Physicians and mental health: Making medical license applications less punitive to doctors who seek help

True or false? If you see a psychiatrist or therapist during medical school, you have to report it to the state medical board when applying for licensure.

True or false? Some state medical boards specifically ask about your diagnoses.

If you struggled to answer either of the questions above, you’re not alone. In the past five years, there has been a shift in which several state medical boards have removed intrusive mental health questions from their licensing applications. This was accomplished through various efforts, including significant advocacy undertaken by the Dr. Lorna Breen Heroes’ Foundation and the Federation of State Medical Boards (FSMB).

Sadly, the pervasive fear of ramifications in our profession has created a culture in which physicians avoid seeking vital mental health treatment. This culture has cost precious lives.

Work in progress

I’d like to share the progress that has been made on revising state licensure and credentialing applications as well as ways you can get involved to keep the momentum going until, ideally, all states follow suit.

Here’s a quick timeline of what led to the changes:

• In 2016, the FSMB was considering potential guidance for state medical boards about working with “disruptive physicians” (those who were difficult to regulate) but found that the root of the issue often stemmed from burnout. This led to the creation of a Workgroup on Physician Wellness and Burnout.
• In 2018, the FSMB made recommendations to state medical boards related to the licensing process based on the workgroup’s findings, which include the following:
  • That state medical boards evaluate whether it’s necessary to include probing questions about mental health, addiction or substance use.
  • Focus on ADA compliance and not providing barriers for an applicant to seek treatment by asking these questions. 
  • That the application questions focus only on current impairment and not on illness or diagnosis. 
  • That state medical boards offer options of “safe haven non-reporting” to applicants who are receiving appropriate mental health treatment. 

In 2019, the AOA adopted a policy paper in which it agreed with the FSMB’s recommendations and urged boards not to ask applicants about their mental health history and instead focus on current impairments.

As of July 2023, there were just five states that were still inconsistent with all four of the FSMB recommendations and only one state was consistent with all four. However, Mark Staz, vice president of education at the FSMB, states that, “Changes are constantly happening ever since the recommendations were released in 2018.” For example, at the time of this interview, Staz shared that there were several boards in the process of making changes based on FSMB recommendations.

And when it comes to these changes, Staz shares, “A big part of the solution is destigmatization through cultural change. If there’s an avenue [that physicians and med students are using] for continuing the conversation about [mental health struggles], it will lead to creating change.”

Dedicated to the cause

Corey Feist, Co-Founder and Chief Executive Officer of the Dr. Lorna Breen Heroes’ Foundation, has spearheaded much of the movement through the foundation’s tireless advocacy efforts. After the Dr. Lorna Breen Health Care Provider Protection Act became law in March 2022, one of the foundation’s first major tasks was to focus on eliminating intrusive questions in licensing and credentialing applications that asked about prior mental health treatment, particularly because the pervasive fear of  having to report a history of treatment was identified as one of the main reasons physicians don’t seek help for burnout or depression.

As a result, they did an audit of states in compliance, which led to the creation of the Wellbeing First Champion badge, which serves as a visual form of recognition to identify the licensure boards, hospital and health systems that have undergone one of the following three recommended changes to remove this barrier in licensure and credentialing applications. Entities begin by auditing all applications, addendums and peer review forms, and changing or removing questions to:

1. Ask one question consistent with the FSMB’s recommended language that addresses all mental and physical health conditions as one, with no added explanations, asterisks or fine print. The FSMB’s recommended language is as follows: “Are you currently suffering from any condition for which you are not being appropriately treated that impairs your judgment or that would otherwise adversely affect your ability to practice medicine in a competent, ethical and professional manner? (Yes/No)”;
2. Refrain from asking probing questions about an applicant’s health altogether; or
3. Implement an attestation model with supportive language around mental health

There are several states that have implemented the attestation model, which include North Carolina, Oregon, Mississippi and Louisiana. A recently updated list of states where applications were consistent with the foundation’s recommendations can be found on the Dr. Lorna Breen Heroes’ Foundation website. As of Sept. 12, 2023, 25 states are consistent with the foundation’s recommendations and an additional 11 states are in the process of reviewing and updating their licensure applications.

“We have seen considerable progress made since we identified this issue,” Feist shares. “Progress at the hospital level, in credentialing offices and in C-suites across the board. In addition, we have seen medical licensing boards embrace this as one issue that they can improve for physicians across the country.”

Become an advocate

So, what are some ways that you can get involved and join this fight? As Feist says, “we need a chorus of voices,” so the more we get involved to bring attention and prioritize this issue, the more impactful our efforts would be. 

The following are some ways that osteopathic physicians and medical students can get involved:

1. Continue to raise awareness of this issue using our personal and professional media platforms.
2. Sign up to receive the FSMB newsletter and follow the Dr. Lorna Breen Heroes’ Foundation (website and social media platforms) to stay up to date with advocacy efforts, press releases and progress made. 
3. Have our respective osteopathic associations help identify osteopathic licensure forms to evaluate for compliance with the FSMB and Dr. Lorna Breen Heroes’ Foundation recommendations.
4. Direct organizations and institutions to the three step toolkit to raise awareness of the issue and push towards implementing changes across institutions.
5. Join the Dr. Lorna Breen Heroes’ Foundation Medical Student Coalition (for medical students). Currently, all osteopathic and allopathic medical schools in the state of Virginia have representatives in the coalition; the coalition will be expanding to medical schools across the country.  
6. Inform colleagues of the changes made in many states’ licensure and credentialing applications.

The hope is this awareness will lessen the fear of seeking support and treatment when people learn that the list of states where intrusive mental health questions are no longer asked is growing. There are many systemic health care problems in the United States that feel beyond our control and seem light-years away from change, but one tangible, immediate way to create change is joining this effort. Changes are currently happening that can improve physician wellbeing very quickly.

If you need help

If you or a colleague is in need of or interested in mental health support for physicians and medical students, please check out the resources below. If you are in crisis, please call 988.

• Physician Support Line
• Emotional PPE
• Physician Mental Health

Related reading:

We are not immune: Recognizing National Physician Suicide Awareness Day

A candid approach to improving resident and physician mental health