There are steps we can take to curb doctors' high suicide rates.
Almost 40 percent of doctors fear that asking for help could imperil their medical license.
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Almost 40 percent of doctors fear that asking for help could imperil their medical license.

(Reuters Health) - Nearly 40 percent of U.S. physicians are reluctant to seek mental health careout of fear that it might imperil their medical license, a recent study suggests.

The reluctance was more pronounced in states where licensing applications questioned doctors about mental health conditions going back more than a year. Physicians in those states were at least 20 percent more likely to report they would be reluctant to seek psychological treatment than doctors in states that asked only about current impairment.

“The medical license application questions are getting in the way of very treatable mental health disorders and probably contributing to the high rates of suicide among physicians,” said lead author Dr. Liselotte Dyrbye, a professor of medicine and medical education at the Mayo Clinic in Rochester, Minnesota.

Past research has found that some state medical boards might sanction physicians just for having a mental health diagnosis, Dyrbye’s team writes in Mayo Clinic Proceedings. Other studies have found that disclosing mental health conditions on licensure forms can lead to overt or covert professional discrimination, they add.

Each state has its own process for licensing doctors. The Federation of State Medical Boards advises licensure boards not to ask about mental health history and indicates that doing so might violate the 1990 Americans with Disabilities Act, Dyrbye and her colleagues note.

“Our own licensing system is creating a barrier to getting help,” said Dr. Katherine Gold, a professor at the University of Michigan in Ann Arbor who was not involved with the new research. “Physicians are appropriately afraid they could lose their license or have restrictions on their license. So of course they are hesitant to seek care.”

Doctors’ hesitation to seek psychological and psychiatric treatment is particularly worrisome, she said, because prior research has shown that doctors, as a group, suffer high rates of depression and suicide.

“We should be doing everything possible to reduce stigma and encourage physicians to get the exact same care we would prescribe to our own patients,” she said by email.

Dyrbye and her team analyzed initial and renewal medical license application forms from all but three states, along with more than 5,800 doctors’ answers to a survey of their attitudes about seeking mental health treatment.

The researchers found that 32 of 48 state licensing boards continue to question doctors about their mental health history. Of 5,829 survey participants, 2,325 reported that potential repercussions of answering questions about their mental health on licensing applications would make them reluctant to seek treatment.

Dyrbye’s team describes the mental health history licensing questions as “a major deterrent” to troubled physicians seeking help.

The American Psychiatric Association has found no evidence that a doctor who has been treated for a mental illness is any more likely than a doctor with no history of mental health care to harm a patient, Dyrbye said in a phone interview.

“We want to lift the barriers to care for mental health conditions before physicians medicate themselves,” she said. “We need to get people help earlier in the process. Our goal is to improve the work lives of physicians so they can deliver excellent, compassionate care to their patients.”

Dyrbye and Gold both called for state licensing boards to limit application and renewal questions about mental health to just current possible impairment.

“We do not have evidence that a physician’s past episode of depression or anxiety poses any risk to patient care,” Gold said. “So instead of protecting patients, these questions basically serve to stigmatize physicians.”

Dr. Thomas Schwenk, dean of the University of Nevada, Reno, School of Medicine, also called for dropping questions about prior history of mental illness from medical licensing and renewal applications.

Physicians no doubt remember answering questions about whether they sought care for mentalhealth on their license applications when they might later actually consider getting care, said Schwenk, who was not involved with the study.

“There are well-accepted and appropriate ways for state licensing boards to ask about physician impairment, and my hope is that this study will move licensing boards to consider those changes,” he said by email.

SOURCE: Mayo Clinic Proceedings, online October 2, 2017.

If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HELLO to 741-741 for free, 24-hour support from the Crisis Text Line. Outside of the U.S., please visit the International Association for Suicide Prevention for a database of resources.

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