Specific questions:
1.) Do you have to submit your medical records / interview with the licensing board?
2.) Did anyone get denied / placed on probation merely because they were bipolar?
3.) Has anyone successfully gotten licensed as a bipolar physician without lying about their condition?
3b) Has anyone lied and what do you think about this option?
4.) Has anyone had the information they submitted to the board leaked to an employer? Has anyone gotten fired for being bipolar?
5.) How often does the board require that you check in with them about your status? Do you have to keep submitting your medical records? IS THIS FOR LIFE?
You should never lie on a med board licensing app, that basically goes without saying
However, I will point out that depending on what the phrasing is, you may not have to disclose
"Have you, or have you ever had, a mental illness that has impacted your ability to practice medicine?"
They may ask if you've been hospitalized for mental health.
The answer to that could be truthfully no, in which case no cat is out of bag.
(In fact, I would argue even if it had impacted you in college, I would still say no, because that has not impacted your ability to practice medicine
Also, if you had no clinical responsibilities that were affected in the first two years of med school, but say you took time off because of mental illness, you could still truthfully answer no. If that forced you to miss out on clinical precepting time, eh, a little harder to say no IMHO)
Plenty of apps that I looked at could be answered in such as way as to be 100% honest and not disclose a history of / current treatment of a mental illness
Some apps are more invasive and that would not be possible
Based on what you've told us here, I don't see any reason for you to worry about this affecting your career in any way. And depending on the state and institution's questions on apps you may never have to disclose, or you check a few boxes and nothing more happens.
I would advise anyone particularly worried to run their paperwork by an attorney that is familiar with board issues particularly, or else ADA law, or employment law if you cannot find the former who can help, to be sure that you are maximizing your right to privacy without running afoul of any law or entity, the reason is because if you can not disclose without breaking any rules that is ideal
I don't see why anyone would be denied or put on probation just for being bipolar.
I also don't know that submitting your medical records would be a standard thing either.... in fact, I know in some instances you just fill out the paperwork and that's it, and in others just having your psychiatrist attest to you being fit for duty, or being assessed by a psychiatrist selected by the board, can suffice.
Now, if you get into the situation where it has affected your work, and you have to answer yes to some of the questions on board/privileges apps, I can tell you a giant and potentially career-ending **** storm can erupt for sure.
You can be forced to submit all your records, in fact, they can be subpoenaed along with your personnel records. They can interview your coworkers. You can be forced to see a board selected psychiatrist, who can essentially mandate whatever they want you to do. They can put you with a Physician Monitoring Program. It doesn't take much even for them to go down this path. They can force you to take regular piss tests to prove you're taking the meds the psychiatrist has prescribed for you (even with a perfect history of compliance). How long do you have to do that after a hiccup? I don't know. I have heard of bipolar physicians referred to a PHP doing all that for 1-2 years and then being released. I've also heard of the involvement being for as long as they were licensed. How draconian a medical board is will vary state by state and I imagine your individual circumstances.
All of the above will likely follow you around in one way or the other for the rest of your entire career, because the records the board has will then follow you to the next state you want to be licensed in as each board will contact prior boards for these.
I know of at least one story from an FM physician who claims he was essentially ousted for getting on the wrong side of the board politically and then having his bipolar disorder used against him unfairly to deny him a license, I believe it was California, I came upon his story in the comments section of an article by Dr. Pamela Wible. She is an advocate for mental health awareness and quality of life issues for physicians and I recommend reading her articles. From there you can find more info on Physician Monitoring Programs as well.
That said, there are plenty of bipolar physicians that practice with no hassle. There are plenty even that run into trouble at work and with the board and still practice with minimal heartache. You just want to do what you can to be one of the happy stories not one of the rare horror stories that do in fact happen.
Lastly I saw there was a questions as to why you don't have to disclose on job app but you do for credentialing.
The reason is ADA law provides that at the level of applying for a job, and a job offer being extended, you are not required to disclose disabilities. This is to prevent discrimination in the hiring process. Once a job offer has been made however, an employer can ask for information as it pertains to you performing your duties. Examples: vaccine titers, TB testing, a physical with occupational health. Typically those forms will ask if you have disabilities, what accommodations you need, at that point they can get into how much can you lift etc, how many stairs can you climb, etc.
I have never been what I would consider disruptive, even when untreated. I was asking where hospitals draw the line at defining "disruptive": if they are reasonable entities or if they target anyone who doesn't act like a robot all the time. I would tend to think the former based on interactions I've had with staff in the ER, but this talk that the administrator gave caused me to question how life in the rest of the hospital actually works. I know one hospital in my state that is transitioning towards a "big brother" atmosphere and would not be shocked if micromanaging employees behavioral quirks is on their list of things to do.
Absolutely there is some big brother micromanaging going on. Medicine is a very conservative and uptight field. Some ex-military docs say it's worse than the military.
These fears you have are totally normal. I remember M1 very clearly and the professionalism lectures. They want to put the fear of God into you and it sounds like they succeeded. Don't worry too, medicine is very critical and quick to find fault, if you step 1 inch over the line you'll be told before you even have the chance to get yourself into too much trouble.
That said, the hyperthymic personality is fairly common in medicine, and as far as hypomania, it depends what symptoms you're manifesting at work. Some will be a help, some might just be an annoyance, others terrible. Common sense does apply here. So far I get the impression you'll be fine.
Quoted shan 564: "As a psych resident, I've had patients say similar things to me ("who would want to [hire,marry,make friends with, etc] a person with bipolar disorder?"), and the answer is that people are a lot more understanding than you might think."
Eh, I find that it's usually people who don't have much experience with it, have experience with people well controlled, or are clinicians with a firm grasp of distinguishing bipolar vs borderline, tend to be more tolerant. As we all know uncontrolled bipolar, or even just manic state, can be totally destructive to relationships. People come back from their manic state to find their life in shambles all the time. You don't always get forgiveness or do-overs. It's tolerated as long as it isn't impacting other people.
My family and friends know and are supportive. The co-worker relationship is a different animal. We have a class where practicing physicians of all specialties come in and tell us how it really is. My class has been told that bipolar = difficult patient that lies all the time. When peers have no idea about your diagnosis and the topic is brought up in the form of a joke by a doctor/teacher, their true thoughts come out. You're right - I don't think everyone would judge me for it. I think most peers, especially the ones I don't know personally, would. So are the administrators, whose job it is to focus on medicine as a business, going to be more or less tolerant that physicians themselves?
The issue is that a lot of patients have bipolar as a diagnosis on their chart, when in reality they have borderline personality disorder, IMHO. (I say this my personal experience. I often question patients in detail when I see this, and when I'm told it was a diagnosis from someone other than a psychatrist, and I don't get a good history for a manic episode on questioning, and I mostly just illicit "I'm moody my mood changes all day I get really sad then really happy," which I get a lot, then I think it's BS. This inappropriate overdiagnosis is a personal peeve of mine so it's often something I address and catch) Whereas bipolar patients by definition are essentially normally in between mood episodes, personality disorders are much more pervasive by definition, and borderline patients often really are more difficult (splitting, idealizing/devaluing, unstable relationships, etc can all be challenges to the therapeutic alliance). Now couple this with the fact that a lot of "difficult" patients are then labeled in the chart as borderline (I've seen this inappropriately done as well often)
and what you get is a conflagration of terms.
moody = bipolar
moody = borderline
difficult patient = borderline or bipolar gets put in chart
bipolar = difficult by some law of transmutation of the above BS
is the logic I'm theorize at work here
There's another piece to this, which is controversial theory I'm sure, and you'd have to check out psycheducation.org to find the reference if you were inclined (I'm not at the moment), which has suggested that there may be some overlap seen in some patients between bipolar disorder and borderline personality, in that perhaps in response to the fluctuating mood espisodes some patients may have developed certain personality traits as coping mechanisms. For example, black or white thinking often present in depression, could perhaps become habitual in some people, or trying to account for seemingly baffling mood fluctuations splitting is seen, that sort of thing.
Anyway, I agree with Dr. Bagel that the presentation of difficult patient = bipolar/borderline is not the appropriate view we should be teaching, it really does exist in the medical culture, and I think understanding why could perhaps encourage clinicians to more appropriately use these labels.
In general, the above is why I do think that MS/residents/attendings should do all they can to hide being bipolar. In my experience there is still too much stigma. The field conflates bipolar/borderline/difficult too much, and even if the above is understood, then you may still have a colleague internally rolling their eyes at you thinking "sure, bipolar, you mean borderline, you mean crazy/difficult."
Check out this quote from Perrotfish, an attending on this board I have a lot of respect for
https://forums.studentdoctor.net/threads/dealing-with-a-malignant-program-director.1171165/
"Don't ever allow your PD to force you to see a counselor or psychiatrist (you can see one on your own if you'd like, but don't ever disclose it to her). Don't ever admit to any angry thoughts, mind altering substance use, or ethical misconduct. Don't give her a single solid reason to fire you."
Taken out of context but was about employment issues in residency and a malignant program director.
Thanks for the input. I feel much better about going through the process now that I know the chances of not getting licensed are limited as long as I maintain treatment. I will disclose repeatedly and trust the system to maintain confidentiality without discriminating.
Please, don't disclose repeatedly and trust the system. There is too much stigma, too many physicians who can tell you how much they regret their mental health struggles becoming known to anyone in their professional sphere. You need to be careful who knows and only disclose when necessary. There are times you want to make an employer aware ahead of time for ADA and accommodation reasons, and where that can later create a defense should it cause you workplace problems, but it is something to weigh carefully.
https://forums.studentdoctor.net/threads/resident-friend-joked-about-suicide.1116935/#post-16240366
Is one of my posts at the bottom on the topic of obtaining psych care while in training.
It is also crucial if you ever have to seek inpatient treatment for mental health to try to go outside the state you practice in, and to try to do so in a state you don't foresee wanting a license in the future. I was told this by a psychiatrist who specializes in treating fellow physicians and has dealt with the board on their behalf. This is because some states can only access those records if you were hospitalized in the state. Some of the apps asking about hospitalizations also can only ask if it was in-state. Also, given the movement to have multi-institutional EHRs, I think the further away geographically you are the better chance you have of the records remaining separate. These EHRs haven't gone very multi-state as of yet.
TLDR:
don't lie but try to keep your mental health struggles a secret
being bipolar usually isn't a big deal in your medical career
on the other hand it could totally **** you
just be smart about keeping it under control, seeking help, and confidentiality
I only became this worried after doing research on the topic and have no first hand knowledge of hospital policy. If this really isn't a big deal then fantastic.
