AMA to State Medical Boards: Don’t Ask About Past Mental Illness
Abstract
The new policy, put forward by the AMA Section Council on Psychiatry, could encourage more medical students and residents to seek treatment if state medical boards follow through.
The AMA wants state medical boards to refrain from asking applicants for licensure about a history of mental illness and substance abuse treatment and to focus only on current impairment by mental illness or addiction.
The policy, approved unanimously by AMA’s House of Delegates during its Interim Meeting last month in Orlando, Fla., was put forward by the AMA Section Council on Psychiatry as an amendment to an AMA Council on Medical Education report, “Access to Confidential Health Services for Medical Students and Physicians.”
Kenneth Certa, M.D., a member of the APA Section Council on Psychiatry and director of psychiatry residency training at Thomas Jefferson University Hospital in Philadelphia, said that the policy, if heeded by state medical boards, should have a positive impact on the willingness of trainees and medical students to seek mental health and substance abuse treatment.
Fear of disclosure about treatment for mental illness and substance use disorders and how that might affect licensure is a pervasive impediment to seeking treatment when students and residents need it, Certa told Psychiatric News.
“I encounter this all the time as a psychiatry residency director at a medical school,” he said. “While I was at the meeting in Orlando, I received a call from a colleague at another training program who had a trainee who wanted to be treated but would agree to treatment only if he could remain anonymous. I regularly get calls like that from students, residents, or even practicing physicians who have had mental health treatment and are worried about how it will affect their licensure status.
“Medical students and residents are a driven group, concerned about their future regarding matching into a program and obtaining licensure, and they want no red flags that might be an impediment,” Certa said.
The original report by the Council on Medical Education did not address licensure application questions, but did urge state medical boards to accept “safe haven” nonreporting for physicians seeking licensure or relicensure who are undergoing treatment for mental health issues. (The latter refers to physicians in state physician health plans for impaired physicians.)
Treatment Needs to Be Accessible to Trainees, Says AMA
The AMA Council on Medical Education report titled “Access to Confidential Health Services for Medical Students and Physicians” calls on the AMA to work with the Liaison Committee on Medical Education and relevant accreditation councils to encourage medical schools and residency/fellowship programs to “provide or facilitate the immediate availability of urgent and emergent access to low-cost, confidential health care, including mental health and substance use disorder counseling services, that include appropriate follow-up, are outside the trainees’ grading and evaluation pathways, and are available in reasonable proximity to the education/training site.”
The report also encourages medical schools to create mental health and substance use awareness and suicide prevention screening programs that would be available to all medical students on an opt-out basis; ensure anonymity, confidentiality, and protection from administrative action; and provide proactive intervention for at-risk students.
Certa said that while the report recommended various ways to address access to care (see box at top right), it “did not go far enough to address this particular impediment” of licensure application questions. APA’s delegation was able to persuade the House of Delegates that “any effort to allow medical students and residents better access to mental health care would not be productive unless state medical boards refrain from asking about past treatment,” Certa told Psychiatric News.
During testimony on the floor of the House of Delegates, Certa presented APA’s Position Statement on Inquiries About Diagnosis and Treatment of Mental Disorders in Connection With Professional Credentialing and Licensing, which is strongly worded to discourage state boards from requiring applicants to disclose a history of illness.
At least one delegate who is a member of a state medical board objected to the amendment, saying that boards are concerned about having access to an applicant’s history of treatment as a matter of public safety. That testimony was countered, however, by several young physicians who testified to their own experience with mental illness and with treatment, including a resident from New York who recounted how he was extremely depressed and had contemplated “doing something bad” before he sought treatment.
(The council report was prompted, in part, by the deaths of two New York City residents by suicide in 2014.)
Certa said that the next step is for state medical boards to adopt the policy. “It’s not a done deal,” he said. “Every board guards its authority to safeguard medicine in its state. One part of the way forward is for the Federation of State Medical Boards [FSMB] to address the problem and perhaps develop model application language for state boards.”
In response to a request from Psychiatric News for comment about the AMA policy, Lisa Robin, FSMB’s chief advocacy officer, told Psychiatric News: “The primary duty of state medical boards is to protect the public. In order to ensure that only individuals who are fully qualified to practice medicine are granted licenses, boards must have sufficient information with which to make licensure decisions.”
Robin added, “In an effort to raise awareness and promote physician well-being, the FSMB formed the Workgroup on Physician Wellness and Burnout. The group has begun engaging in a multi-part work program that will help educate state medical boards on how to identify burnout and to raise awareness in order to reduce stigma associated with seeking help. It is our hope that the findings of our work group will help further the progress being made to support physician health and increase patient safety.”
The wording about past treatment on licensure applications varies from state to state. Moreover, the language in some state applications can be difficult to interpret; for instance, a board may ask an applicant if he or she currently has “any mental illness or any physical illness or condition that might interfere with [the] ability to competently and safely perform the essential functions of practice?”
If the applicant has bipolar disorder or chronic depression that is well managed and the applicant is currently healthy, he or she may answer “no.” But if, in the case of a malpractice action, the applicant is shown to be taking medication, the applicant could be accused of lying on the application and lose his/her medical license (as well as the liability case), since the chronic disorder could be construed as interfering with the clinician’s ability.
“Psychiatrists should monitor their state boards and work with their state medical societies to apply pressure if they find that licensure applications contain language requiring disclosure of past treatment,” Certa said. “And we have to get the message to our trainees that they do not need to worry about licensure as they consider treatment.” ■
The AMA Council on Medical Education Report titled “Access to Confidential Health Ser-vices for Medical Students and Physicians” and other reports and resolutions from the AMA House of Delegates meeting are posted here. APA’s Position Statement on Inquiries About Diagnosis and Treatment of Mental Disorders in Connection With Professional Credentialing and Licensing can be accessed here.
