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Medical Licensure Questions and Physician Reluctance to Seek Care for Mental Health Conditions



      To determine whether state medical licensure application questions (MLAQs) about mental health are related to physicians' reluctance to seek help for a mental health condition because of concerns about repercussions to their medical licensure.


      In 2016, we collected initial and renewal medical licensure application forms from 50 states and the District of Columbia. We coded MLAQs related to physicians' mental health as “consistent” if they inquired only about current impairment from a mental health condition or did not ask about mental health conditions. We obtained data on care-seeking attitudes for a mental health problem from a nationally representative convenience sample of 5829 physicians who completed a survey between August 28, 2014, and October 6, 2014. Analyses explored relationships between state of employment, MLAQs, and physicians' reluctance to seek formal medical care for treatment of a mental health condition because of concerns about repercussions to their medical licensure.


      We obtained initial licensure applications from 51 of 51 (100%) and renewal applications from 48 of 51 (94.1%) medical licensing boards. Only one-third of states currently have MLAQs about mental health on their initial and renewal application forms that are considered consistent. Nearly 40% of physicians (2325 of 5829) reported that they would be reluctant to seek formal medical care for treatment of a mental health condition because of concerns about repercussions to their medical licensure. Physicians working in a state in which neither the initial nor the renewal application was consistent were more likely to be reluctant to seek help (odds ratio, 1.21; 95% CI, 1.07-1.37; P=.002 vs both applications consistent).


      Our findings support that MLAQs regarding mental health conditions present a barrier to physicians seeking help.
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        • Center C.
        • Davis M.
        • Detre T.
        • et al.
        Confronting depression and suicide in physicians: a consensus statement.
        JAMA. 2003; 289: 3161-3166
        • Shanafelt T.D.
        • Hasan O.
        • Dyrbye L.N.
        • et al.
        Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014.
        Mayo Clin Proc. 2015; 90 ([published correction appears in Mayo Clin Proc. 2016;91(2):276]): 1600-1613
        • Gold K.J.
        • Andrew L.B.
        • Goldman E.B.
        • Schwenk T.L.
        “I would never want to have a mental health diagnosis on my record”: a survey of female physicians on mental health diagnosis, treatment, and reporting.
        Gen Hosp Psychiatry. 2016; 43: 51-57
        • Shanafelt T.D.
        • Balch C.M.
        • Dyrbye L.
        • et al.
        Special report: suicidal ideation among American surgeons.
        Arch Surg. 2011; 146: 54-62
        • Schernhammer E.
        Taking their own lives—the high rate of physician suicide.
        N Engl J Med. 2005; 352: 2473-2476
        • Cedfeldt A.S.
        • Bower E.A.
        • Grady-Weliky T.A.
        • Flores C.
        • Girard D.E.
        • Choi D.
        A comparison between physicians and demographically similar peers in accessing personal health care.
        Acad Med. 2012; 87: 327-331
        • Gross C.P.
        • Mead L.A.
        • Ford D.E.
        • Klag M.J.
        Physician, heal thyself? regular source of care and use of preventive health services among physicians.
        Arch Intern Med. 2000; 160: 3209-3214
        • Shanafelt T.D.
        • Oreskovich M.R.
        • Dyrbye L.N.
        • et al.
        Avoiding burnout: the personal health habits and wellness practices of US surgeons.
        Ann Surg. 2012; 255: 625-633
        • Centers for Disease Control and Prevention
        BRFSS prevalence & trends data.
        (Updated January 23, 2017. Accessed November 17, 2016)
        • American Psychiatric Association
        Position statement on confidentiality of medical records: does the physician have a right to privacy concerning his or her own medical records?.
        Am J Psychiatry. 1984; 141: 331-332
        • Wallace J.E.
        • Lemaire J.B.
        • Ghali W.A.
        Physician wellness: a missing quality indicator.
        Lancet. 2009; 374: 1714-1721
        • Altchuler S.I.
        Commentary: granting medical licensure, honoring the Americans with Disabilities Act, and protecting the public; can we do all three?.
        Acad Med. 2009; 84: 689-691
        • Hendin H.
        • Reynolds C.
        • Fox D.
        • et al.
        Licensing and physician mental health: problems and possibilities.
        J Med Licensure Discipline. 2007; 93: 6-11
        • Sansone R.A.
        • Wiederman M.W.
        • Sansone L.A.
        Physician mental health and substance abuse: what are state medical licensure applications asking?.
        Arch Fam Med. 1999; 8: 448-451
        • Miles S.H.
        A challenge to licensing boards: the stigma of mental illness.
        JAMA. 1998; 280: 865
        • Worley L.L.
        Our fallen peers: a mandate for change.
        Acad Psychiatry. 2008; 32: 8-12
        • Scutchfield F.D.
        • Benjamin R.
        The role of the medical profession in physician discipline [editorial].
        JAMA. 1998; 279: 1915-1916
        • Federation of State Medical Boards
        Americans With Disabilities Act of 1990: Licensure Application Questions; A Handbook for Medical Boards.
        Federation of State Medical Baords of the United States, Inc, Dallas, TX2006
        • Schroeder R.
        • Brazeau C.M.
        • Zackin F.
        • et al.
        Do state medical board applications violate the Americans with Disabilities Act?.
        Acad Med. 2009; 84: 776-781
        • Polfliet S.J.
        A national analysis of medical licensure applications.
        J Am Acad Psychiatry Law. 2008; 36: 369-374
        • American Psychiatric Association
        Position statement on inquiries about diagnosis and treatment of mental disorders in connection with professional credentialing and licensing.
        (Published 2015. Accessed December 12, 2016)
        • American Psychiatric Association Work Group on Disclosure
        Recommended Guidelines Concerning Disclosure and Confidentiality.
        American Psychiatric Association, Washington, DC1997
        • Council on Psychiatry and the Law
        Discrimination Against Persons With Previous Psychiatric Treatment: Postion Statement.
        American Psychiatric Association, Washington, DCMarch, 1997 (APA Document Reference No. 970002)
        • Hansen T.E.
        • Goetz R.R.
        • Bloom J.D.
        • Fenn D.S.
        Changes in questions about psychiatric illness asked on medical licensure applications between 1993 and 1996.
        Psychiatr Serv. 1998; 49: 202-206
        • Council on Medical Education
        Access to Confidential Health Services for Medical Students and Physicians (Recommendation B).
        (American Medical Association website) (Accessed December 12, 2016)
        • Hampton T.
        Experts address risk of physician suicide.
        JAMA. 2005; 294: 1189-1191
        • Shanafelt T.D.
        • Boone S.
        • Tan L.
        • et al.
        Burnout and satisfaction with work-life balance among US physicians relative to the general US population.
        Arch Intern Med. 2012; 172: 1377-1385
        • Clement S.
        • Schauman O.
        • Graham T.
        • et al.
        What is the impact of mental health-related stigma on help-seeking? a systematic review of quantitative and qualitative studies.
        Psychol Med. 2015; 45: 11-27
        • ten Have M.
        • de Graaf R.
        • Ormel J.
        • Vilagut G.
        • Kovess V.
        • Alonso J.
        • ESEMeD/MHEDEA 2000 Investigators
        Are attitudes towards mental health help-seeking associated with service use? results from the European Study of Epidemiology of Mental Disorders.
        Soc Psychiatry Psychiatr Epidemiol. 2010; 45: 153-163
        • Rath K.S.
        • Huffman L.B.
        • Phillips G.S.
        • Carpenter K.M.
        • Fowler J.M.
        Burnout and associated factors among members of the Society of Gynecologic Oncology.
        Am J Obstet Gynecol. 2015; 213: 824.e1-824.e9