Would you be hesitant to seek help for a mental health disorder if you thought it could compromise your career?

It’s a decision that many physicians struggle with when considering treatment for burnout, depression, anxiety and other mental health disorders.

Studies have found that many clinicians are reluctant to seek help for mental health issues because they believe it will negatively impact their ability to attain, retain or renew their state medical license, or diminish them in the eyes of their colleagues.

Daniel Saddawi-Konefka, MD, MBA

When the first surge of the COVID-19 pandemic hit last spring, Daniel Saddawi-Konefka, MD, MBA, the program director for the Anesthesia Residency at Massachusetts General Hospital, was worried that these barriers would prevent his residents from getting the help they needed.

He shared these concerns with his neighbor, Ariel Brown, PhD, a Director of medical science at Sage Therapeutics in Cambridge and former research scientist in Department of Psychiatry at Mass General.

Brown wanted to find a way to help, and the two started a nonprofit organization called The Emotional PPE Project, with a mission to connect any healthcare worker in the country to free mental health care services from licensed therapists.

Saddawi-Konefka and Brown also wanted to advocate for systemic changes in the medical field that could increase the availability of mental health resources for physicians—and to reduce the stigma that often accompanies seeking help.

They first looked at how questions about mental health disorders are posed on initial state medical license applications. Application forms vary by state as do the type and nature of questions asked about mental health.

Ariel Brown, PhD

In 2018, a working group on physician burnout from the Federation of State Medical Boards issued a series of recommendations designed to reduce the barriers to accessing mental health care. Four of their recommendations related directly to medical license applications:

• If the questions about mental health are asked, they should be limited to conditions that result in impairment (“only if impaired”)
• The questions should be limited to conditions that the individual is currently experiencing (preferred) or has experienced within the past two years (“only if current”)
• The application should have the option for safe haven non-reporting, where applicants are not obligated to report their diagnosis or treatment history if they are being monitored by and in good standing with a physician health program (“safe haven non-reporting”)
• The application should include supportive/normalizing language regarding physicians who seeking mental health care (“supportive language”)

With those recommendations in mind, the team analyzed publicly available initial medical license applications from all 50 states as well as Washington DC, Guam, the Northern Mariana Islands and the US Virgin Islands (a total of 54 applications).

The applications were rated on a scale of 0-4 based on their consistency with each of the FSMB recommendations. They found that as of July 2020:

• 39 applications (72%) were consistent with the “only if impaired” recommendation
• 41 applications (76%) were consistent with the “only if current” recommendation
• 25 applications (46%) were consistent with the safe haven non-reporting recommendation
• 17 applications (31%) had no questions that would require reporting mental health conditions
• Only 8 applications (15%) were consistent with the “supportive language” recommendation

Only one state—North Carolina—met all four of the FSMB recommendations at the time of the team’s analysis.

Five states—Alaska, Idaho, Wyoming, Florida and Kansas, were not consistent with any of the recommendations (though the applications for Alaska and Florida have since been revised and appear to be more in line with the FSMB recommendations).

More widespread adoption of the FSMB’s recommendations could be a small move toward reducing physician fears about the impact of seeking treatment for mental health care, Saddawi-Konefka says.

“While it is important for state boards to know if a physician has an impairment that will impact patient care, there’s a balance that needs to be struck in terms of keeping physicians safe as well.”