Response to “Do Medical Licensing Questions on Health Conditions Pose a Barrier to Physicians Seeking Treatment? A Literature Review”

We read with interest the recent article “Do Medical Licensing Questions on Health Conditions Pose a Barrier to Physicians Seeking Treatment? A Literature Review,” noting particularly the authors' conclusion that medical licensure health disclosure questions create a barrier for physicians accessing care.¹ We appreciate the authors' recognition of this distinctive barrier to physicians seeking care, their call for reducing stigma associated with mental health, and their emphasis on the need to encourage treatment-seeking among physicians. As individuals engaged in work to remove barriers to medical students seeking mental health care, we are writing to also implore academic medical centers (AMCs) to engage in parallel efforts to reduce barriers to medical students receiving mental health care. Specifically, we call for the removal of questions that stigmatize mental health from credentialing applications.

Medical students are committed to becoming capable and compassionate physicians for their future patients. This preparation includes the recognition that medicine is a demanding profession that necessitates a certain degree of self-care and introspection. As such, many students seek mental health care and other related services. Unfortunately, students do so without knowing that seeking such care could affect their licensure application in some states and could have other negative implications on their medical careers. One paper found that 91% of US medical students were unsure or incorrect about state licensing board requirements regarding mental health disclosure, and 75% opposed mandatory disclosure.²

Underscoring medical students' lack of knowledge about these requirements is data from 2017 showing that 11% of US medical students experience suicidal ideation.³ Compounded with other stressors inherent to medical training, it is easy to imagine how the most vulnerable medical students being disproportionately affected by such stigmatizing questions on future applications. These practices may affect medical students' transition into residency, and in the long-term can impact the health of the future physician workforce.

We need to remove structural barriers to mental health care at multiple levels. AMCs are a logical place to enact reform since all medical students start their careers in these institutions and many AMCs are developing programs encouraging student mental health and wellness. If AMCs commit to the removal of questions about mental health or mental health care from medical credentialing applications, we will take a tangible step towards better care of and support for medical students.