Humans Before Heroes

Reframing Mental Health Licensure Questions

“If you’ve trained for all these years as a physician and then you can’t practice because back 10 years ago you had postpartum depression, that’s really threatening.”

— Katherine J. Gold, MD, MSW, MS

Humans Before Heroes—
Reframing Mental Health Licensure Questions

Humans Before Heroes is an initiative of the American Medical Women’s Association that was launched in conjunction with the 3rd National Physician Suicide Awareness Day. While the COVID-19 pandemic had brought physicians into the spotlight as heroes risking their lives to treat patients on the frontlines, as humans there was an emotional toll from balancing work with home life, the physical risk of contracting the illness, the exhaustion, and the grief. We had long known that physicians have high rates of suicide rates within professions, but our mental health needs were amplified after this shared trauma. It is critical that we remove all barriers to care-seeking so no frontline hero is left sacrificing themselves for others. Mental health treatment must be normalized and encouraged without fear of losing one’s livelihood and purpose from intrusive questions about physical or mental health issues on licensure application and renewal forms.

The Federation of Medical State Boards has a list of 10 recommendations regarding mental health licensure questions that balance the medical board’s mission to protect patients from impaired physicians while allowing physicians to seek care without fear of losing one’s license.

This site is intended to give the tools needed to become a champion in your state to reframe the mental health licensure questions.

There has been no greater need for change or momentum for it, than now.

Join Our Efforts

 

Events

  • Protecting Mental Health: An Essential Component of Clinical Care (Dec. 14, 2022)
    • Self-Regulation: Exploring How Acknowledging Emotions Can Create Effective Solutions.
    • In the Healing the Healer Series, we recognize that medical knowledge and technical skills are insufficient to prevent mental health challenges and produce well-rounded physicians. To optimize one’s mental health, we must acknowledge healing and growth’s personal and professional components. In this session, we will discuss (and utilize) coaching and EFT Tapping (an evidence-based mind-body technique) to help you acknowledge and regulate emotional states that may prevent you from showing up as your best self.
    • Melissa Hankins, MD, CPC and Quidest Sheriff, DO, MS
  • Protecting Mental Health: An Essential Component of Clinical Care (Oct. 25, 2022)
    • In the first session of the Healing the Healer Series, we recognize that medical knowledge and technical skills are insufficient to prevent mental health challenges and produce well-rounded physicians. To optimize one’s mental health, we must acknowledge healing and growth’s personal and professional components. In this session, we will learn about workplace measures and safety nets, personal self-care practices and the language to improve well-being.
    • Quidest Sheriff, DO, MS

 

Mental Health Questions on Initial State Licensure Applications

 

This map is a snapshot from a two years ago and is currently pending updates.

Osteopathic Licenses

Sixteen states have separate medical and osteopathic boards for licensure.  These states are Arizona, Arkansas, California, Florida, Hawaii, Maine, Michigan, Nevada, New Mexico, Oklahoma, Pennsylvania, Tennessee, Utah, Vermont, Washington, and West Virginia.   

In 2020, Lincoln and Wagner reviewed the state licensure applications of the 16 states with separate osteopathic licenses.  The categorized the states’ compliance with the American with Disabilities Act (ADA) as yes, no or intermediate.  The intermediate category was defined as those states with a timeframe impairment between 2 and 5 years or hypothetical situation.  

Of note, only 7 of the above 16 states had different applications for osteopathic and allopathic physicians.   Each of those 7 states (Arizona, California, Maine, Nevada, New Mexico, Oklahoma and West Virginia), the language was not in complete compliance with the ADA.

For 9 of these 16 states had the same language for both MD and DO license questions, 7 were ADA complaint.  Only Florida was noncompliant.  Arkansas was intermediate.   

Examples from two states:

Arizona

Osteopathic Board License Applications

Questions

Mental Health Questions

    • Have you recently been notified, diagnosed with or made aware of any initial or worsening symptoms of a current condition which did or may impair or limit your ability to safely practice medicine?
    • If you answer “yes”, you must submit a detailed written narrative statement concerning matter(s) including the name of the healthcare providers and treatment centers where you were treated along with the discharge summary of your treatment and progress. If you are currently participating or have participated in a confidential agreement or order in a program for the treatment and rehabilitation of doctors of osteopathic medicine impaired by alcohol, drug abuse or for other issues, please submit a copy of the agreement/order along with compliance reports from the state monitoring programs.

Substance Abuse Questions

    • Have you entered into a diversion program for evaluation, treatment or monitoring for substance abuse or dependency or for correction of communication or boundary issues, in lieu of or as a condition of resolving a matter before a regulatory board, criminal or civil court; OR have you been notified that such action is pending? You must answer “yes” even if you received a pardon, the convictions were set aside, the records were expunged, your civil rights were restored and whether or not the sentence was imposed or suspended.
    • If you answer “yes”, you must submit a detailed written narrative statement concerning matter(s) including the name of the healthcare providers and treatment centers where you were treated along with the discharge summary of your treatment and progress. If you are currently participating or have participated in a confidential agreement or order in a program for the treatment and rehabilitation of doctors of osteopathic medicine impaired by alcohol, drug abuse or for other issues, please submit a copy of the agreement/order along with compliance reports from the state monitoring programs.

Prior Impairment

    • If you answer “yes”, you must submit a detailed written narrative statement concerning matter(s) including the name of the healthcare providers and treatment centers where you were treated along with the discharge summary of your treatment and progress. If you are currently participating or have participated in a confidential agreement or order in a program for the treatment and rehabilitation of doctors of osteopathic medicine impaired by alcohol, drug abuse or for other issues, please submit a copy of the agreement/order along with compliance reports from the state monitoring programs

Awareness of Declarations and Attestation

    • I hereby give my permission for the Arizona Board of Osteopathic Examiners to secure additional information concerning me or any of the statements in this application from any person or any source the Board may desire.
    • I hereby authorize, request and direct any person, firm, officer, corporation, association, organization or institution to release to the Arizona Board of Osteopathic Examiners any files, documents, records or other information pertaining to the undersigned requested by the Agency, or any of its authorized representatives in connection with processing my application for chiropractic licensure.. 
    • I hereby release the aforementioned persons, firms, officers, corporations, associations, organizations and institutions from any liability with regard to such inspection or furnishing of any such information.
    •  I further authorize the Arizona Board of Osteopathic Examiners to disclose to the aforementioned organizations, persons, and institutions any information which is material to my application, and I hereby specifically release the Board from any and all liability in connection with such disclosure. 
    • I further agree to submit to questioning by the Board or any member thereof, and to substantiate my statements if desired by the Board

Other Forms (Initial App)

    • Form No. 2: VERIFICATION OF POSTGRADUATE TRAINING
      • b. Did this individual ever take a leave of absence or deferment/break from his/her training?
      • d. Did this individual participate in a confidential or public diversion program for substance abuse monitoring?

Oklahoma

Osteopathic Board License Applications

Questions

  1. Have you ever been diagnosed or treated for any mental or physical illness that would hinder your ability to practice osteopathic medicine? 

If Yes, give full details on a separate page. Also, please provide a separate letter addressed to each physician, therapist, and/or institution authorizing them to release whatever information this Board may require. This letter will be used to verify the information you have given and to obtain records concerning your care and treatment. 

  1. Have you ever interrupted your training because of illness or impairment (physical, mental or chemical)? 

If Yes, provide full details including dates and the names and addresses of each training institution on a separate notarized statement. Furnish a separate letter addressed to each institution authorizing them to release whatever information this Board may require. 

  1. Have you ever been unable to practice osteopathic medicine because of illness or impairment? 

If Yes, provide full details including information concerning your diagnosis and treatment and date of occurrence, treating physician(s), etc. in a separate notarized statement. Furnish a separate letter addressed to each, authorizing them to release whatever information this Board may require, including your medical records. 

Substance Abuse

  1. Have you ever been chemically dependent? 

If Yes, give full details on a separate page. In addition, please provide a separate letter addressed to each physician, therapist, institution, and support group that provides care and treatment and after care, authorizing them to release whatever information this Board may require. This letter will be used to verify the information you have given and to obtain records concerning your care, treatment, and participation. 

  1. Are you now taking scheduled prescription medication, marijuana or any illegal substances of any kind? 

If Yes, provide the pertinent information regarding the illness, giving rise to the need for the medication, the name of the drug(s), dosage, etc., in a separate notarized statement. This statement should also discuss who prescribes your medication, where you obtain it, etc. Provide a letter addressed to each prescribing physician, pharmacy, and/or other entity, authorizing them to release any information this Board may require.

References:

Osteopathic Medical Licensing Compliance With the Americans With Disabilities Act of 1990 (The Journal of the American Osteopathic Association, 2020)

Fearing License Issues Depressed Doctors Don’t Get Help (The DO, 2017)

Resources

Behind the Research with JAOA Podcast (Oct 6, 2020)

Resources

Statements & Recommendations

American Psychiatric Association Position Statement on Inquiries about Diagnosis and Treatment of Mental Disorders in Connection with Professional Credentialing and Licensing

American Medical Association Access to Confidential Health Services for Medical Students and Physicians H-295.858

American Academy of Emergency Medicine Position Statement on Inquiries about Diagnosis and Treatment of Mental Disorders in Connection with Professional Licensing and Credentialing

American College of Emergency Physicians Joint Statement on Supporting Clinician Health in the Post-COVID Pandemic Era

Report and Recommendations of the FSMB Workgroup on Physician Wellness and Burnout

Articles

Licensing Barriers and Physician Mental Health

Mental Health Disclosure Questions on Medical Licensure Applications: Implications for Medical Students, Residents, and Physicians (Academic Medicine, 2022)

Improving How State Medical Boards Ask Physicians About Mental Health Diagnoses: A Case Study From New Mexico (Ann Intern Med, 2020)

Physician-Friendly States for Mental Health: A Review of Medical Boards (Qualitative Research in Medicine and Healthcare, 2020)

Suffering in Silence: Mental Health Stigma and Physician Licensing Fears (American Journal of Psychiatry, 2018)

State Medical Licensing Boards’ Practice May Hurt Physician Mental Health (Michigan Medicine Family Practice)

Medical boards change or consider amending mental health-related licensing questions (MDedge, 2019)

Fearing license issues, depressed doctors don’t get help (The DO, 2017)

Videos

Help: A Commentary on Stigma About Mental Healthcare for Doctors

Physician Reluctance to Seek Care for Mental Health Conditions

Physicians Connected

Toolkit

Guidance Document

Kansas State Board of Healing Arts Guidance Document on Universal Impairment Licensure Question

 

Key People

Click on each person’s name to learn more!

 

Key Resources

These are key resources for those who want to get up to speed on the issues and experts on this topic in approximately an hour.

Physician Reluctance to Seek Care for Mental Health Conditions (October 2017)- 10 min video

“Dr. Liselotte Dyrbye, a Professor of Medicine and Medical Education at Mayo Clinic in Rochester, MN, shares results of her study appearing in the October 2017 issue of Mayo Clinic Proceedings, which examined the association between medical licensing application questions and physicians’ reluctance to seek care for mental health issues. The authors note physicians were more likely to be reluctant to seek care for mental health concerns if they worked in a state where initial/renewal medical license application questions asked about diagnosis or treatment for a mental health condition rather than only asking about current impairment from a mental health condition. Available at: http://tinyurl.com/y98onsjx.”

Unspoken: Doctor Depression and Suicide (August 2018)- 18 min video

“Researchers estimate hundreds of physicians die by suicide every year in the U.S., but exact numbers are hard to come by. Newsy takes an in-depth look at the challenges doctors face to get mental health treatment.”

Medical Licensure Questions about Mental Illness and Compliance with the American with Disabilities Act (December 2018)- Article

“This article first reviews the prevalence of psychiatric illness among medical students and physicians. It then turns to the stigma faced by those so afflicted. Next, it reviews the legal precedents regarding the validity of licensure questions about these concerns with a focus on the seminal 2014 Louisiana Supreme Court Settlement Agreement. This review is followed by a detailed presentation of the questions currently asked by the medical licensure bodies in the 50 states and the District of Columbia and an evaluation of their validity under the ADA.”

Supplemental Resource: Report and Recommendations of the FSMB Workgroup on Physician Wellness and Burnout (July 2018)- Article

“At its Annual Meeting, held April 26–28, 2018, the FSMB House of Delegates adopted a new policy on physician wellness and burnout intended to provide guidance for state medical boards as they seek to address this issue among their licensees. The full text of the policy is being offered here as a supplemental resource for readers of this special edition of the Journal.”

AMWA Physicians in Crisis Toolkit

 

Infographics

Federation of State Medical Boards-Recommendations for Licensure Questions

Final_ FSMB recommendations for licensure questions

 

Medical Licensure Questions About Mental Illness and Compliance with the American with Disabilities Act

Medical licensure Questions about mental illness and compliance with the American with Disabilities act

 

Partners

 

Steering Committee

 

AMWA advocated for and helped support the passage of the Dr. Lorna Breen Health Care Provider Protection Act (S. 4349 and HR 8094). The Act had bi-partisan support in both the House and Senate and was endorsed across the health care industry. It was signed into law by President Biden on March 18, 2022.

The Dr. Lorna Breen Health Care Provider Protection Act ” aims to reduce and prevent suicide, burnout, and mental and behavioral health conditions among health care professionals. Health care professionals have long experienced high levels of stress and burnout, and COVID-19 has only exacerbated the problem. While helping their patients fight for their lives, many health care professionals are coping with their own trauma of losing patients and colleagues and fear for their own health and safety. This bill helps promote mental and behavioral health among those working on the frontlines of the pandemic. It also supports suicide and burnout prevention training in health professional training programs and increases awareness and education about suicide and mental health concerns among health care professionals.”  — Dr. Lorna Breen Foundation