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
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
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
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
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.
Courtesy of G. Richard Smith, M.D.
G. Richard Smith, M.D.: Physicians who seek treatment on their own do
not have to report it.
"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. ▪