On Tuesday, the Medical Board of California held an Interested Parties hearing regarding mental and physical health questions on licensing applications in the state. As many of you know, there is concern that the existing questions are an overreach into the personal lives of applying doctors and could either dissuade practitioners from applying for their license or from answering honestly due to pervasive stigma and the current phrasing of the language.
During the hearing, the Board heard from three planned speakers before public comment. The first speaker was Mark Staz, Chief Learning Officer for the Federation of State Medical Boards (FSMB). In his presentation, Mr. Staz shared the history of the FSMB and their previous work providing guidance to state medical boards on their licensing questionnaires. Initially, the FSMB’s work focused on ensuring consistency with the Americans with Disabilities Act, but through their research, they determined that more work was necessary to assess disrupted physician behavior and burnout, ultimately leading to the creation of the FSMB workgroup on Physician Wellness and Burnout. They assessed whether it is necessary to include probing questions about a physician applicant’s mental health, addiction, or substance use and determined that asking these questions could prove counterproductive to achieving patient protection. Based on this, the FSMB provided a series of recommendations on best practices, and Mr. Staz acknowledged that the current language in California’s questionnaire may have a chilling effect on applicants. He concluded with discussing the Attestation Model in which licensees acknowledge their responsibility in seeking appropriate treatment rather than being required to disclose any health issue that is properly addressed and that California moving in this direction could make the controversial language in the current application unnecessary.
The second and third speakers were Dr. Janelle Rhyne with the North Carolina Medical Board and Stephanie Loucka with the Ohio State Medical Board, both of whom shared their respective state’s recent efforts in making changes to their licensing applications. Dr. Rhyne shared that North Carolina has moved in the direction of an Attestation Model and are optimistic about its impact. North Carolina attempted a retrospective analysis to assess the impact of the changes but could not draw definitive conclusions due sample size and the limitation of the information. However, they did receive helpful feedback regarding physician burnout and challenges that may provide benefit in trying to address this issue. Ms. Loucka expressed similar sentiment in Ohio, with consistent indications being drawn about physician burnout and feelings of a lack of recognition including data suggesting nearly half of practitioners experiencing challenge getting treatment was due to insufficient time to do so. Ohio is much earlier in this process than North Carolina, but they view this as a positive opportunity to take a hard look at the impacts to practitioners while trying to protect the public.
Finally, the Board opened the hearing up to public comment, which saw a mix of responses from an array of organizations and individuals. The California Medical Association, CSAP, the UC System, and other like groups were among those who thanked the Board for their interest in this issue and reiterated their recommendations provided earlier through written comment. A copy of CSAP’s letter is here. On the other side, individuals citing their volunteer affiliation with Consumer Watchdog participated by sharing their concern in changing the language with many sharing personal anecdotes about improper practice from medical professionals having detrimental impacts on themselves or loved ones. Individual, unaffiliated practitioners also phoned in to share their thoughts on the questions.
No decisions were stated by the Board, but they thanked all those who participated. We will continue to monitor this situation and keep you apprised to any next steps or outcomes.