Can you absolutely and unequivocally answer “no” to all of the following questions:

Has your license to practice in any jurisdiction ever been limited, restricted, reduced, suspended, voluntarily surrendered, revoked, denied, or not renewed?

Have you ever been reprimanded by a state licensing agency, or are any of these actions pending with respect to your license; are you under investigation by any licensing or regulatory agency?

Has your professional employment or membership in a professional organization ever been subject to disciplinary proceedings, denied, limited, restricted, reduced, suspended, revoked, not renewed, or voluntarily relinquished during or under threat of termination for any reason?

Has your Drug Enforcement Agency registration or other controlled substance authorization ever been limited, restricted, reduced, suspended, revoked, denied, or not renewed, or have you voluntarily surrendered or limited your registration during or under threat of investigation or are any such actions pending?

Have you ever been sanctioned or suspended by Medicare or Medicaid?

Have you ever been reported to the National Practitioner Data Bank?

Have you ever been convicted of a felony or misdemeanor, or are you under investigation with respect to such conduct?

Has a professional liability claim ever been assessed against you, or are there any professional liability cases pending against you?

Has any liability insurance carrier canceled, refused coverage, or rated up because of unusual risk, or have any procedures been excluded from your coverage?

Do you currently have, or have you ever been treated for, any medical, chemical dependency, or psychiatric conditions that might adversely affect your ability to practice medicine or surgery or perform the essential function of your position?

Have your hospital or clinic privileges ever been limited, restricted, reduced, suspended, revoked, denied, or not renewed, or have you voluntarily surrendered or limited your privileges during or under the threat of an investigation, or are any such actions pending?
Have you voluntarily or involuntarily withdrawn or been suspended from any professional organization or society; or internship, residency, or fellowship training program?

Has there been any incident(s) in which you have involuntarily or voluntarily withdrawn your application for appointment, clinical privileges, or reappointment before a decision was made by a professional organization or society; or hospital or health care facility’s governing board?

If you can truthfully answer “no” to all these questions, then you are probably in the minority, according to physician advocate, advisor, and author Pamela Wible, MD. She says doctors are trained to “lie to avoid punishment and to preserve their job, identity, ego, status, and money.”

It seems that various organizations want carte blanche to review our curriculum vitae. They want to probe our background like we’re an open book. Mandatory professional disclosures haunt us throughout our careers. They appear on applications of all sorts for medical licenses, membership in professional organizations and societies, and privileges in hospitals and clinics.

It’s okay and perhaps necessary in some instances for entities to have access to our professional lives, but our entire career? The open-ended nature of these questions really irks me. “Have you ever …?” Yes, once I farted so hard against the hardwood floor in gym class that the sound resonated throughout the gymnasium. My astonished gym teacher took it in stride as the class erupted into laughter. Why can’t licensing and professional bodies cut us some slack like my gym teacher?

Sometimes I wonder whether regulatory authorities are out to get us. Many physicians face enormous challenges when seeking to renew their medical licenses or obtain a new license when they relocate. In fact, in 2021, the Federation of State Medical Boards (FSMB) reported that over 7,000 actions were taken against physicians, and approximately half (3.402) were serious enough to warrant discipline: reprimands, fines, probation, CME requirements, licenses surrendered or revoked, and other conditions that were imposed.

That number may not seem high given over 1 million licensed physicians in the U.S. What is concerning, however, is the following statement from the FSMB on their website: “In an age of rapidly developing technology, state medical boards have improved recognition capabilities to know when and how to appropriately discipline physicians …” Uh, oh. Better watch your back, Jack.

And then, there is a follow-up statement about the “tremendous variance in statutory, funding, judicial, administrative and geographic environments from state to state.” In other words, it’s a free-for-all when it comes to punishing doctors, with each state conducting business and meting out discipline as it sees fit. A recent study, for example, found considerable variation between states in the questions they asked about mental health on initial applications for licensure.

Probing a physician’s mental health is by far the most damaging of all questions. Dr. Lorna Breen was a New York City emergency physician who died by suicide during the COVID-19 pandemic. Her family believes her suicide was directly attributable to her fear of reporting to authorities the mental health treatment she had received and that sanctions would be levied against her license and practice. Fear of disclosure about treatment for mental illness and substance use disorders and how that might affect licensure is a pervasive impediment to seeking psychiatric treatment.

The American Society of Anesthesiologists proposes to distill all questions asked by medical licensure bodies, accrediting organizations, and medical specialty boards that are related to mental and physical health on applications to one question: “Do you have a medical condition that currently impairs your ability to practice medicine?”

This approach provides physicians leeway in three ways. First, it asks about current impairment and eliminates disclosing past history.

Second, the answer does not require an automatic “yes” simply for seeking or accepting mental health treatment. One can answer “no” as long as there is no incapacity to function in a competent, ethical, and professional manner, which is in line with the FSMB recommendation to state medical boards to appropriately differentiate between the illness with which a physician has been diagnosed and the impairments that may result.

Third – and this is a real slippery slope – the doctor could rationalize that mental health treatment is not the equivalent of medical treatment and answer “no” on that basis, but I don’t recommend dancing on the head of that pin. The FSMB clearly states: “[T]here is no distinction between impairment that might result from physical and mental illness that would be meaningful in the context of the provision of safe treatment to patients.”

However, sometimes creative thinking is needed. Dr. Wible considers herself honest, but she admits to succumbing to 8 of 10 lies she discusses in her op-ed – not only about applications but about work habits, relationships, and self-confidence. Of course, falsification or misrepresentation of any item or response on licensing and credentialing applications is a sufficient basis for denying a license or other privileges.

But physicians don’t need punishment; they need licensing officials to back off until their recovery is attained. Most unwell physicians recover, perhaps, except for some sexual predators. In reality, there is little research on the effectiveness of disciplinary penalties for preventing reoffending, regardless of the nature of the initial infraction.

My eyes start to glaze every time I’m bombarded by questions on licensing and credentialing applications. I don’t know about you, but when it comes to answering all those questions, I plead the fifth.

Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. His forthcoming book is titled Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.