Previous research has suggested high rates of suicide and depression among physicians when compared with the general public. Debilitating mental illness can critically impact physicians’ ability to care for themselves or their patients and effectively practice medicine overall. However, most state medical boards require disclosure of mental health issues on physician licensing applications, which has been thought to increase stigma around mental health among healthcare providers and impact physicians’ desire to seek help for such issues.
Anecdotal Evidence or Real Phenomenon?
“I had heard physicians warning others not to seek treatment for mental health diagnoses or to do things like go to a different city to seek care, and I was curious if this was something I was just seeing anecdotally or if it was a real phenomenon,” says Katherine Gold, MD. For a study published in General Hospital Psychiatry, Dr. Gold and colleagues surveyed a convenience sample of physician mothers from a closed Facebook group that represents all medical specialties. Although the study involved only women, Dr. Gold says stigma and mental health reporting issues apply to both men and women. An anonymous, 24-question survey asked participants about mental health history and treatment, perception of stigma, opinions about state licensing questions on mental health, and personal experiences with reporting.
Among more than 2,000 respondents representing all 50 states and the District of Columbia (average age, 30-59), nearly one-half reported that they felt they met criteria for a psychiatric disorder at a given time since medical school but had not sought treatment. “More than two-thirds of reasons for people not seeking treatment were stigma-related,” says Dr. Gold. “They were afraid they would have to report to others or that colleagues would find out, and many believed that physicians shouldn’t need mental health treatment.” Other key reasons for respondents not seeking treatment included the belief that they could manage the issue independently and limited time.
Many respondents also felt that questions on state licensing boards asking “Do you have a diagnosis of mental illness?” were a major barrier for wanting to seek care for fear of jeopardizing one’s medical license, according to Dr. Gold. In fact, only 6% of those who were ever diagnosed or treated for a mental condition reported that information to the state. Other respondents said they sought care in different cities or health systems, paid cash for mental health-related prescriptions, or wrote their own prescriptions. Yet, three-quarters of those who had been diagnosed or treated for a mental health condition reported that their condition did not pose a potential safety risk to patients, including well-controlled depression or previously resolved post-partum depression.
Addressing the Stigma?
“Medicine attracts people who are hard-working, perfectionistic, competitive, and have high self-expectations,” Dr. Gold says, “and the culture of medical school, residency, and training is to make no mistakes, be perfect all the time, work hard, and not show any weaknesses. Although that appears to be changing, it has driven this culture in which physicians don’t want to talk about their own mental health issues. There are currently 43 state medical boards that ask questions about mental health on their licensing applications. Some ask questions that are limited to the problems that might cause impairment, but many states still ask simply, ‘Do you have a mental health diagnosis?’ or ‘Have you ever had a mental health diagnosis?’ We believe that inhibits physicians from ever wanting to get something like that put on their record. I think the first step would be to try to make the questions on state medical licensing boards be compliant with the Americans with Disabilities Act and also be written in a way as to identify physicians who might be currently impaired, not physicians who maybe once had postpartum depression, a time-limited problem, or an appropriately treated condition in remission.”
According to Dr. Gold, physicians should be aware of the types of questions their state medical boards ask in regard to mental health and speak up when those questions are not appropriate. “It’s important that physicians talk more about mental health and try to normalize it, but that’s hard when providers feel there will be a consequence if they seek help,” she adds. “Efforts to change the culture in which everything has to be perfect are important. A culture in which physicians don’t feel they can seek treatment for mental health, but yet mental health conditions can be harmful to them and their patients, is a problematic scenario. Although some state boards have reported efforts to change their questioning regarding mental health, there is still much work to be done as many states are out of compliance.” In the meantime, Dr. Gold strongly encourages that clinicians with mental health issues not try to treat themselves or write their own prescriptions and instead seek the care of another physician.