Acute episodeds of mental illness (grief, dysthymia, depression, anxiety, insomnia, PTSD, etc.) can strike ANYBODY at difficult times in their lives. Persons with recurring acute or chronic mental illness learn over time how to manage exacerbations of their symptoms, just like with any other chronic disease (diabetes, asthma, arthritis, heart disease, etc.). As with other chronic health problems, mental illness has the potential to cause impairment in the workplace when it is not properly recognized and treated.
Unlike with other chronic health problems, however, physicians with ANY history of mental illness may be automatically assumed by their state medical licensing board to have occupational impairment based simply upon their diagnosis. This assumption, by definition, is prejudice.
Once a potentially impairing mental health condition is even suspected in a physician, a formal investigation into that physician's competency may legally be initiated by their state licensing board or Physician Health Program (PHP). This investigation often involves complete loss of privacy of personal health information, including the physician's entire medical and psychiatric history, up to and including psychotherapy content. This personal health information may be reviewed, shared, discussed, and evaluated by untrained and unqualified state licensing officials, consultants, and contractors -- in order to ultimately make a determination on whether or not, and under what conditions, the physician should be allowed to continue practicing medicine. In some states, these practice conditions (and by implication the potential stigma of mental illness) are also made public. Practice conditions may include submitting to ongoing loss of privacy and autonomy in the physician's private life and medical/psychiatric care. Most states have procedurally and statutorily removed all due process rights for physicians caught up in this system.
We are working to help reconcile the need to protect the individual rights of physicians living and working with mental illness (including their right to privacy) with the need for state medical boards to protect the public. We feel that the question of a physician's fitness to practice medicine should ultimately be based upon professional competence and conduct, and not upon prejudice about mental illness.
If you are a physician struggling with physical or mental illness, disability, and/or substance abuse, we strongly encourage you to consider getting professional help. It may just save your life (and/or the life of one of your patients). Get help BEFORE you become impaired (in most states, you are legally required to report suspected physician impairment -- even if this is in yourself). If you hesitate to seek help because you are concerned about the possibility of losing your privacy, consider getting treatment in a different town, paying cash, and/or using an alias. Unfortunately, for the time being, there may be no better way to protect yourself from state medical licensing board injustice. If you ever learn that you are being investigated by your state licensing board, immediately contact a reputable licensed attorney for guidance and counsel. You may also be able to find support and advocacy from your state medical association. You are not alone!
Beyond Stigma: Bringing the Conversation About Mental Illness Forward
Medical LicensingA Challenge to Licensing Boards: The Stigma of Mental Illness - 1998 JAMA article by Minnesota physician Stephen H. Miles, MD, Professor of Medicine and Bioethics at the University of Minnesota, who experienced discrimination from his state licensing board in 1996 when he disclosed the diagnosis and treatment of his mental illness on a routine relicensing questionnaire. He filed an ADA complaint with the U.S. Department of Justice against the Minnesota Board of Medical Practice for illegally demanding that he submit to the Board copies of all of his mental health treatment records -- including therapy records-- as a condition of his relicensure to practice medicine. See DOJ opinion letter: Miles v. Minnesota Board of Medical Practice. Dr. Miles is currently practicing in Minnesota under an unrestricted license.
Disabled physician denied license: Supreme Court to rule on whether doctor may sue under AwDA - 2003 JADA article about California physician Michael J. Hason, MD who was initially refused a state medical license in 1998, due to his history of mental illness. Dr. Hason has been practicing in California under a probationary license since 2001.
Normal Is a Place I Visit - 2004 JAMA article by Washington physician Suzanne J. Fiala, MD, who risked the humiliation and stigma of medical board scrutiny when she published her first-hand account of a practicing physician living (and working) with bipolar illness. Dr. Fiala is currently practicing in Washington under an unrestricted license.
Licensing and Physician Mental Health: Problems and Possibilities - 2007 article from the Journal of Medical Licensure and Discipline, an official quarterly publication of the FSMB (Federation of State Medical Boards).
Our Fallen Peers: A Mandate for Change - 2008 article from Academic Psychiatry, the official journal of the International Journal of the American Association of Chairs of Departments of Psychiatry, American Association of Directors of Psychiatric Residency Training, Association for Academic Psychiatry, and Association of Directors of Medical Student Education in Psychiatry.
Physicians Working and Living with Mental Illness
Psychiatrists Not Immune To Mental Illness—or Stigma -
Commentary: Impaired Physicians and the New Politics of Accountability - 2009 article from Academic Medicine, the official Journal of the Association of American Medical Colleges (AAMC).
Physicians, Medical Students Struggle with Mental Illness and Suicide - 2008 article from the AAMC Reporter, the official periodical newsletter of the Association of American Medical Colleges (AAMC).
In October of 2010 the Oregon Medical Board finally revised a longstanding Oregon Administrative Rule which had required automaticsuspension of licensees with mental illness treated in a hospital for more than 25 consecutive days (http://www.oregon.gov/OMB/Rules/Oct2009/Final_847-065-0005.pdf).
Physician Suicide
www.physiciansuicide.com - Website dedicated to physicians suffering from depression.
Experts Address the Risk of Physician Suicide - 2005 article from the Journal of the American Medical Association (JAMA).
Taking Their Own Lives -- The High Rate of Physician Suicide - 2005 article from the New England Journal of Medicine (NEJM).
Confronting Depression and Suicide in Physicians - A Consensus Statement - 2003 article from the Journal of the American Medical Association (JAMA).
Physician Suicide Prevention Project - ongoing efforts aimed at physician depression and suicide, managed by the American Foundation for Suicide Prevention (AFSP).
Doctors in Distress - 2011 article from The Lancet
This page was last updated on 6/15/2013.