As of July 2020, North Carolina was the only state that followed all Federation of State Medical Boards recommendations regarding a physician’s mental health and efforts to seek treatment if needed, according to a report in JAMA.
The report also found five states — Alaska, Florida, Idaho, Kansas and Wyoming — “were not consistent” with any of the federation’s recommendations for medical license applications, according to a press release.
“No one should wait to get treatment or not get treatment at all because they worry they could lose their job that they put years and money into, and derive purpose from,” Jessi Gold, MD, MS, an assistant professor and director of wellness, engagement and outreach at Washington University School of Medicine in St. Louis, told Healio Primary Care.
“There are enough barriers to care in our broken mental health system without adding this additional, heavy burden,” she said. “This research shows just how widespread this problem still is.”
Rates of depression, burnout and suicide are higher among physicians than the general population; however, many physicians are hesitant to seek mental health care, “consistently citing fear of negative ramifications for licensing,” Gold and colleagues wrote. State medical license applications often ask questions about mental health history or its potential impact on competency. Physicians who practice in states that include mental health questions on medical license applications are more hesitant to seek help, according to the researchers.
In 2018, the Federation of State Medical Boards (FSMB) issued recommendations on physician wellness, some of which focus on licensing applications. These recommendations, according to Gold and colleagues, include:
- limiting mental health questions to conditions that result in impairment;
- limiting mental health questions to conditions within the last 2 years;
- offering “safe haven nonreporting” if mental health questions are asked; and
- including “supportive language” about seeking mental health care.
Gold and colleagues assessed the 50 states, the District of Columbia, Guam, the Northern Mariana Islands and the U.S. Virgin Islands medical licensing boards’ adherence to each of the four FSMB recommendations. If state licensing boards did not ask questions that would require disclosing a mental health condition, they were deemed to be consistent with the first three recommendations. Based on their adherence, the boards received a score of one to four.
The researchers reported that 39 licensing boards were consistent with the recommendation limiting questions to conditions that result in impairment; 41 were consistent with the recommendation limiting questions to current conditions; 25 were consistent with the safe haven nonreporting recommendation; and eight were consistent with the supportive language recommendation. Seventeen boards did not ask questions that would require disclosing a mental health condition (thus, consistent with the first three recommendations). The mean score across all boards was 2.1.
The “varied” nature of the findings may pose a conundrum for some physicians, according to Ariel Brown, PhD, a study coauthor and cofounder of The Emotional PPE Project.
“There may be professional repercussions in the state they were first licensed, but not where they would like to move to,” she said. “When mental health is stigmatized in a portion of states, the concern bleeds over to others. This is why all states should conform to the FSMB recommendations; then there will be no question.”
With between 300 and 400 physicians committing suicide annually, there are dire ramifications to licensing boards not following the recommendations, according to Brown.
“This is a crisis and it’s unacceptable,” she said. “We need to be taking whatever steps we can to destigmatize getting support during tough times. No one should have to choose between their career and asking for help. The consequences are too big.”
The researchers encouraged all physicians to ask their respective state medical boards to “examine and revise” their medical licenses to ensure they address physician mental health. They also recommend that physicians ask their congressional representatives to support efforts such as the Lorna Breen Health Care Provider Protection Act and volunteer or donate to mental health advocacy organizations such as The Emotional PPE Project and National Alliance on Mental Illness.
The Emotional PPE Project. New JAMA study highlights urgent need for state medical boards to reform licensing practices to protect the mental health of physicians during COVID and beyond. https://www.prnewswire.com/news-releases/new-jama-study-highlights-urgent-need-for-state-medical-boards-to-reform-licensing-practices-to-protect-the-mental-health-of-physicians-during-covid-and-beyond-301293317.html. Accessed May 17, 2021.