She whispered when she said “panic attacks.”

Not because she thought I would judge her or fail to understand. But because she was a physician, and in her world, saying the wrong thing to the wrong person could cost her everything.

She found me through a colleague of a colleague. No insurance, no documentation trail, no diagnostic codes, no third-party systems. She paid in cash. She never used her full name.

“If I tell you who I really am,” she asked once, “can the board find out?”

She wasn’t being dramatic. She was being careful.

Because in many states, a history of therapy, even therapy for stress, can raise red flags on licensing or credentialing applications. Not just for those in crisis. Even those seeking preventive care are told, think twice before you tell anyone you’re not OK.

She didn’t come to me because I’m well-known.

She came because I don’t have to report her.

She is not alone. In fact, her fear is common enough that it has shaped an entire underground model of care.

Her story is not rare. And it doesn’t start in adulthood. It starts in medical training.

Where the fear comes from

For years, nearly every state medical board included some version of the same question:

“Have you ever been diagnosed with, treated for, or sought counseling for a mental-health condition that could impair your ability to practice?”

Thanks in large part to advocacy by the Lorna Breen Heroes Foundation, that is beginning to change. As of February 2025, more than 500 hospitals and several insurers have verified that their credentialing forms no longer include intrusive mental health questions, protecting access to care for over 200,000 clinicians.

That is meaningful progress. But the physicians I work with rarely know which forms have changed. What they remember is the warning they received early in their careers: If you admit you’re struggling, someone may decide you’re not safe to practice. That kind of fear doesn’t vanish just because the form does.

Those words still land like a trapdoor.

Physicians know that answering “yes” can trigger intrusive follow-up, mandated monitoring, or a license delay that derails a career. Saying “no” feels safer. And so the sleepless nights, the chest-tightening panic on morning rounds, the grief after the last code blue all stay underground.

The implicit lesson is clear:

Get help if you must, but be sure no one can trace it back to you.

For many clinicians, that lesson begins in training, where admitting struggle is still coded as weakness and where a single evaluative comment can shadow an entire career. By the time they reach my office, secrecy is muscle memory.

Practicing off the grid

Because of that secrecy, a parallel system of care has formed in the shadows.

• Cash sessions at odd hours so calendars stay blank.
• Untraceable phone numbers and encrypted email.
• Progress notes locked in a drawer or, when clinically appropriate, kept only in my head.

What I offer is still evidence-based, bound by licensure, and accountable to my ethical code. But it is also intentionally quiet. It is built around the reality that full transparency, for some, still feels dangerous. Not because they’re hiding something harmful, but because they’re trying to survive in a system that punishes vulnerability.

I do good work here. We talk about childhood trauma, moral injury, the weight of holding sixteen simultaneous deaths from the COVID surge of 2021. We practice grounding skills for the flashbacks that come when the rapid-response pager chirps. We plan for conversations with spouses who hear the sobbing in the shower but still don’t know why.

My clients get better. They sleep again. They parent again. They remember why they loved medicine in the first place. Yet each breakthrough carries a bitter edge.

They are healing in hiding because the system that licensed them to heal does not grant them the same grace.

The ethical bind

Some nights I wonder if I am part of the solution or part of the cover-up.

When I protect a physician’s secret, I preserve their livelihood. But do I also reinforce a board policy that punishes honesty?

When I accept cash only, I preserve their privacy. But I shut out clinicians who cannot afford to pay.

When I withhold a diagnosis code, I spare them scrutiny. But I erase data that could prove how common their suffering really is.

I am an ethicist by training. Yet nothing in my textbooks prepared me for this quiet calculus. We are taught that sunlight is the best disinfectant. That transparency is the moral high ground. But what happens when transparency is weaponized against the very people who keep the health care system standing?

A system that prefers silence

Medical boards say their duty is to protect patients from impaired clinicians. That goal is noble. The reality is messier.

The Federation of State Medical Boards has encouraged licensing boards to ask only about current impairment, not mental health history. But the stigma remains. In a 2023 AMA survey, 79 percent of physicians said there is stigma around seeking mental health care. That kind of fear doesn’t vanish just because the form does.

The imbalance is striking:

• A physician may perform surgery after a sleepless thirty-hour shift and face no licensing inquiry.
• The same physician might attend three therapy sessions for panic attacks and worry that one checkbox could end their career.

In practice, we reward stoicism, not safety.

What trust could look like

The physician who first whispered “panic attacks” still sees me every month. She now laughs easily, sets firmer boundaries with call schedules, and mentors residents on emotional resilience. She uses her full name on my intake form. It stays in my locked file, but she no longer trembles when she signs it.

I asked her recently what real change would look like.

“I shouldn’t need a secret therapist,” she said.
“I should be able to say I’m human and still be trusted to practice medicine.”

Trust like that would not weaken patient safety. It would strengthen it. A clinician who is cared for openly and without fear takes better care of everyone else.

A door we can choose to open

Familiar phrases like “physician resilience” and “burnout prevention” are not the problem. What matters is how we respond when we learn that our well-meant policies drive good doctors into hiding. If changing a few checkboxes, rewriting a few board questions, or offering real privacy protections helps clinicians speak freely, that small shift can open something bigger: honesty, healing, and a health care workforce that no longer has to recover in the dark.

The medical board still does not know I exist. That was the point.

But when clinicians can walk through the front door of a therapist’s office without fear, I will be there too. Visible, trusted, and no longer necessary.

Jenny Shields is a licensed clinical psychologist and nationally certified health care ethics consultant specializing in clinician burnout, moral distress, ethical trauma, and complex psychological assessments. Based in The Woodlands, Texas, she leads a private practice—Shields Psychology & Consulting, PLLC, where she offers confidential counseling, consultation, and education for physicians, nurses, therapists, and health care leaders nationwide. Dr. Shields is committed to shifting the conversation in health care from individual resilience to system-level ethical reform. She is affiliated with Oklahoma State University and regularly contributes insights through public speaking and writing, including features on Medium. Her professional presence extends to platforms like LinkedIn, Google Scholar, ResearchGate, the APA Psychologist Locator, and the National Register of Health Service Psychologists.