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I'm reaching out to physicians who are in treatment / have undergone treatment for bipolar then had to get licensed / relicensed. I cannot find anything in plain language about the licensing procedure for individuals with bipolar. I know that some states ask if you have ever been impaired by mental illness (not since a short period in undergrad) and other states inquire about specific diagnoses (bipolar is named.) I know the ADA has scolded boards for doing so, yet they still do it. I've read articles, been on every thread you can think of, even asked (anonymously) the councilor to look around and try to find out what the licensing process is and no one knows.

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?

The areas I am looking at are Georgia, Illinois, and Florida, but anyone with related experiences please post!

I am frustrated and angry. No one told me that by seeking help I tied both hands. I wouldn't be successful without meds and therapy, yet I might spend 200K then not get licensed?

A little about me. I am a female M1 with 5 years experience in the medical field.
Thank you in advance for your help.
 

michaelrack

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The reason no one can give you a simple answer is that there is a different licensing procedure/application for every state. Each state medical license application has a question about mental illness (some apps list specific diagnoses ever, some impairment within a certain time, etc). To answer ques #1: if you answer the mental illness question "yes", then usually you will have to submit records, etc.

3. yes
5. varies from board to board
 

gutonc

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3b. Lying about this has a chance of succeeding but a much higher chance of getting caught (at some point) and not only losing that license, but never being able to get another license in another state either.

Don't lie.
 
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shan564

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The risk associated with lying is significantly higher than the risk associated with telling the truth.

Plenty of physicians have no problem holding up their licenses despite suffering from a mental illness. Just follow the rules.
 

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I don't have personal experience with this, but I am interested in licensing issues and regularly read board reports, etc. My thought is that no one can say anything for sure, but I doubt a well-controlled mental illness would stop you from being licensed. You will likely have to submit records, and you will face some greater scrutiny, including checking up regarding compliance with treatment and all that.
 
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I don't have personal experience with this, but I am interested in licensing issues and regularly read board reports, etc. My thought is that no one can say anything for sure, but I doubt a well-controlled mental illness would stop you from being licensed. You will likely have to submit records, and you will face some greater scrutiny, including checking up regarding compliance with treatment and all that.

Thanks for the advice everyone. I'm not planning on lying. That's why I'm trying to find out now before my debt accrues any more. I took years making sure my health was in order and making sure I could do the 24 / 48 hour shifts required in residency before committing to medical school. For some reason the thought of getting everything right then failing based on a judgement call made by a group of politicians never occurred to me. When you feel helpless, you consider all the options. As it stands, I going to make an anonymous email address to message the boards in question.

Doctor Bagel - I have heard that "well-controlled" is relative, and the definition can be altered at random by the board using it. Apparently there was a court ruling (in NJ?) that states the medical licensing boards are not held to the policies stated in the American Disabilities Act because of the gravity of the profession.

If any of you figured out one of your peers was bipolar, you would never interact with them the same way again. No one at my school knows. My mentor doesn't know. No one at my job knows, nor will they ever. I've never put a patient at risk and consider myself good at my job. I know and am fine with receiving treatment for the rest of my life. Even so, some of my partners can tell when I'm hypomanic. They say I appear high strung and animated. Based on the input I've received (from a hospital administrator that came to speak at our school), if I behaved in this fashion in a hospital setting, I can be branded as "disruptive", reported, and my diagnosis released to the hospital and my peers. She made it seem like anything even slightly abnormal is disruptive and grounds for firing. I feel like I'm walking on eggshells. I'm sure all of you have worked with physicians who gets a little manic sometimes when sleep deprived. Have you witnessed action against them? Are the board reports that you read released to the public with named diagnoses? The two I've gotten ahold of do include diagnoses and are posted on the internet for all to see (NC reports). Do you have to tell your employer if you're in treatment / have a mental health history or are physicians protected like everyone else from having to disclose this information?

I know I haven't earned the right to post on a physician / resident board so thank you for your continued patience. I appreciate your input.
 
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Thanks for the advice everyone. I'm not planning on lying. That's why I'm trying to find out now before my debt accrues any more. I took years making sure my health was in order and making sure I could do the 24 / 48 hour shifts required in residency before committing to medical school. For some reason the thought of getting everything right then failing based on a judgement call made by a group of politicians never occurred to me. When you feel helpless, you consider all the options. As it stands, I going to make an anonymous email address to message the boards in question.

Doctor Bagel - I have heard that "well-controlled" is relative, and the definition can be altered at random by the board using it. Apparently there was a court ruling (in NJ?) that states the medical licensing boards are not held to the policies stated in the American Disabilities Act because of the gravity of the profession.

If any of you figured out one of your peers was bipolar, you would never interact with them the same way again. No one at my school knows. My mentor doesn't know. No one at my job knows, nor will they ever. I've never put a patient at risk and consider myself good at my job. I know and am fine with receiving treatment for the rest of my life. Even so, some of my partners can tell when I'm hypomanic. They say I appear high strung and animated. Based on the input I've received (from a hospital administrator that came to speak at our school), if I behaved in this fashion in a hospital setting, I can be branded as "disruptive", reported, and my diagnosis released to the hospital and my peers. She made it seem like anything even slightly abnormal is disruptive and grounds for firing. I feel like I'm walking on eggshells. I'm sure all of you have worked with physicians who gets a little manic sometimes when sleep deprived. Have you witnessed action against them? Are the board reports that you read released to the public with named diagnoses? Do you have to tell your employer if you're in treatment / have a mental health history or are physicians protected like everyone else from having to disclose this information?

I know I haven't earned the right to post on a physician / resident board so thank you for your continued patience. I appreciate your input.
Don't know if it'll matter much to you, but I wouldn't judge a coworker for being bipolar. It usually won't endanger patient's lives, unless it is extremely disabling, in which case you wouldn't have made it through med school and residency. I work with plenty of people that have diagnosed mental illnesses and severe personal problems, of various degrees, from mild depression on up to alcoholism, bipolar disorder, drug addiction, and more. We're people, we all have problems and we aren't perfect. So long as you can perform well when you need to and recognize when you need to take some personal days or seek help, most people wont think any less of you. Sure, there's a few dinguses out there. But haters gonna hate, so don't dwell on it.
 

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. Do you have to tell your employer if you're in treatment / have a mental health history or are physicians protected like everyone else from having to disclose this information?
.

Usually you don't have to put it on a job application, but you do need to put it on any application for privileges (hospital staff privileges).
 

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So once you're hired and they can't take it back? Is this information public?
You're making this harder than it really is. Every contract will have some sort of termination clause but it's not going to be for medical reasons unless you're completely unable to do the job.

The issue with licensing and credentialing is generally separate from employment. You will have to disclose it if/when asked about it and will likely have to appear before the professional board at each hospital you need privileges at and explain the issues and how it's controlled. It's unlikely to restrict your ability to practice but it will definitely be a hassle to explain...and that's life.

And no, this information is not public. If you ever have your license suspended or revoked, the fact that it's revoked and the reason for it will be public though. But again, you're more likely to lose your license or privileges if it comes out that you lied than for having a well controlled mental illness.
 

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This is a really, really difficult topic.

First, a bit of clarification. You mentioned above that a court ruling in NJ made boards immune to the ADA requirements. Nothing could be further from the truth. The case in question is "Medical Society of New Jersey v. Jacobs", and this case was decided in favor of the physician -- that the board's questions were overly broad, vague, and violated the ADA. This case has caused boards to alter their questioning. There was some push to exempt BoM's from the ADA, but that's not moving forward that I know of. There's an interesting congressional committee hearing on this topic if you want to review it (from 1997): http://commdocs.house.gov/committees/judiciary/hju52589.000/hju52589_0f.htm

The question is balancing physician privacy with patient safety. Let's say a physician has a history of alcohol abuse, but is now in recovery. Should this be reportable to the board? Some would argue that the physician has a right to privacy, and as long as they are sober at the time of licensure, they should not need to disclose this. Presumably, their medical license could be limited, or even blocked by the board for something in the past that might never be a problem again. On the other hand, the board would argue that relapse for substance abuse is high, and that they could monitor the physician to ensure that patient safety is maximized, but only if they are allowed to ask about it. It's a very interesting problem without a simple solution.

The issue with mental health is more complicated than that of substance abuse, but the argument remains the same. How often do physicians with bipolar disease end up uncontrolled and hurt patients (via substandard care, not violence)? Is there any way to predict this? If the answers are "rarely" and "no", then how willing are we to have the board monitor bipolar physicians (and what exactly is that monitoring)?

If you're not bipolar, it's easy to just say that it's fine. So, let's take this up a notch. Let's assume that all physician health issues could impact patients. Therefore, all physician health records should be reviewed by the board on a regular basis. Would you really want the BoM reviewing your records? Do you think they would really be kept confidential, or if something juicy was in there do you think it could get leaked? Would you avoid seeing a health provider because you were worried that something in your records would trigger a review of your practice?

No easy answers.
 
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If any of you figured out one of your peers was bipolar, you would never interact with them the same way again.
Definitely not true. Happened many times in many settings. It doesn't affect my interaction with them any more than it would if they'd told me that they have well-controlled rheumatoid arthritis. 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.

I'm sure all of you have worked with physicians who gets a little manic sometimes when sleep deprived. Have you witnessed action against them? Are the board reports that you read released to the public with named diagnoses? The two I've gotten ahold of do include diagnoses and are posted on the internet for all to see (NC reports). Do you have to tell your employer if you're in treatment / have a mental health history or are physicians protected like everyone else from having to disclose this information?
I've heard of many such circumstances. Most of the time, the program's response is the opposite of what you're describing - rather than chiding/punishing them, they'll usually make special accommodations to help the person deal with the illness. If you're particularly worried about your co-workers not understanding, just go into psychiatry - not only are we well-acquainted with the difficulties associated with mental illness, but it's also a specialty that tends to attract people with a background of various mental illnesses, so you won't feel like you're different from everybody else in your field.

I know I haven't earned the right to post on a physician / resident board so thank you for your continued patience. I appreciate your input.
Seems like a common theme in your post is a concern about your own self-worth and your capabilities. You seem to define yourself and your capabilities in terms of your illness. I won't go any further with the psychotherapy/analysis, since that would be inappropriate in this context, but I can tell you that it is perfectly appropriate for a med student to post on the "general residency issues" board with questions about residency.

Bottom line - you have not tied your hands. You will not be unable to get licensed. Many people have gotten through successfully, and I'm sure that your psychiatrist will tell you the same thing. When I said that "the risk of lying is higher than the risk of telling the truth," I meant that the risk of telling the truth is low. On the off chance that you run into a state board that is particularly intolerant, then I'm sure you'll find at least 30-40 other state boards that will be helpful.
 

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You're making this harder than it really is. Every contract will have some sort of termination clause but it's not going to be for medical reasons unless you're completely unable to do the job.

The issue with licensing and credentialing is generally separate from employment..

Technically yes. If you are applying for a private practice job, make sure to submit the hospital priv apps yourself (rather than having the practice secretary do it). If you are applying for an employment with a hospital (including a practice owned by a hospital) is there any guarantee that the administrator doing the hiring doesn't see the privilege application?????? IN the past (7-9 years ago) when I applied for jobs at state psych hospitals, I filled out and submitted the job app and the hosp priv app at the same time..

AS others have noted, the OP shouldn't have major difficulties getting licensed and credentialled
 
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Interesting topic. I'm not sure what course medical boards should take. Airline pilots face even worse scrutiny. If a pilot is found to have depression, for example, they are grounded for a period of time (https://www.faa.gov/licenses_certif...alissuance/antidepressants/index.cfm?print=go), which seems counterproductive. I would rather have a pilot who's depression is being treated than a pilot who is hiding symptoms out of fear of the punitive measures from the FAA.

Thankfully, medical boards have more latitude than the FAA. Physicians can continue to practice despite psychiatric diagnoses, even while on diversion for substance abuse (though this varies from state to state). Most consumer advocate groups would probably prefer the medical boards be more punitive than they are, so you can be little thankful for that. However, medical boards can be very political and I don't entirely trust them to keep these matters private. If a doctor is in the newspaper for example, you can just watch as the medical board starts circling their wagons.

There is also a slippery slope issue. We're not required to report hypertension and smoking on our license applications, though this would increase the likelihood that we suffer a stroke or MI while on-call (thus putting patients at risk). Long-haul truckers, for example, are required to have blood pressure under control to drive. So why don't we make a similar requirement for doctors, especially those who perform procedures. There does appear to be a bias against psychiatric diagnoses that is out of proportion to the risk posed to patients. I would expect better from the medical field.

None of this really helps the OP, though. I'm a little concerned by this statement:

"Even so, some of my partners can tell when I'm hypomanic. They say I appear high strung and animated. Based on the input I've received (from a hospital administrator that came to speak at our school), if I behaved in this fashion in a hospital setting, I can be branded as "disruptive", reported, and my diagnosis released to the hospital and my peers."

Being a little "high-strung" is not exactly a cause for concern, but if your behavior rises to the level where hospitals consider taking disciplinary actions against you, I would be concerned about how well controlled your bipolar really is. Perhaps a psychiatrist with experience treating physicians can help you determine if you are really ready for clinical rotations. Good luck.
 
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captaincrunch - Wow, didn't know that about airline pilots! At least we aren't the only ones. I guess I didn't clarify enough. My partners sometimes think I can get a bit intense. In a field that prides itself on staying extremely calm in the face of a sh*tstorm, anything other than complete calm is thought to be indicative of a newbie/ride along. So sometimes, the guys I work with poke fun at me after a tense priority call, but this may just be my personality and not stress induced hypomania. 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.

gutonc - Thanks for the straight talk :) 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.

shan564 - I've never actually posted anything on the internet ever, let alone started a conversation like this. There is another thread chiding a premed for posting on the resident/physician forum. Just trying to be respectful.

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."

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?

aProgDirector - interesting article and thanks for the clarification. Check this out though, much different than the information you found and it was published in 2014. NCBI has some interesting articles too.
Article: http://www.jaapl.org/content/36/3/369.full
Excerpt: "Case law from New Jersey has determined that specific questions about bipolar, psychotic, or sexual disorders are acceptable based on a higher perceived potential of posing a direct threat to the public, and on the relapsing-remitting courses of these illnesses.6" (seriously bipolar and pedophilia are lumped in together. If that doesn't say something about the perspective of legislative bodies I don't know what does.)
This article concludes: "The results of this study also show that despite current recommendations, there has been a paradoxical increase in licensure questions about an applicant's history of treatment or hospitalization for mental illness or substance use."

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.
 
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...but I can tell you that it is perfectly appropriate for a med student to post on the "general residency issues" board with questions about residency.


shan564 - I've never actually posted anything on the internet ever, let alone started a conversation like this. There is another thread chiding a premed for posting on the resident/physician forum. Just trying to be respectful.

Actually shan564 is *incorrect*. SDN policy has been that user post queries in their "home forums" (ie, med students in the med student forums, residents in the residency forums etc) because the residency forums are for questions of interest to those who are currently in training.

However, we let this one stand presumably because this specific question is relevant to residency and practice and makes sense in this forum.

But in general, medical students should post in the med student forums.
 

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captaincrunch - 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.

Depends on the situation.

I yelled and said the "F word" in the OR today over a mistake that the OR staff made. Its highly unlikely that anyone will say anything to me other than, "we will fix it/won't happen again".

If I was yelling and cursing routinely, at specific or random employees or patients, throwing instruments, etc. then it would be a problem which could be defined as disruptive.

You are not expected to be a "robot"; you are expected to provide good care for your patients and treat your co-workers with respect. If occasionally you slip, it is generally well tolerated.
 

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Depends on the situation.

I yelled and said the "F word" in the OR today over a mistake that the OR staff made. Its highly unlikely that anyone will say anything to me other than, "we will fix it/won't happen again".

What did they do?
 

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What did they do?
They took radioactive material out of the OR (a specimen containing I-125), without my permission, and couldn't tell me where it was. I scrubbed out and found it left it out on the OR control desk counter.

The requirement by the Nuc Med department, at the request of the Nuclear Regulatory Commission, is that the material will always be in the possession of someone with a nuclear medicine license - that means me. It is never to leave the OR except in my hands or someone from Nuc Med. We could lose our nuc med license over it if the material went missing.
 
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They took radioactive material out of the OR (a specimen containing I-125), without my permission, and couldn't tell me where it was. I scrubbed out and found it left it out on the OR control desk counter.

The requirement by the Nuc Med department, at the request of the Nuclear Regulatory Commission, is that the material will always be in the possession of someone with a nuclear medicine license - that means me. It is never to leave the OR except in my hands or someone from Nuc Med. We could lose our nuc med license over it if the material went missing.

Yeah, that was a really dumb move on the part of your OR staff. I'd say that deserves "F&ck" and a few other choice cusswords.
 
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Yeah, that was a really dumb move on the part of your OR staff. I'd say that deserves "F&ck" and a few other choice cusswords.
It wasn't my usual team - after 300 pm, so a crew that doesn't work with me often. All the more reason then, IMHO, for them to really take extra care to ask about how to handle things they aren't familiar with. I give inservices, I micromanage but at some point, I have to trust that people are being careful. :mad:
 
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It wasn't my usual team - after 300 pm, so a crew that doesn't work with me often. All the more reason then, IMHO, for them to really take extra care to ask about how to handle things they aren't familiar with. I give inservices, I micromanage but at some point, I have to trust that people are being careful. :mad:

It seems like common sense that you do not lose track of radioactive material.
 
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It seems like common sense that you do not lose track of radioactive material.
Yes, it does.

I'm not sure they know what exactly I'm doing half the time. My regular team has some sense especially my scrub nurse (because she has a family history of breast cancer, so she's actually interested in what I do, and she listens as I'm talking with the med studs), but most others? Nada. Its like reinventing the wheel sometimes.
 

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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?

It sounds like your school presents a backwards view of mental illness. I've never been taught in my psychiatry training that people with bipolar disorder are difficult patients who lie all the time. Bipolar disorder can be both challenging to diagnose and treat, but hopefully those of us in the field don't blame our patients for that. Your school also seems to promote a false dichotomy between good doctors and medical students and bad "disruptive" doctors, which I guess isn't that different from ideas that lots of us in this field internalize. However, physicians do things that are potentially "disruptive" all the time and rarely get fired. We're not robots. I doubt your hyperintensity will lead to a label or to getting fired. I'm sorry that your school presents you with such scary images about actually being a human who also happens to be a doctor.
 

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Become a psychiatrist. That way, your colleagues will generally be pretty understanding. It's a field that tends to attract a lot of people who have dealt with some sort of mental illness.
 

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Become a psychiatrist. That way, your colleagues will generally be pretty understanding. It's a field that tends to attract a lot of people who have dealt with some sort of mental illness.

I admit this post is in contrast to my previous post, but I'm not sure psychiatry residencies are any more open to residents with a known mental illness than other residencies. In fact, we might have more biases. So, in sum, don't write about your struggles with mental illness in your personal state, even for psych. I think that we get on some level that most of us have some personal experience with mental illness either in ourselves or our families, but we don't like that part of ourselves.

Not saying you shouldn't be a psychiatrist, but I don't think we're as free of bias as we should be. Also, psychiatry is pretty darn emotionally draining, so I think in some ways it's a harder specialty if you struggle with a mental illness.
 
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I admit this post is in contrast to my previous post, but I'm not sure psychiatry residencies are any more open to residents with a known mental illness than other residencies. In fact, we might have more biases. So, in sum, don't write about your struggles with mental illness in your personal state, even for psych. I think that we get on some level that most of us have some personal experience with mental illness either in ourselves or our families, but we don't like that part of ourselves.

Not saying you shouldn't be a psychiatrist, but I don't think we're as free of bias as we should be. Also, psychiatry is pretty darn emotionally draining, so I think in some ways it's a harder specialty if you struggle with a mental illness.

I will never ever refer to any psych anything ever in any application ever. I was smart enough to decide this before med school applications. Anyone reading this who is planning on applying (med school, residency, etc) - Dr. Bagel is completely correct and it would be wise to listen to him.

Thank you to all the psychiatrists out there who care about their patients and don't give up on us. It may take us years but we get there as long as we're invested. My psychiatrist right now is particularly inspiring. However, I've already considered and decided no to psychiatry - I am not capable of doing the job that you all do.

Psychiatrists are not free of bias - I've been psychoanalyzed on this thread by a psych resident already if you scroll up (well meaning and it is the internet, but probably a pain if it happens every day at work, even silently.) I'm long finished psychoanalyzing my life and dwelling on the past and I don't need to be reminded of it at work every day. Probably going to stick with the ER staff since everyone in emergency medicine has to be a bit unbalanced on some level. But they do leave you alone about it :) If I discover during rotations that I need more structure, interventional cardiology or cardio in general also seems enjoyable. Just don't want to do internal med to get there...
 

shan564

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I will never ever refer to any psych anything ever in any application ever. I was smart enough to decide this before med school applications. Anyone reading this who is planning on applying (med school, residency, etc) - Dr. Bagel is completely correct and it would be wise to listen to him.
I definitely agree with that, except that the last word should be "her."

Psychiatrists are not free of bias - I've been psychoanalyzed on this thread by a psych resident already if you scroll up (well meaning and it is the internet, but probably a pain if it happens every day at work, even silently.) I'm long finished psychoanalyzing my life and dwelling on the past and I don't need to be reminded of it at work every day. Probably going to stick with the ER staff since everyone in emergency medicine has to be a bit unbalanced on some level. But they do leave you alone about it :) If I discover during rotations that I need more structure, interventional cardiology or cardio in general also seems enjoyable. Just don't want to do internal med to get there...
I agree in general, and sorry if I was overstepping my bounds earlier. My only reason for endorsing psychiatry was because I've met a lot of psych residents who suffer from mental illnesses of varying severity, and as long as they make an effort to control it, I tend to only have more respect for them... especially because I feel that it gives them a unique insight into their patients' struggles. But yeah, there's definitely a lot of bias.

I agree that EM is probably a good choice. Maybe even better than psychiatry. You might want to be careful about the varying shifts required of EM docs, since (as you probably know) it's important to maintain a good sleep schedule if you have bipolar d/o... but it's nice that EM features discrete shift schedules. It would be tough to survive an IM residency, since the sleep schedule is so varied. Personally, I might have chosen pathology if I were in the same boat, but that's probably because pathology was already my #2 choice. Or I might have still gone for psych.

The point I was trying to make with my "psychoanalysis" earlier was that I think that you are probably not as limited as you might think. Sorry if it sounded like I'm telling you what to do, and I hope it didn't sound like psychotherapy, because it would have been bad psychotherapy. I have known a lot of people with bipolar disorder (to varying degrees of severity) who have had very successful careers in multiple areas, including medicine.
 

Giic

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Dear OP:
Wish I saw this thread 2 years ago. I cant read it all, but I did read the first few comments. My personal opinion is:
(1) Choose a field carefully. There are many many fields in medicine where you could be very successful. If you think sleep-deprivation makes your condition worse, then avoid a specialty that involves in-house night shifts. I think even the best of people are cranky and slightly manic when sleep-deprived, and there are studies showing lapse in judgement & coordination occurs in most people. This might be amplified in someone with mental illness, and may trigger episodes. I'm a strong advocate for doctors being able to work shorter, but more frequent shifts. I personally feel "dangerous" when I'm in my 21st-22nd hour of a 24-hour shift, and I perform much much better when doing 3 nights in a row. I'm as sharp & awake as the nurses are.
(2) Regarding "disruptive physicians".... There are a TON out there, and most are still in practice. Not saying this is good or something to aspire to. But there are a lot of very badly behaved physicians who get away with it because they bring in money for the hospital.
 
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Crayola227

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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
 

Crayola227

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I definitely agree with that, except that the last word should be "her."


I agree in general, and sorry if I was overstepping my bounds earlier. My only reason for endorsing psychiatry was because I've met a lot of psych residents who suffer from mental illnesses of varying severity, and as long as they make an effort to control it, I tend to only have more respect for them... especially because I feel that it gives them a unique insight into their patients' struggles. But yeah, there's definitely a lot of bias.

I agree that EM is probably a good choice. Maybe even better than psychiatry. You might want to be careful about the varying shifts required of EM docs, since (as you probably know) it's important to maintain a good sleep schedule if you have bipolar d/o... but it's nice that EM features discrete shift schedules. It would be tough to survive an IM residency, since the sleep schedule is so varied. Personally, I might have chosen pathology if I were in the same boat, but that's probably because pathology was already my #2 choice. Or I might have still gone for psych.

EM is likely a terrible choice for someone who is bipolar unless they are really certain that their condition on meds is going to stand up to sleep changes. In residency you will have to have ever changing hours. As an attending the only way to have consistent hours is to trade days shift for swing/graveyard shifts, or get seniority/head of department and even then. Plenty of non-polar ED docs I know find the sleep shifts depressing. Some work part time and have 1-2 shifts per week which even if hectic might still allow you a regular enough schedule when you're off to not be a problem. Guess it depends how sensitive your bipolar is.

IM residency is likely fine, actually, depending on the scheduling of nightfloat. I know of programs where nightfloat is like 1 week every 5 weeks of wards which would not be a schedule. Others, you do one to two 4-week blocks for the whole year, coupled with the senior is only doing an overnight 1-2 times a week on wards/ICU. So it would depend.

Frequently I see debates on this board about the old q 3-4 call systems and the nightfloats being used at most of the progams now to adjust to work hour restrictions, and I haven't brought up that I think one advantage is that the more regular sleep hours are likely beneficial to bipolar residents, depending how sensitive their rhythms are. I've seen different estimates of bipolar prevalence in gen pop, anywhere from 1-2% to as high as 10%. Granted, how much we care if the nightfloat is better for the small number of bipolar residents, I don't know. We don't care that much about resident health in general.
 

Raryn

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I'm filling out a a licensing application right now. To quote the relevant question:

Have you had or do you now have any disease or condition that interferes with your ability to perform the essential functions of your profession, including any disease or condition generally regarded as chronic by the medical community, i.e., (1) mental or emotional disease or condition; (2) alcohol or other substance abuse; (3) physical disease or condition, that presently interferes with your ability to practice your profession? If yes, attach a detailed statement, including an explanation whether or not you are currently under treatment.

The explanatory document goes on to say:
Submit the following documentation:

A report from any and all physicians, counselors, or therapists from whom you have received treatment for any chronic disease or condition (i.e., chemical/ alcohol dependency, depression, etc.). The report must include dates of treatment, method of treatment, diagnosis, and prognosis. Attach a detailed statement advising whether you are currently under treatment. If you have been treated as an inpatient/outpatient at any time for any disease or condition, then it will be necessary for you to have the institution(s) submit, directly to this Department, copies of any and all admitting histories, physicals and discharge summaries for each inpatient/outpatient stay or treatment.

I don't see any way to interpret those statements and be able to NOT let the licensing board know about bipolar disorder, unless you've *never* been symptomatic (in which case, how do you know you have bipolar disorder?)
 

Crayola227

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I'm filling out a a licensing application right now. To quote the relevant question:

The explanatory document goes on to say:

I don't see any way to interpret those statements and be able to NOT let the licensing board know about bipolar disorder, unless you've *never* been symptomatic (in which case, how do you know you have bipolar disorder?)

Never argued that there are apps that are worded in a such a way that one cannot truthfully answer and not disclose.

I said there were some that were not worded in such a way.

Also, when I went on my interviews many programs provided a copy of the state medical board licensing app, and it was something I took note of, that some states are "safer" for physicians with mental illness from a privacy standpoint.

An example of one that is less Draconian simply asks if within the last 5 years if you have had a physical or mental health condition that impaired practice, substance abuse/dependency, inpatient treatment for either. That example is the one I personally filled out, and will not share for confidentiality of my location.

There is another one that is similar.
This one is from Florida:
(emphasis mine with bolding and underlining)
http://flboardofmedicine.gov/apps/medical-doctor-app.pdf
page 14

CONFIDENTIAL AND EXEMPT FROM PUBLIC RECORDS DISCLOSURE*
9. HEALTH HISTORY
If you answer “Yes” to any of the questions in this section you are required to send the following items:
A self-explanation providing accurate details that include name of all physicians, therapists, counselors,
hospitals,institutions, and/or clinics where you received treatment and dates of treatment.
A report directed to the Florida Board of Medicine from each treatment provider about your
treatment, medications, and dates of treatment. If applicable, include all DSM III R/DSM IV/DSM
IV-TR Axis I and II diagnosis(es) code(s), and admission and discharge summary(s).
A.
Yes
No
In the last five years, have you been enrolled in, required to enter into, or participated in any drug or alcohol recovery program or impaired practitioner program for treatment of drug or alcohol abuse that occurred within the past five years?
B.
Yes
No In the last five years, have you been admitted or referred to a hospital, facility or impaired practitioner program for treatment of a diagnosed mental disorder or impairment?
C.
Yes
No During the last five years, have you been treated for or had a recurrence of a diagnosed mental disorder that has impaired your ability to practice medicine within the past five years?
D.
Yes
No During the last five years, have you been treated for or had a recurrence of a diagnosed physical disorder that has impaired your ability to practice medicine?
E.
Yes
No In the last five years, were you admitted or directed into a program for the treatment of a diagnosed substance-related (alcohol/drug) disorder or, if you were previously in such a program, did you suffer a relapse within the last five years?
F.
Yes
No During the last five years, have you been treated for or had a recurrence of a diagnosed substance-related (alcohol/drug) disorder that has impaired your ability to practice medicine within the past five years?

Are we noticing a pattern?

Just because you have an example of a licensing app for which one would have to disclose a history of currently controlled asymptomatic bipolar disorder that had never impaired practice, DOES NOT MAGICALLY MEAN THAT IS THE CASE EVERYWHERE.

I have just proven that some states trust you to answer these questions honestly, and that essentially if you've had your **** together for the last 5 years and not had your mental health affect your job, that they will just LEAVE IT AT THAT. Nothing more to say.

So thank you for pointing out what I already said, which is that yes, some states you will have to give them every detail of your medical history, maybe including your bra size.

Your point however did not invalidate what I said, which is that some forms are worded in such a way that you can answer honestly and never have to go into the fact that you have a diagnosis of bipolar disorder, as I have proven with a direct example you can read the app yourself if you don't believe me.
 

Doctor4Life1769

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Just have an attorney review it and review how you should answer the questions. There is an art to it. Give too much information not directly asked and you run the risk of having more issues/delays.
 
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