MD How does a dx of MDD post sexual assault affect licensing?

[MDSurvivor]

As the title says, how does a dx of MDD post sexual assault affect future medical licensing? I've noticed that many licensing forms ask whether or not you've been diagnosed with depression or any psychiatric disorder. Does anyone know what should I do or whether the dx can be changed to something else (I didn't get a blood test to check my thyroid levels, etc)? Thanks.

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[acapnial]

As the title says, how does a dx of MDD post sexual assault affect future medical licensing? I've noticed that many licensing forms ask whether or not you've been diagnosed with depression or any psychiatric disorder. Does anyone know what should I do or whether the dx can be changed to something else (I didn't get a blood test to check my thyroid levels, etc)? Thanks.

I believe you do have to disclose mental illnesses and demonstrate what was down about it (SSRI, CBT, whatever) but as long as your practice isn't impaired by it that's the end of it. It would only give you trouble if you had a psych disorder that was out of control and because of that you couldn't safely practice medicine. I have no idea how you would go about challenging the diagnosis but it's probably more work.

 

[Peach Newport]

Let me guess - California..?

 

[cbrons]

I believe you do have to disclose mental illnesses and demonstrate what was down about it (SSRI, CBT, whatever) but as long as your practice isn't impaired by it that's the end of it. It would only give you trouble if you had a psych disorder that was out of control and because of that you couldn't safely practice medicine. I have no idea how you would go about challenging the diagnosis but it's probably more work.

You don’t have to disclose mental illnesses at all on medical license forms unless they interfere with your ability to practice medicine.

 

[DoctorG2020]

We've had numerous physicians talk to our class about this issue. It's something that should not affect your opportunity for interviews, but it may unfortunately depending on who is reading through your application. As Lev0phed mentioned, I don't believe you have to disclose this unless it affects your ability to practice medicine. I know that many people are diligently working to change the phrasing of this question as to prevent any unnecessary detriment to the applicant, and hopefully there will be change soon!

 

[Peach Newport]

You don’t have to disclose mental illnesses at all on medical license forms unless they interfere with your ability to practice medicine.

Not true. Some states require disclosure of all psychiatric diagnoses.

 

[emergencycat]

Unless it impacts your ability to practice medicine, it should not affect licensing. As I understand it, in the states that ask, you have the option of disclosing IF it impacts your ability to practice. If you believe that it does not affect you in that way, then simply do not disclose it. This, like any medical issue, is an extremely private matter and protected medical information. If during residency your MDD affects you and you need to talk to your PD about it (say, to take a LOA or request accommodations) you could simply disclose (and have your treating psychiatrist confirm) that you have MDD that requires accommodations.

Edit: the above poster stated that some states require disclosure of all psych conditions. I was unaware of that, or of which states do. If your state does, you should be fine, and you could just disclose MDD. If your psychiatrist is unwilling to amend the diagnosis, you could certainly find another who is willing to do so. As I see it, simply stating that you have MDD is still accurate. EDIT: read Crayola's post about this below, I was incorrect.

Obviously just an M2, so take the world of practicing lawyers/physicians above mine. My knowledge just comes from researching issues with disability in medicine and from prior legal/policy work.

 

[Crayola227]

Unless it impacts your ability to practice medicine, it should not affect licensing. As I understand it, in the states that ask, you have the option of disclosing IF it impacts your ability to practice. If you believe that it does not affect you in that way, then simply do not disclose it. This, like any medical issue, is an extremely private matter and protected medical information. If during residency your MDD affects you and you need to talk to your PD about it (say, to take a LOA or request accommodations) you could simply disclose (and have your treating psychiatrist confirm) that you have MDD that requires accommodations.

Edit: the above poster stated that some states require disclosure of all psych conditions. I was unaware of that, or of which states do. If your state does, you should be fine, and you could just disclose MDD. If your psychiatrist is unwilling to amend the diagnosis, you could certainly find another who is willing to do so. As I see it, simply stating that you have MDD is still accurate.

Obviously just an M2, so take the world of practicing lawyers/physicians above mine. My knowledge just comes from researching issues with disability in medicine and from prior legal/policy work.

No, you often can't get providers to amend the diagnosis, if it's accurate and based on the facts of your case. Even going for a 2nd opinion and doctor shopping.

Some states will require full disclosure of ALL psych diagnoses EVER, but that's a small minority. I imagine any state is used to seeing MDD on the list, and it's possible even that they might ask to see all your medical records as a condition of licensure (to be clear, you could say no to this request, but as you might guess...)

However, if it has never interfered with your ability to practice medicine, typically everything goes smoothly, aside from if they need to see your records, and even then, that usually only delays things if anything. If you had to take a LOA I'm not sure how you should best answer this, as I'm not sure that affects your practice of medicine besides having a leave, where you are not practicing medicine. I'm splitting hairs. You should still probably answer yes, and mention the LOA (that's actually an appropriate and less concerning way for you to handle severe mental illness in medicine). If it clearly affected your ability to practice, and especially if there is evidence of that via your medical records, school, or otherwise, then you must answer yes, unequivocally.

It gets a bit murkier if the question is worded, "or could ever affect your ability to practice." I think you can use your judgement here. If your depression was precipitated by a particular time limited event and you have recovered, I think that's reasonable here to answer no. If you have a chronic mental illness, I think you need to use your judgement.

Also, NEVER lie to the medical board. That has the potential make your clinical career toast forever. You don't want to appear to be lying either, so an LOA 2/2 MH is likely a reason to answer "yes" to any question about it affecting ability to practice, to be clear.

Almost every state licensure form I've seen (and I've seen quite a few) even if you answer it has not affected your ability, might ask if you've ever been psychiatrically hospitalized (think about it, you could have been psychiatrically hospitalized before ever being a med student, in which case, you would say no it has never affected ability to practice, yet answer yes to the question of being hospitalized). This is a much bigger deal.

The advice I was given by a psychiatrist that specialized in treating physicians with mental health issues AND dealing with the medical board of my state, recommended that if such hospitalization was necessary, to receive it outside your home state and the state of practice, and private pay out of pocket. I think they said there was somewhere good in New Mexico or Arizona. I think the implication was to make it easier to hide the hospitalization. I don't want to discourage people from getting help or encourage lying or hiding anything to any regulatory board, but given what a big deal even voluntary psych hospitalization is as far as your career and licensing, and how such stigma leads people to not seek such care at all even when needed, I think I would be remiss if I didn't pass along the advice of this psychiatrist.

Lastly, some states ask the question about psych dx in a certain way that even if you can answer honestly without disclosing anything, they might ask what medications you are on and for what condition they are for (so even if you take propranolol for anxiety, depending on the form it may or may not be clear why propranolol). In that case, they're going to figure it out if you are still on meds, and may have questions.

The fact your depression was precipitated by a major life stressor that is not likely ongoing, and I'm assuming your depression is under control now, with or without ongoing treatment at this time, and that it is not currently affecting your ability to practice, even if it has in the past, leads me to conclude you could likely feel free to disclose on any of these forms and have no problems ultimately obtaining licensure. As I said, typically the worst thing that might happen is that they may want to see your records or obtain a note from your treating provider that you are fit for duty. Some cases, you might have to see a provider of their choosing.

Honestly, I really don't think you need to overthink this, I think you can be 100% honest, totally disclose, and not have any issues.

I went into so much detail, because often people will either state psych dx disclosure on license forms is "no big deal" or they tell you that you will be screwed. The answer is actually in the middle and more complex than that, and varies by state. Also, many don't know about the implications of psychiatric hospitalization. I've read more than one state law and licensing form on the topic. Every time it comes up, I just try to dispel myths, provide information that may or may not be useful to anyone reading SDN. You never know when you or a colleague will be a situation to need to consider these issues. MH changes over time, and as I'm sure OP is aware, life can always bring us new medical diagnoses.

You can read my past posts and that of others on this board on this topic.

 

[Crayola227]

OP,

If my post wasn't clear, based on what you've told us, you shouldn't worry that disclosing your situation will in any way hurt your ability to be licensed in any state. You don't have to disclose why you had MDD and it should be fine. If for some reason you need to disclose more information about specifics, I would expect you not to have issues there either.

OP, I am so very sorry about what happened to you. None of this was your fault, the traumatic event, or any mental health issues you have now. I also want to say how glad I am that you sought help. You can seek help while having a successful career in medicine. The key is to be smart about it, and proactive. It sounds like you are doing that now, by working with your providers and seeking career help here. I would also encourage you if you have any trusted mentors at school that could advise you.

I want you to know that I knew an intern very close to me, that was sexually assaulted during medical school, and had severe issues with PTSD during intern year. They were able to go to program leadership and receive support. It did actually affect their ability to practice medicine, but it was something the program was able to handle internally without involving any report to the medical board, through a combination of some time off, increased supervision and support for patient safety, assistance in obtaining mental health services, and working that into the schedule. Colleagues chipped in here and there so they could attend appointments and other personal matters related to the assault. Their education was not affected. Perhaps in the future they will have to checkbox "yes" to having ability to practice medicine affected. However, this resident was able, with full support of any leadership and colleagues they confided in, to not only successfully complete their intern year, but to go on and be successful for the rest of their residency. They have also informed me they have made a full recovery on a personal and professional level.

I am confident you can fully recover and succeed. From a career perspective, this does not have to hold you back in any way.

 

[emergencycat]

Thanks for sharing your knowledge, Crayola. Apologize for my misunderstanding. Thought I'd share a link to this study which clarifies which states license' language is consistent with the AMA's recommendation on mental health questions on license applications and license renewal forms:
http://www.mayoclinicproceedings.org/article/S0025-6196(17)30522-0/fulltext

 

[cbrons]

Not true. Some states require disclosure of all psychiatric diagnoses.

And do those states have access to your medical record? Or require you to grant them access?

 

[cbrons]

No, you often can't get providers to amend the diagnosis, if it's accurate and based on the facts of your case. Even going for a 2nd opinion and doctor shopping.

Some states will require full disclosure of ALL psych diagnoses EVER, but that's a small minority. I imagine any state is used to seeing MDD on the list, and it's possible even that they might ask to see all your medical records as a condition of licensure (to be clear, you could say no to this request, but as you might guess...)

However, if it has never interfered with your ability to practice medicine, typically everything goes smoothly, aside from if they need to see your records, and even then, that usually only delays things if anything. If you had to take a LOA I'm not sure how you should best answer this, as I'm not sure that affects your practice of medicine besides having a leave, where you are not practicing medicine. I'm splitting hairs. You should still probably answer yes, and mention the LOA (that's actually an appropriate and less concerning way for you to handle severe mental illness in medicine). If it clearly affected your ability to practice, and especially if there is evidence of that via your medical records, school, or otherwise, then you must answer yes, unequivocally.

It gets a bit murkier if the question is worded, "or could ever affect your ability to practice." I think you can use your judgement here. If your depression was precipitated by a particular time limited event and you have recovered, I think that's reasonable here to answer no. If you have a chronic mental illness, I think you need to use your judgement.

Also, NEVER lie to the medical board. That has the potential make your clinical career toast forever. You don't want to appear to be lying either, so an LOA 2/2 MH is likely a reason to answer "yes" to any question about it affecting ability to practice, to be clear.

Almost every state licensure form I've seen (and I've seen quite a few) even if you answer it has not affected your ability, might ask if you've ever been psychiatrically hospitalized (think about it, you could have been psychiatrically hospitalized before ever being a med student, in which case, you would say no it has never affected ability to practice, yet answer yes to the question of being hospitalized). This is a much bigger deal.

The advice I was given by a psychiatrist that specialized in treating physicians with mental health issues AND dealing with the medical board of my state, recommended that if such hospitalization was necessary, to receive it outside your home state and the state of practice, and private pay out of pocket. I think they said there was somewhere good in New Mexico or Arizona. I think the implication was to make it easier to hide the hospitalization. I don't want to discourage people from getting help or encourage lying or hiding anything to any regulatory board, but given what a big deal even voluntary psych hospitalization is as far as your career and licensing, and how such stigma leads people to not seek such care at all even when needed, I think I would be remiss if I didn't pass along the advice of this psychiatrist.

Lastly, some states ask the question about psych dx in a certain way that even if you can answer honestly without disclosing anything, they might ask what medications you are on and for what condition they are for (so even if you take propranolol for anxiety, depending on the form it may or may not be clear why propranolol). In that case, they're going to figure it out if you are still on meds, and may have questions.

The fact your depression was precipitated by a major life stressor that is not likely ongoing, and I'm assuming your depression is under control now, with or without ongoing treatment at this time, and that it is not currently affecting your ability to practice, even if it has in the past, leads me to conclude you could likely feel free to disclose on any of these forms and have no problems ultimately obtaining licensure. As I said, typically the worst thing that might happen is that they may want to see your records or obtain a note from your treating provider that you are fit for duty. Some cases, you might have to see a provider of their choosing.

Honestly, I really don't think you need to overthink this, I think you can be 100% honest, totally disclose, and not have any issues.

I went into so much detail, because often people will either state psych dx disclosure on license forms is "no big deal" or they tell you that you will be screwed. The answer is actually in the middle and more complex than that, and varies by state. Also, many don't know about the implications of psychiatric hospitalization. I've read more than one state law and licensing form on the topic. Every time it comes up, I just try to dispel myths, provide information that may or may not be useful to anyone reading SDN. You never know when you or a colleague will be a situation to need to consider these issues. MH changes over time, and as I'm sure OP is aware, life can always bring us new medical diagnoses.

You can read my past posts and that of others on this board on this topic.

“Provider” lol. Why physicians use that idiotic political term is beyond me.

Anyway you need to stop. You’ve done this in multiple threads on this subject, and all it’s really doing is scaring the med students into thinking they can’t see a therapist or take Prozac if they want to get a medical license.

I will repeat what I have stated before. There is no state in this country (United States of America) that requires access to your medical records as a prerequisite for medical licensure. Not a single one. As such, you do not have to disclose anything about your highly private mental health/psychiatric records.

 

[Peach Newport]

“Provider” lol. Why physicians use that idiotic political term is beyond me.

Anyway you need to stop. You’ve done this in multiple threads on this subject, and all it’s really doing is scaring the med students into thinking they can’t see a therapist or take Prozac if they want to get a medical license.

I will repeat what I have stated before. There is no state in this country (United States of America) that requires access to your medical records as a prerequisite for medical licensure. Not a single one. As such, you do not have to disclose anything about your highly private mental health/psychiatric records.

Do me a favor. Apply for a California state medical license. Indicate that you’ve been treated for Alcoholism in the past. Then tell them you will not release your medical records to the board, citing privacy concerns. See how far you get in the licensing process.

 

[cbrons]

Do me a favor. Apply for a California state medical license. Indicate that you’ve been treated for Alcoholism in the past. Then tell them you will not release your medical records to the board, citing privacy concerns. See how far you get in the licensing process.

If you didn’t tell them about the alcoholism treatment, how exactly would they find out?

I’m guessing not by auditing your medical record. Actually, I’m not guessing.

 

[Crayola227]

“Provider” lol. Why physicians use that idiotic political term is beyond me.

Anyway you need to stop. You’ve done this in multiple threads on this subject, and all it’s really doing is scaring the med students into thinking they can’t see a therapist or take Prozac if they want to get a medical license.

I will repeat what I have stated before. There is no state in this country (United States of America) that requires access to your medical records as a prerequisite for medical licensure. Not a single one. As such, you do not have to disclose anything about your highly private mental health/psychiatric records.

I said provider, because it can vary exactly who the medical board might want to evaluate you, or whose notes regarding your fitness for duty they would like to see.

I made it clear to OP in a separate post that they should have no problems. I have never said a medical student shouldn't see a therapist or take medication if that is indicated. I never said they would not be able to get a license.

However, if they think they may never have this knowledge revealed to a medical board in the process of licensure or later down the road, that would be a lie. Typically things go without a hitch, rarely there are delays. But to say there are never consequences beyond that, would be a lie.

When I went on my residency interviews, in over 24 states, I reviewed all of their licensing forms, which wasn't difficult seeing as at least half of the programs included a copy with the handouts they give you. Because it was something I wanted to be aware of.

I was alarmed at how many state medical boards indicated that they might want to review your psychiatric records depending on how you filled out their forms. However, I wasn't alarmed about those with mental health issues getting licensed. I was more worried about red tape. I've said as much in all my posts.

I think it is relevant for anyone asking this question or reading this thread, to know the types of questions asked, the potential actions from the medical board, and how things like psychiatric hospitalizations are looked at in general by licensing boards; in fact, all of this is usually a matter of law or official written policy made by the medical board.

To act like there are zero repercussions from disclosure, or even non-disclosure, would be a lie.

Be thoughtful in managing your mental health. Be proactive. Don't just assume that it will all go smoothly and that your privacy is sacrosanct.

 

[Crayola227]

If you didn’t tell them about the alcoholism treatment, how exactly would they find out?

I’m guessing not by auditing your medical record. Actually, I’m not guessing.

We talked about this. You could lie. If for some reason your health becomes an issue during your residency and your ability to practice medicine safely is questioned, it could lead to steps where you would be required to disclose your medical record to the medical board, or have your license suspended. It could lead to your records being subpoenaed, even.

This is not conjecture. This is historical fact. I thought it was shocking until I saw it happen.

This is also why you should never lie to the medical board.

 

[cbrons]

We talked about this. You could lie. If for some reason your health becomes an issue during your residency and your ability to practice medicine safely is questioned, it could lead to steps where you would be required to disclose your medical record to the medical board, or have your license suspended. It could lead to your records being subpoenaed, even.

Typical rubbish.

What do you imagine would happen that would give a medical board the right to examine your medical records?

 

[Microshaft]

strong username to post content ratio

if so, damn...

 

[Rendar5]

I only see 1 person spouting opinionated rubbish without any backup of evidence or experience written

 

[cbrons]

I only see 1 person spouting opinionated rubbish without any backup of evidence or experience written

You want me to provide evidence of a negative? That’s not how it works bud. The people trying to scare everyone need to produce the evidence.

 

[Rendar5]

You want me to provide evidence of a negative? That’s not how it works bud. The people trying to scare everyone need to produce the evidence.

How about explain the incidents where a physician reported major psychiatric illness and was hospitalized and did not have to provide any medical record supporting the fact that they are able to reliably practice in order to obtain state licensure. The only one acting scared is you. It looks like the people you’re arguing with here are actually familiar with some cases. I do know an ex of mine needed a healthcare provider of some sort to say she was safe to practice due to some alcohol and psych issues during med school, and I know she would have taken a huge career risk if she didn’t voluntarily disclose information. It doesn’t stop her from getting a license. Just a few hoops. Lying to a medical board on the other hand...I know stuff varies from state to state and I can’t speak for all 50. Some might not need a report. And it only needs reporting if it is something that would interfere with care such as having psychotic episodes, etc. plain old depression requiring outpatient treatment wouldn’t really apply.

 

[MDSurvivor]

We talked about this. You could lie. If for some reason your health becomes an issue during your residency and your ability to practice medicine safely is questioned, it could lead to steps where you would be required to disclose your medical record to the medical board, or have your license suspended. It could lead to your records being subpoenaed, even.

This is not conjecture. This is historical fact. I thought it was shocking until I saw it happen.

This is also why you should never lie to the medical board.

Looking through all the posts, I'm quite concerned about the future prospect of my career. I just don't want to disclose and then have to have my entire life re-examined again in front of a total group of strangers, and then get blamed again. I mean if we just look at how SDN reacted to a physician sexually assaulting patient(s) (link here) and then the accusers getting blamed, what will happen to me?

The entire ordeal after being assaulted has affected me quite heavily. I feel like psych is already a very subjective specialty, and I would really rather not have a dx on the record as it raises more questions than answers, creating more problems and stress. If anyone does have any idea on how I can challenge the dx and possibly get it removed, can you let us know?

 

[cbrons]

How about explain the incidents where a physician reported major psychiatric illness and was hospitalized and did not have to provide any medical record supporting the fact that they are able to reliably practice in order to obtain state licensure. The only one acting scared is you. It looks like the people you’re arguing with here are actually familiar with some cases. I do know an ex of mine needed a healthcare provider of some sort to say she was safe to practice due to some alcohol and psych issues during med school, and I know she would have taken a huge career risk if she didn’t voluntarily disclose information. It doesn’t stop her from getting a license. Just a few hoops. Lying to a medical board on the other hand...I know stuff varies from state to state and I can’t speak for all 50. Some might not need a report. And it only needs reporting if it is something that would interfere with care such as having psychotic episodes, etc. plain old depression requiring outpatient treatment wouldn’t really apply.

“An ex of mine”

Ok bud.

Getting a DUI or using illegal drugs = criminal issue. Of course they are going to demand info for those types of things. That is very clearly not what the OP is talking about. She is talking about depression/anxiety treatment.

 

[cbrons]

Looking through all the posts, I'm quite concerned about the future prospect of my career. I just don't want to disclose and then have to have my entire life re-examined again in front of a total group of strangers, and then get blamed again. The entire ordeal after being assaulted is already quite heavy. I feel like psych is already a very subjective specialty, and I would really rather not have a dx on the record as it raises more questions than answers, creating more problems. If anyone does have any idea on how I can challenge the dx and possibly get it removed, can you let us know?

I wouldnt let anyone scare you with their fictional stories about medical boards subpeoning the treatment records of physicians when they apply for a license. That’s not how the law works. Just because you are a physician doesn’t mean the state board of medicine has a right to go through your personal medical records.

Now if you have a history of DUI or volunteer a history of substance abuse, they may ask that you provide documentation from your physician (not a “provider”). A few states ask if you have any medical conditions which could impact your ability to practice medicine safely. If you answer yes, then whatever other documentation they want is on you. They cannot simply order a hospital to hand over your records, hence they cannot verify any of it without your permission. They do not have the authority to do that.

The medical board is never going to find out that you are seeing a therapist unless you want them to know you are seeing one. Same goes for taking medication.

There is literally no reason to suffer.

 

[MDSurvivor]

I wouldnt let anyone scare you with their fictional stories about medical boards subpeoning the treatment records of physicians when they apply for a license. That’s not how the law works. Just because you are a physician doesn’t mean the state board of medicine has a right to go through your personal medical records.

Now if you have a history of DUI or volunteer a history of substance abuse, they may ask that you provide documentation from your physician (not a “provider”). A few states ask if you have any medical conditions which could impact your ability to practice medicine safely. If you answer yes, then whatever other documentation they want is on you. They cannot simply order a hospital to hand over your records, hence they cannot verify any of it without your permission. They do not have the authority to do that.

The medical board is never going to find out that you are seeing a therapist unless you want them to know you are seeing one. Same goes for taking medication.

There is literally no reason to suffer.

The problem is quite a few of the questions are stated in black-and-white terms like "Have you ever been dx with depression, ..." or "Have you ever been dx with ... or any psychiatric disorder?" I mean we already have people who understand MI and yet discriminate against it. I read a post on here before about someone who was raped and then the PD/interviewer (a psychiatrist) asked "do you have PTSD?" and started grilling the individual. I don't want that to happen to me. I don't want to have to have my private life of being raped opened all over again. I'd really rather have it handled very privately and not have that label sticking around that can haunt me in the future. This just makes be afraid/reluctant to continue to seek help and I really, really don't want that stigma on me. I don't want to be like singing and dancing kumbaya and pretending that it's ok and there's no stigma. When you're competing with people, you don't want your weakness to be held against you. On the other hand, I've also read on SDN how someone sought counseling after a divorce and the medical board began to be very aggressive wanting to know all the details...why the singular focus on mental health?

 

[neoevolution]

When state medical boards subpoena medical records, how do they know which doctor to subpoena? Do they make you turn over insurance records to see who you've been to?

 

[MDSurvivor]

When state medical boards subpoena medical records, how do they know which doctor to subpoena? Do they make you turn over insurance records to see who you've been to?

I have no idea. I sometimes wonder whether MDD is purely dx solely for billing purposes. I seriously wonder why medical boards can't treat being hit by a car and the aftermath of being raped in a similar light.

 

[Beargryllz]

Just leave it blank and in the 1-in-a-million chance you get called on it, argue about it

 

[Rendar5]

On the other hand, I've also read on SDN how someone sought counseling after a divorce and the medical board began to be very aggressive wanting to know all the details...why the singular focus on mental health?

It’s not just mental health. There are several things that come up when applying for licensure. I had to send a letter and write a couple paragraphs about a malpractice suit I was named in as a resident (5 years later the suit was finally dropped against the 11 residents named so I finally don’t have to list it). when getting my license and when applying for hospital privileges. I freaked out about it several times. It never affected anything though because it wasn’t anything egregious. So you may have to write that you have MDD in some states. You don’t need to explain any background information on it. You don’t have to tell anyone you were raped. At worst you get a letter from your psychiatrist stating that you’re ok to practice medicine. And in most states if it doesn’t interfere you don’t have to list it. Short of uncontrolled psychosis and delusions it won’t affect anything to the degree you fear. One friend in medical school was suicidal and depressed from his own issues that have social stigmatizations and had to be psychiatrically hospitalized for it. In 3rd year. He had no issues getting licensed, was a chief resident, and has worked in a couple states and never had any issues getting licensed. I’m not ware that he ever had to share the stories that were associated with his depression.

 

[neoevolution]

It’s not just mental health. There are several things that come up when applying for licensure. I had to send a letter and write a couple paragraphs about a malpractice suit I was named in as a resident (5 years later the suit was finally dropped against the 11 residents named so I finally don’t have to list it). when getting my license and when applying for hospital privileges. I freaked out about it several times. It never affected anything though because it wasn’t anything egregious. So you may have to write that you have MDD in some states. You don’t need to explain any background information on it. You don’t have to tell anyone you were raped. At worst you get a letter from your psychiatrist stating that you’re ok to practice medicine. And in most states if it doesn’t interfere you don’t have to list it. Short of uncontrolled psychosis and delusions it won’t affect anything to the degree you fear. One friend in medical school was suicidal and depressed from his own issues that have social stigmatizations and had to be psychiatrically hospitalized for it. In 3rd year. He had no issues getting licensed, was a chief resident, and has worked in a couple states and never had any issues getting licensed. I’m not ware that he ever had to share the stories that were associated with his depression.

What about recovered addicts? There was a post from a resident a while back who disclosed a history of some sort of addiction and the board made him get repeated drug tests

 

[Crayola227]

Typical rubbish.

What do you imagine would happen that would give a medical board the right to examine your medical records?

It's not rubbish when it's true.

I don't have to imagine. LOL, I know exactly what would happen.

 

[Crayola227]

The problem is quite a few of the questions are stated in black-and-white terms like "Have you ever been dx with depression, ..." or "Have you ever been dx with ... or any psychiatric disorder?" I mean we already have people who understand MI and yet discriminate against it. I read a post on here before about someone who was raped and then the PD/interviewer (a psychiatrist) asked "do you have PTSD?" and started grilling the individual. I don't want that to happen to me. I don't want to have to have my private life of being raped opened all over again. I'd really rather have it handled very privately and not have that label sticking around that can haunt me in the future. This just makes be afraid/reluctant to continue to seek help and I really, really don't want that stigma on me. I don't want to be like singing and dancing kumbaya and pretending that it's ok and there's no stigma. When you're competing with people, you don't want your weakness to be held against you. On the other hand, I've also read on SDN how someone sought counseling after a divorce and the medical board began to be very aggressive wanting to know all the details...why the singular focus on mental health?

First of all, it is VERY easy for this to NEVER come up in any residency or job interview. Nothing I ever said about the medical board should make you think that this would ever go anywhere else.

Before you even accept and interview in a state, you can look up that state's licensing forms. Or if not, call anonymously and ask them what they ask for regarding mental health. Every form I have seen has indicated what steps the board would take if they were to want to do more beyond taking your word for the fact that you had MDD but you're managing work fine. Rarely would they want anything further. There are plenty of ways if they did want more information, to provide it and protect your privacy, and not go into any gritty details.

I've talked in here about the very worst case scenarios, so people know what they are, and what to do about it. Because believe me, when it happens to you and you come looking to SDN.... let's just say I have an idea of how the rubber of theory meets the road of experience. And it's better going in already knowing all the potential outcomes. In fact, it helps you aim for the one you want.

The worst case scenario is NOT going to happen to you. And the worst case scenario is still manageable.

I get that you're been through a lot of trauma so this is all just more unknown unpleasant bullshyte, and I don't blame you if you never want to talk about this ever again, and certainly not with anyone you don't want to.

You seriously won't need to. This is only going to come up if it affects your ability to practice. Take an LOA before that can happen, and then you could theoretically say no. If you have to say yes...

The board will likely DO NOTHING. If they wanted to ask you about it, you could be vague and it would be fine. If they wanted to see your records for some reason... you can ask your psychiatrist/provider what is in your records. You could ask them to communicate with the board in a way to respect your privacy but address any concerns the board has.

If you have to deal with the board regarding your license and your mental health, and SERIOUSLY from what you have described it's not going to happen to you, but on the off chance it did, you can easily (although not cheaply) get an attorney that specializes in dealing with that state medical board, and have them represent you. In fact, I highly recommend it to anyone who can afford it for anytime you have any concerns about dealing with the board. It's up to you if the attorney just advises you or formally represents you. Beyond a few instances, you won't even have to talk to the board directly if you go the latter route. In fact, most of the time they are barred from contacting you directly, and everything goes through the attorney.

I have seen how a residency program crucified some residents with mental health... while supporting the one that had been sexually assaulted. Given your circumstances, no medical board is going to grill you about this. They likely won't even ask you for jack squat after filling out your form.

I think I checked mine that I had a mental illness in the past, but that is didn't affect my ability. I did this to apply to one of the most Orwellian boards as far as MH. Nothing happened. No follow up needed at all.

I didn't go into all this to freak you out. I just wanted the thread to know everything I know about mental health and licensing, because people come in saying a lot of things that they think should be true, but isn't based on experience, so I'm just putting the word out there. The good, bad, zebras, and horses. Yours is a horse.

 

[Crayola227]

Just leave it blank and in the 1-in-a-million chance you get called on it, argue about it

I guarantee that if it went poorly, this would be infinitely worse than having just opened the can of worms to begin with

 

[Crayola227]

When state medical boards subpoena medical records, how do they know which doctor to subpoena? Do they make you turn over insurance records to see who you've been to?

Here's how this works.

You apply for a license. Fill out the form. Check the boxes. Say the board wants more info about your mental health. They could say, "We require that you release your records to us as a condition of licensing." You could say, "No." They could say, "We won't license you."

So you comply and sign over your records.

This is how things can go initially. Say that doesn't happen.

Here's the thing in any case. When you apply for that license, you typically sign something saying that you would cooperate with any investigation the board may need to make into your practice. This will apply to malpractice suits, complaints lodged against you by anyone to the board, if there is other concern for negligence or wrongdoing, or if there is reason to think that you are practicing in some way impaired. Make sense? Makes sense to most people, so they sign this.

It varies state by state how the state law is written regarding the powers of the board. Every state board is just that, it is a government regulatory body that is legislated into existence. The law establishes it, and gives it some powers. Sometimes the powers are very specific and limited, and other times vague and broad. To some degree or another every board is granted some leeway to make up its own rules, or official policy, which are almost as good as law as far as the physician is concerned.

As a resident, you are being closely supervised by your program. Some problems the program can just manage internally. Some problems they are required to report to the board. If mental illness started to affect your work, there's a lot of things that might happen as a result. The program or the board might have questions for you about your performance and any mental illnesses that might be affecting it, and what, if anything you are doing about it. You might say, "I am under the care of Dr. X for Y" to make everyone happy. They might ask for a note from "Dr. X". Let's say that the board wants more, though.

Let's say that you want to refuse to let the board see all your medical records now. This has gone too far!

The board may have already opened a formal investigation already, or may do so now.

The way they know who to subpoena, is that at some point the physician was complying with the board, either at initial licensure, or later on as I've described, and the board is aware of what providers you are seeing.

The other thing is, that most people are insured through their employer. Yes, the board can ask the hospital for any records related to your employment as part of an investigation. They can then access your insurance records.

Why can the board do this? Well, you already signed that as a condition of your licensure, you would cooperate in an investigation. If the investigation is into your mental health, it stands to reason they need your medical records. HIPAA protects your medical information in certain ways, and with certain exceptions. Basically, 2 things: you have signed that you will comply with the investigation, and that investigation isn't necessarily closed if you decide to forfeit your license, and a judge has to find that under state law the board (government regulatory body with authority) has the legal right to access those records as evidence as part of their investigation, and be willing to sign an order for your records. It is a court order. They're not exactly impossible for a medical board to get depending on the state and law, and it amuses me that everyone is so shocked. I was too, until I learned how things work.

Talk to any psychiatrist about subpoenas.

This is one reason why a lot of physicians will tell you to seek care outside your hospital system, EHR system, and pay out of pocket for some things.

 

[Rendar5]

What about recovered addicts? There was a post from a resident a while back who disclosed a history of some sort of addiction and the board made him get repeated drug tests

My ex had this. There are programs out there just for physicians with substance abuse where they do random testing and treatment. The programs are very familiar with licensing and as long as you stick with them they’ll satisfy the medical boards

 

[NickNaylor]

I am licensed in a state that only requires disclosure if a disorder might affect your ability to practice. I developed anxiety during MS3, saw a psychiatrist for about a year, took an SSRI for about 6 months, and then tapered off. Continued seeing a psychotherapist regularly.

I did not report any of this to the medical board as I did not feel that it impacted my ability to practice. Even though I was prescribed a BZD at one point, there was no follow-up whatsoever and I was never asked to provide any additional information.

Every state is going to have its own peculiarities so you will ultimately have to investigate this on your own for the state you’re applying for licensure in, but I find it exceedingly hard to believe that having a history of MDD and taking an antidepressant will have any impact whatsoever on your ability to get a license. You may have to answer some questions about it and provide treatment records (a gross invasion of privacy and ridiculousness IMO, but that’s neither here nor there), but MDD is so common - particularly in medical trainees - that in the absence of markedly severe symptoms (e.g., MDD with psychosis) I can’t imagine this would limit your ability to get licensed.

 

[MDSurvivor]

I am licensed in a state that only requires disclosure if a disorder might affect your ability to practice. I developed anxiety during MS3, saw a psychiatrist for about a year, took an SSRI for about 6 months, and then tapered off. Continued seeing a psychotherapist regularly.

I think it starts getting tricky when boards add the word "might" affect your ability to practice. I'd like to see someone write something normal like sleep deprivation.

 

[NickNaylor]

I think it starts getting tricky when boards add the word "might" affect your ability to practice. I'd like to see someone write something normal like sleep deprivation.

At least in my state, the threshold of “affect your ability to practice” is quite high. “Affect your ability to practice” does not mean that you’re practicing at 90% of your usual level. “Affect your ability to practice” is interpreted to mean complete inability to practice medicine safely, and even the threshold of “practice medicine safely” is quite high and essentially describing gross negligence.

Thus, the operating phrase is not “might” but “affect your ability to practice.”