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Efforts to stop medical licensing boards from asking questions that could be used to discriminate against applicants with mental illness or substance abuse problems appear to be paying off.
A survey of state medical licensing boards published in APA's Psychiatric Services last month shows applications now focus more on current impairment from mental illness than diagnosis and treatment.
"An increasing number of medical boards are asking applicants questions related to current disabilities and treating psychiatric illness more evenly with physical illness," said Thomas Hansen, M.D., lead author of the article and an associate professor of psychiatry at Oregon Health Sciences University in Portland.
Hansen and his colleagues surveyed 66 members of the Federation of State Medical Boards in 1993 and late 1995 about questions on licensure applications that address mental, substance abuse, and physical disorders.
Sixty-three of the 66 boards responded in 1993 and all in early 1996. Federation members represent the 50 states, some of which have separate boards for osteopathic medicine, and Puerto Rico, Guam, the Virgin Islands, and the District of Columbia.
The results showed that 75 percent of the boards asking questions about mental illness in 1996 focused on level of impairment compared with only 42 percent in 1993.
For example, the North Carolina Medical Board asks, "Have you ever been or have you been told you are personally or professionally impaired as a result of your medical, surgical, or psychiatric condition other than substance abuse?"
In 1996, 53 of the 66 boards (80 percent) asked questions about mental illness on licensure applications compared with 48 of the 63 boards (76 percent) in 1993.
An even higher percentage of medical boards asking about physical illness in 1996 also addressed impairment (41 of 43). The boards were not surveyed in 1993 about impairment from physical illness or substance abuse, according to the article.
In contrast, fewer boards asking questions about substance abuse in 1996 addressed impairment (20 of 62 boards, or 32 percent).
Hansen attributed the fewer number of stigmatizing questions in general on medical licensure applications to lawsuits based on the Americans With Disabilities Act (ADA). The lawsuits challenge state medical boards and events such as a 1994 ruling in Clark v. Virginia Board of Bar Examiners against asking applicants broad questions about mental health treatment.
Two ADA-based lawsuits were brought against the New Jersey Board of Medical Examiners by the Medical Society of New Jersey between 1991 and 1994 challenging the boards' use of questions related to mental illness, substance abuse, and treatment.
At the court's urging, the medical board agreed to develop new questions that addressed applicants' current behavior and capability.
Hansen commented to Psychiatric News that despite these successes, about 25 percent of state medical boards are still asking applicants broad questions about past psychiatric illness that could be used to discriminate against them. For example, some boards have required applicants to report any previous psychotherapy for any condition.
"Medical boards justify asking these questions on the basis of protecting the public from impaired physicians," he commented. "Balancing the individual physician's interest with society's need for protection poses a difficult dilemma. However, the adverse consequences of stigmatizing mental illness include embarrassment for the physician and interference with seeking treatment."
The authors suggested that the ADA, passed in 1990, may be a useful guide for appropriate medical licensure questions because of its broad mandate for protecting people from discrimination.
"The ADA standards suggest that medical boards should emphasize current impairment, note recent behaviors, and not impose unnecessary burdens on physicians simply because of a perception of possible disability."
The authors also recommended that APA district branches consider contacting their local medical licensing boards to review the language on applications related to mental illness to assess whether questions focus on current disabilities.
If the language appears discriminatory, Hansen recommended that district branches form a committee and involve their board of medical examiners in developing new language as the Oregon Psychiatric Association has done, according to Hansen.