The AMA will seek model language for state medical licensure applications that will eliminate discriminatory questions about past mental illness.
A resolution written by the Section Council on Psychiatry requests that the AMA work with the Federation of State Medical Boards and other appropriate stakeholders to develop model language for medical licensure applications that is nondiscriminatory and “does not create barriers to appropriate diagnosis and treatment of psychiatric disorders.”
It was approved with wide support.
“Depression and other psychiatric disorders are as common in physicians as they are in the general population,” psychiatry section council member Jerry Halverson, M.D., testified during reference committee hearings. “There is very good evidence that even the history of psychiatric treatment, not only current psychiatric disability, does lead to more difficulty obtaining licensure in what could only be called a discriminatory practice. The history of a psychiatric disorder does not make you an incompetent physician, but there are states that follow that logic. Our AMA has a policy against such discriminatory questions, yet they are still widely used.”
Fellow section council member Ken Certa, M.D., who is director of student mental health services at Thomas Jefferson University School of Medicine, said fear of such questions on licensure applications definitely has an effect on medical students seeking treatment.
“There is nothing that impairs students more in accessing mental health care than this issue of the licensure application,” he said. “It is absolutely discriminatory. Students worrying about this have led to really horrible outcomes—people leave the profession or much worse. Previous illness really doesn't matter. The only thing that should matter in licensure is current illness.”
In other action of interest to psychiatry, the House of Delegates approved a Council on Science and Public Health (CSPH) report addressing underreporting of child abuse by physicians.
The council's review found that nearly 3 million cases of suspected child abuse are reported to child protective services annually. Although physicians are required to report suspected cases of child abuse, several retrospective studies indicate that physicians do not report all suspected cases of child abuse.
“Physicians are more likely to report a case if they perceive the injuries to be inconsistent with the medical history and if the patient was referred for suspected abuse,” according to the report. “Variables influencing the decision to report include injury type, severity, and apparent family risk factors. Several explanations have been advanced for physicians not reporting suspected abuse, including lack of training and clinical experience and gaps that exist in medical school curricula and residency training. Other barriers to reporting include uncertainty surrounding HIPAA requirements, lack of clinical support services, and poor communication and collaboration among professionals who evaluate, investigate, and adjudicate child maltreatment.”
CSPH and psychiatry section council member Louis Kraus, M.D., who wrote much of the CSPH report, testified in reference committee hearings. “We have 3 million reported cases of child abuse, with very real morbidity and mortality, yet many physicians do not report suspected child abuse,” he said. “The issue is not whether or not they suspect abuse, but that they suspect it and choose not to report it for a variety of reasons.”
The report calls on AMA to do the following:
These notable actions were also taken by the House of Delegatges at last month's meeting:
The CSPH report on physician reporting on child abuse and all resolutions can be accessed at <www.ama-assn.org/ama/pub/meeting/i09-reports-resolutions/business-hod.shtml>.