but if they believe that their condition may affect their ability to competently practice, they would need to report this information to the Board. The Board then reviews these on a case-by-case basis,” he added.
The Minnesota Board of Medical Practice asks the following question on its physician application form: “Have you within the past 5 years been advised by your treating physician that you have a mental, physical, or emotional condition, which, if untreated, would be likely to impair your ability to practice medicine with reasonable skill and safety?”
Minnesota does not single out mental health nor any specific diagnoses in this question. Another asks, “Have you ever been diagnosed with, treated for, or do you currently have” followed by a list of fourteen conditions and categories with checkboxes that include bipolar disorder, schizophrenia, depression, seasonal affective disorder, “any dissociative disorder,” “any psychotic disorder,” and “any condition requiring chronic medical or behavioral treatment.”
“You don’t write a question like that unless you believe there’s something very wrong with having a mental impairment,” explained Jo Anne Simon, JD, a disability rights attorney and New York State Assembly member. “If they’re worried about protecting the public, they’re doing more damage to the effort…by furthering stigma.”
Debora Stovern, the executive director for the Alaska State Medical Board, said a ‘yes’ response on an application question regarding mental health, addiction, or substance abuse does not mean the application will be denied. The licensing board “may require additional assessment, may grant an unrestricted license, may grant a conditioned or probationary license, or may deny a license,” she said.
“I think the FSMB is on the right track,” said Liselotte Dyrbye, MD, MHPE, co-director of the Mayo Clinic’s Physician Well-Being Program in Rochester, Minnesota, adding, “Even if the state medical board fixes their licensure applications, [physicians] still have to deal with the questions when they try to get malpractice insurance, disability insurance, and hospital privileges.”
Pamela Wible, MD, a family physician and author of Physician Suicide Letters Answered, isn’t so sure. She argued, if a mental health question needs to be asked, the question should be short and sweet and to the point. “Ask it in seven words or less, the same way on every form: ‘Are you currently impaired?’” she said.
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