This concludes 鶹ý's investigation of the extent to which state medical boards probe into physicians' past and current mental health. some physicians previously treated for psychiatric conditions faced in renewing their licenses; part two examined legal issues raised by state boards' policies. In this final segment, we asked board officials for their side.
The initial physician licensure application for Texas includes the following question:
"Within the past 5 years, have you been diagnosed with or treated for any: psychotic disorder, delusional disorder, mood disorder, major depression, personality disorder or any other mental condition which impaired or does impair your behavior, judgment or ability to function in school or work."
Texas's medical license procedure complies with recommendations by the Federation of State Medical Boards (FSMB) and other stakeholders to focus on impairment rather than disease. However, its 5-year window clashes with the idea of targeting only current problems.
"There's a reason why the questions are asked," Jared Schneider, communication's officer for the Texas Medical Board, told 鶹ý over the phone. "We want to make sure that people are competent, that physicians are safe to practice and treat patients in Texas."
Asked whether Texas was considering any changes to its licensure applications, Schneider said both the initial application and renewal forms had "undergone a very lengthy stakeholder process to arrive at" its current form roughly a decade ago.
"There's no changes that are forthcoming," he said.
As for concerns about the privacy of physician health information, Schneider stressed that neither the completed initial application form or medical license renewal form, nor any of the other personal information that might be requested by the board, "none of that is disclosable to the public."
In a follow-up email, Schneider noted that just asking for an additional information from physicians about a condition or treatment they received doesn't mean they will be the subject of an investigation.
"Physicians can seek mental health treatment without having to report, but if they believe that their condition may affect their ability to competently practice, they would need to report this information to the Board. The Board then reviews these on a case-by-case basis," Schneider wrote.
Questions asked by the Minnesota Board of Medical Practice on its share similarities with those asked in Texas.
For example: "Have you within the past 5 years been advised by your treating physician that you have a mental, physical, or emotional condition, which, if untreated, would be likely to impair your ability to practice medicine with reasonable skill and safety?"
However, Minnesota does not name specific diagnoses, does not single out mental health, and asks specifically whether an individual is receiving treatment for whatever condition he or she referenced "so that such impairment is avoided."
The in Alaska, however, includes some questions that would undoubtedly be seen as "probing" or overly expansive.
One question asks, "Have you ever been diagnosed with, treated for, or do you currently have" followed by a list of 14 different conditions and condition categories with check boxes. The boxes include bipolar disorder, schizophrenia, depression, seasonal affective disorder, "any dissociative disorder," "any psychotic disorder," and "any condition requiring chronic medical or behavioral treatment."
"You don't write a question like that unless you believe there's something very wrong with having a mental impairment," argued Jo Anne Simon, JD, a disability rights attorney and New York State Assembly member.
"If they're worried about protecting the public, they're doing more damage to the effort ... by furthering stigma," she added. Since, such questions will undoubtedly discourage physicians from seeking help.
Debora Stovern, the executive director for the Alaska State Medical Board, told 鶹ý in an email that the board is aware of the FSMB's recent recommendations, but is not currently proposing any changes to the application questions.
She also noted that "a 'yes' response on an application question regarding mental health, addiction, or substance abuse does not mean the application will be denied.
After careful evaluation, the board "may require additional assessment, may grant an unrestricted license, may grant a conditioned or probationary license, or may deny a license," she wrote.
While licensing files are deemed public records, Stovern added that "these matters may be required to be kept confidential by state or federal law."
"I think the FSMB is on the right track," said Liselotte Dyrbye, MD, MHPE, co-director of the in Rochester, Minnesota.
Arthur Hengerer, MD, director and past chair of the FSMB board of directors, confirmed that the FSMB is now talking to state boards individually about their licensure forms.
While there is "good momentum" to create meaningful change, the language used by state medical boards in their forms is only one fight in a broader front, Dyrbye noted. "Even if the state medical board fixes their licensure applications, [physicians] still have to deal with the questions when they try to get malpractice insurance, disability insurance, and hospital privileges," she said.
For this reason, Pamela Wible, MD, a family physician and author of , advocated "uniformity" and for questionnaires to comply with federal laws such as the ADA.
She and Dyrbye told 鶹ý that all questions about mental health should be removed entirely. But if the question needs to be asked, said Wible, "Ask it in seven words or less, the same way on every form: 'Are you currently impaired?'"