Physicians seeking licensure or renewal of licensure in Arkansas will no longer have to answer questions about past psychiatric treatment or any medical treatment, including psychiatric, that was not ordered by a professional credentialing body.

A concerted effort by physician leaders in the state led to the removal of language in the licensure application that may have been responsible for preventing physicians from seeking mental health or substance abuse treatment, according to psychiatrist G. Richard Smith, M.D.

"We accomplished two things," Smith told Psychiatric News. "We equalized the language in the application so that mental health conditions are not specifically singled out. And we raised the bar for what is considered a reportable condition by making it so that treatment had to be ordered by a credentialing or professional standards board.

"If a surgeon is required by the quality committee at a hospital to seek treatment for a neurological disorder because of errors in surgery, that's reportable," Smith explained. "But if the surgeon seeks treatment on his own, it's not."

The same is true when a physician seeks treatment for a psychiatric condition, including substance abuse, Smith said.

He is the Marie Wilson Howells Professor and chair of the Department of Psychiatry and Behavioral Science at the University of Arkansas for Medical Sciences and chief of staff at University Medical Center.

The language in the original question from the "Application for Medical Licensure in Arkansas and Centralized Credentials Verification Service" read as follows: "Have you been, or are you presently, being treated for a mental health condition? If yes, was this voluntary or the result of a medical board action? Explain."

That question was revised to read: "Have you ever been advised or required by any licensing, credentialing, or privileging body to seek treatment for a physical or mental health condition? If yes, please explain."

Similarly, the question from the application for licensure renewal read as follows: "Since your last attestation, have you ever been or are you presently being treated for a mental health condition? If yes, was this voluntary or the result of a Medical Board action?"

That question has been revised to read: "Since your last attestation, have you been advised or required by the Arkansas State Medical Board or any other licensing or privileging body to seek treatment for a physical or mental health condition?"

Smith said that getting the language changed was no small feat: it required several years and the coordinated efforts of the University Medical Center, Arkansas Psychiatric Society, the Arkansas Medical Society. The changes became effective this month.

It appears that Arkansas is not the only state whose medical board requires some form of reporting about treatment for psychiatric and substance abuse conditions. Unpublished research on the matter provided to Psychiatric News by Smith's office shows a range of approaches used by state medical boards within the past five years in asking about past treatment. Of 45 state applications available online for review, 18 were focused on current impairment, and most of these considered physical and mental conditions similarly. However, some boards specified different criteria for mental and physical conditions; one board asked if the applicant had ever been diagnosed or treated for a psychiatric condition.

Eleven of the boards surveyed also asked questions about a history of diagnosis or treatment for a mental or emotional condition. Often these were specified as major mental disorders such as psychotic disorders. However, a few did not specify which conditions the state considered relevant to medical practice.

Another common approach related to whether there had been impairment within a specific period of time, usually the last five years. Seven boards used this approach, and six asked whether there had been a diagnosis of a major mental disorder within a specific period, usually five years, according to the research.

Smith told Psychiatric News that two suicides by physicians, including one by a prominent cardiovascular surgeon, prompted an investigation at the University Medical Center into barriers to seeking treatment for depression and other mental disorders, including substance abuse. A series of focus groups with physicians at the medical center revealed that the language in the state's licensure and relicensure applications was a significant deterrent to seeking care.

"What we found over three or four years is that the reporting language in the application would serve as a trigger to all hospitals and managed care organizations in the state," Smith said. "They would get a report [from the state medical board indicating a physician had sought psychiatric treatment] and would send a follow-up questionnaire and notice to the physician requiring a note from the treating psychiatrist that it was not a problem for the doctor seeking treatment to practice medicine.

"The doctors were faced with a situation of either lying and thereby incurring a risk for a felony or facing bureaucratic red tape and the potential exposure of their privacy," Smith said. "The other alternative was just to not seek treatment."

A 2003 consensus statement of physicians convened by the American Foundation for Suicide Prevention found that a medical licensing application that sought information about psychiatric treatment could be a significant barrier to physicians' seeking treatment. Among the group's recommendations was one that called for ensuring that "licensure regulations, policies, and practices are nondiscriminatory and require disclosure of misconduct, malpractice, or impaired professional abilities rather than a diagnosis (mental or physical)."

That statement appeared in the June 18, 2003, Journal of the American Medical Association. ▪