Quoted: Medical Licensing and Mental Health

[NotAProgDirector]

Everyone knows that, if you receive mental health treatment as a physician, you have to disclose it to your state medical board. But I have yet to meet anyone who has actually gone through a review process (or at least anyone willing to admit it), or anyone who knows how the decision is made whether to suspend a medical license for mental health reasons.

Assuming that someone received care for a psychiatric diagnosis that does not (in the opinion of the treating psychiatrist) prevent safe practice by the physician patient, I was wondering about the following:

(1) Do you have to disclose all records related to the diagnosis? If so, would that include psychotherapy notes, which in most cases have more protection than other types of documentation?

(2) Do state medical boards require formal hearings where you have to make a personal appearance? Do they ever require an independent evaluation by their own psychiatrists, like on those TV court dramas?

(3) Once you disclose this, are you obligating yourself to reporting all mental health follow-up the rest of your career? Do you have to participate in the impaired physician programs that they have for substance abusers?

(4) I know that public notification is made when a license is suspended or revoked, as well as when boards issue letters of concern or censure. Does the board also make mental health diagnoses public if no adverse action is taken?

Thanks for any help you can offer. I'm not there yet, but might be in the next 6mo or so.

I'm not going to readily agree with your initial assumption -- that you need to disclose any mental health problem to your medical board to get licensed. Each state is different, and hence the rules will be different for each. Since I'm from New England, let's choose Massachusetts to look at since it tends to be seen as one of the "most strict" states in NE to get a license from.

The questions on the application are these:

16-A. Since becoming a medical student, have you been diagnosed with or treated for a medical condition which in any way currently limits or impairs your ability to practice medicine or to function as a physician?
16-B. Do you currently have a medical condition which in any way limits or impairs your ability to practice medicine or to function as a physician?

The instructions state:

16-A and 16-B. Medical condition: “Medical condition” includes physiological, mental or psychological conditions or disorders, such as, but not limited to orthopedic, visual, speech, hearing and memory impairments, cerebral palsy, epilepsy, muscular dystrophy, multiple sclerosis, cerebrovascular disease, cognitive disorders, cancer, heart disease, diabetes, emotional or mental illness, specific learning disabilities, HIV disease, tuberculosis, drug addiction and alcoholism.
“Ability to practice medicine” is to be construed to include all of the following:
1. The cognitive capacity to make appropriate clinical diagnoses, exercise reasoned medical judgments and learn and keep abreast of medical developments; and
2. The ability to communicate those judgments and medical information to patients and other health care providers, with or without the use of aids or devices, such as voice amplifiers; and
3. The physical capability to perform medical tasks such as physical examination and surgical procedures, with or without the use of aids or devices, such as corrective lenses or hearing aids.
“Currently” does not mean on the day of, or even the weeks or months preceding the completion of this application. It means recently enough to have an impact on one’s functioning as a licensee, or within the past two years.

So, looking at these rules:

1. If you take an SSRI for depression, or if you get counseling regularly, as long as it doesn't affect your ability to practice medicine, doesn't need to be reported.
2. If you hear voices telling you to kill people, even if you're on medication which keeps it under control, you should probably report that.
3. Between those two extremes, there's a lot of gray area. Whether or not to report will depend on how old the problem is, whether it required a leave of absence, and whether it affected your training.

To answer your questions:

1. You are not required to release your records. You need to explain what the problem was and what was done about it. It's possible that the board will request more information, and then you'll need to balance your need for privacy against the board's need for information.

2. The board can request that you meet with them in person. Some boards do this all the time, some very rarely.

3. Only if you're impaired

4. No, not that I know of.

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[nitemagi]

I would just be aware of the risk of a situation being reported by a third party to the board, particularly if you haven't disclosed it previously. It's an interesting and gray area, and a big issue within all of medical practice as fear of disclosure often leads to avoiding getting treatment.

This can be an issue in credentialing as well. But I'd agree with aPD, they usually ask not whether you have a mental disorder/illness, but whether you have a mental disorder that impairs your ability to practice. Which is a self-assessment. I've never seen an actual disclosure in our state medical board newsletter about the actual illness, but there's an occasional "medical illness that impairs their ability to practice."

If you're worried, can always consult a lawyer.