We are over 25 years apart in our careers. One of us began her medical career in a time before the internet and email. The other is a digital native. Remarkably, though, our experiences have been very similar in one respect. We have spoken with colleagues who decided to avoid seeking care for their mental health concerns. Why? Due to fears that this type of medical care might adversely impact their careers.
In 1998, I (RK) spoke with a physician colleague who had developed clinical depression and refused to seek treatment. “I can’t take the risk; what if they won’t allow me to be a doctor anymore?”
In 2022, I (AT) had a long conversation with one of my premed colleagues who struggled with social anxiety. “I know I need treatment, but I don’t want to risk medical schools finding out and rejecting me.”
Why are we still having these same conversations when medicine has advanced so significantly in the last quarter century? And especially when the house of medicine is in agreement on certain core principles:
- Doctors should be allowed to seek medical care.
- Doctors should be encouraged to seek medical care.
- Doctors should be able to access the same high-quality care they provide.
Why are doctors still hesitant to seek medical care for their mental health? One major reason is regulation. Unfortunately, doctors in many states encounter systemic barriers to care in the form of licensure questions.
The types of questions asked during the licensing process have been shown to vary significantly across different states. For example, many states ask questions that stigmatize current (or even previous mental health treatment) when it has no impact on the physician’s ability to provide high-quality care. Although some states have made progress in removing these questions, others have not made any progress.
Take these credentialing questions from two different states.
Massachusetts: “Do you have a medical or physical condition that currently impairs your ability to practice medicine?”
Alaska: 25 mental health questions are asked, including “Have you ever been diagnosed with, treated for, or do you currently have” followed by a list of 14 mental health conditions, including depression, seasonal affective disorder, and “any condition requiring chronic medical or behavioral treatment.”
There are real consequences in states where invasive and stigmatizing mental health questions are still used. Physicians experiencing mental health problems report being reluctant to seek treatment to avoid disclosure. Surveys have found that 39 percent of physicians report being afraid, or knowing other physicians who are afraid, to seek mental health treatment owing to the questions on licensure applications. The Physician Burnout and Depression Report from Medscape reports that 43 percent of responding physicians reported that they would not seek help for emotional distress to “avoid disclosure to medical boards.” Another survey found that 50 percent of reporting physicians reported experiencing symptoms of burnout and were reluctant to seek mental health care if they had to report it on applications for licensure renewal.
In its efforts to remove barriers to physicians receiving medical care, the Dr. Lorna Breen Foundation has focused on state-by-state efforts to remove such damaging questions. They and others have done a remarkable job of effecting change in just a few years. According to their website, 19 out of the 50 states in America have adopted less stigmatizing approaches to mental health. These recommended approaches include:
- Removing questions that ask about mental health diagnoses (Some states have incorporated this recommendation by asking about impairment as opposed to diagnosis)
- Combining physical and mental health into one question
- Using more supportive language about mental health
Furthering these efforts is important and urgent. It has been well-established that burnout, depression, and anxiety have a high prevalence in the medical profession–especially following the pandemic. Tragically, an estimated 300 to 400 physicians die by suicide every year, while many more continue to suffer from treatable conditions.
Although the statistics are alarming, relatively minor changes to the licensure process can make a major difference in terms of physicians feeling comfortable seeking medical care. We can all contribute by contacting our legislators, especially if you live in Alaska or any of the other 31 states that use invasive and stigmatizing language about mental health.
Beyond advocating for regulatory changes, we can continue educating our pre-medical students, medical students, residents, and physician colleagues about current state law and licensing requirements. We can also encourage our colleagues to seek treatment when needed, providing information on organizations that provide confidential medical care. With so much progress in medical therapies over the last quarter-century, we look forward to the time when the providers of care can–finally–fully avail themselves of these advances without fear of stigma or undue consequences.
Alexandra Townsley is an incoming medical student. Rajani Katta is a dermatologist and author of Conquer the Medical School Interview and The Successful Match.
