Data from a research letter published in JAMA suggest that state medical license applications infrequently and inconsistently adhere to recommendations regarding physician mental health. Across 54 states, jurisdictions, and territories, only 1 state adhered to all 4 evaluable recommendations from the Federation of State Medical Boards (FSMB) regarding the psychiatric well-being of physicians.

In 2018, the FSMB introduced 10 recommendations addressing mental health and burnout among physicians, among which 4 are evaluable in licensing applications. The recommendations advise against asking broad questions about mental health, as such practice frequently discourages practitioners from seeking help.

Specifically, the FSMB provided the following 4 guidelines for mental health-related questions on licensing applications: (1)”only if impaired,” or only inquiring about mental health conditions which result in significant impairment; (2) “only current,” or limited to questions about mental health symptoms in the past 2 years; (3) “safe haven nonreporting,” or offering physicians to not report diagnoses or treatment history if they are enrolled in a Physician Health Program; and (4) “supportive language,” or phrasing of questions in such a way that avoids stigmatizing psychiatric conditions.

To assess whether states and territories adhered to these FSMB recommendations, authors obtained copies of initial license medical applications from 50 US states, the District of Columbia, Guam, the Northern Mariana Islands, and the US Virgin Islands.

Data from each application were coded for consistency with the 4 FSMB recommendations. Each state received an overall “consistency” score ranging from 0 to 4, indicating consistency with none to all recommendations, respectively.

Of applications from 54 states and territories, 39 (72%) adhered to the “only if impaired” recommendation; 41 (76%) to the “only current” recommendation; and 25 (46%) to the “safe haven nonreporting” recommendation. Seventeen states (31%) had applications which did not address mental health, and were thus considered to adhere to these 3 recommendations.

Just 8 states (15%) were consistent with the “supportive language” recommendation. A total of 5 states had a consistency score of 0, indicating adherence to none of the 4 recommendations. Just 1 state (North Carolina) was consistent with all recommendations. The mean consistency score was 2.1±1.1.

According to these findings, FSMB recommendations have yet to be fully adopted in initial medical licensing applications. Although the number of states adhering to recommendations has improved since 2017, the authors emphasized the necessity of more inclusive licensing practices.

In the midst of the COVID-19 pandemic, the mental health burden among physicians has intensified drastically. As such, “barriers to help-seeking pose an even greater threat to physician wellness,” the authors wrote.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Saddawi-Konefka D, Brown A, Eisenhart I, Hicks K, Barrett E, Gold JA. Consistency between state medical license applications and recommendations regarding physician mental health. JAMA. 2021;325(19):2017-2018. doi:10.1001/jama.2021.2275

This article originally appeared on Psychiatry Advisor