Even as doctors across America encourage their patients to share concerns about depression or anxiety so they can get be treated, a new study suggests depressed doctors may be less likely to seek help themselves.
Part of the reason lies in concern that, due to stigma, others may doubt their ability to keep up with a demanding profession.
But there’s another factor: Many states require physicians to report any mental diagnosis—no matter how mild, treatable, or how far in the past—to their state medical licensing board. Physicians may fear that seeking help for depression or anxiety could lead to restrictions on their medical license.
Avoiding treatment or paying cash
In a survey answered by more than 2,100 female physicians who are also mothers, nearly half believed they had met the definition for a mental illness at least some time during their career, but had not sought treatment. Two-thirds reported that fear of stigma drove them to keep their worries quiet.
One in three of the women who answered the survey said they’d been given a formal mental health diagnosis since medical school. Many thought they could manage their situation on their own, including writing their own prescriptions or paying cash for visits to avoid having an insurance company record, says lead researcher Katherine Gold, assistant professor of family medicine and obstetrics and gynecology at the University of Michigan Medical School.
Only 6 percent of those who had ever been diagnosed had reported it to their state licensing board, as most felt their condition didn’t affect the care they gave.
More research is needed on this issue, to reduce stigma among physicians and to help physicians feel safe seeking care, Gold says. And state standards should be examined to make sure focus on medical conditions which currently affect patient care, rather than requiring disclosure of old, mild, or stable and well-controlled problems.
The study, published in General Hospital Psychiatry, surveyed physicians anonymously via a closed Facebook group that acts as an informal career and parenting support network for more than 57,000 physicians who are mothers.
The situation is exacerbated by variations in state reporting requirement, Gold says. For instance, some states ask if physicians have ever been diagnosed with a mental health problem, while others ask if they’ve had such a diagnosis in the last few years. Some ask if they have ever been hospitalized for a mental health reason. Most positive responses result in increased investigation by boards.
“There has always been a stigma and a fear around mental illness, and that’s what’s reflected in many state licensing board questionnaires,” Gold says.
“There’s a huge discrepancy between what states ask about physical conditions—such as whether those conditions affect their ability to practice—and what they ask about mental conditions, where the impact on their abilities is not asked about.”
And while studies have shown that substance use issues can have an impact on physicians’ ability to practice, few studies have looked at whether and how non-substance-related mental health issues impair physician performance. In fact, some physicians report working even harder to keep their depression or other condition from affecting their patient care.
Challenges under the Americans with Disabilities Act to licensing requirements for other professions such as lawyers, may help to change the questions states ask physicians, Gold says. Since some mental health issues—such as post-partum depression or anxiety related to a specific event—are self-limiting, the wording of a state’s questions matters greatly. Similarly, medication and psychotherapy can control symptoms of other conditions over the longer term.
One option to help states modernize requirements around mental health might be to adopt the approach that hospitals use when deciding whether to extend credentials to a physician: requiring endorsements from a physician’s peers or supervisors based on performance.
Other researchers from the University of Michigan and from the University of Nevada are coauthors of the study.
Source: University of Michigan