Some licensing questions at odds with the ADA

Researchers found that some state medical board applications may violate the nearly 20-year-old Americans with Disabilities Act.

The majority of state licensing applications contain questions or requests for sworn affidavits or signed releases authorizing access to information about substance abuse or a physician's physical or mental health. Such inquiries appear to violate the ADA, which prohibits discrimination on the basis of disability. The requests for information were faulted primarily because they delved into past conditions and behaviors that no longer may be relevant, according to the study.

Some of the questions could discourage physicians from seeking necessary treatment to avoid public disclosure, stigmatization and denial of their license, researchers said.

The study, published in the June Academic Medicine, is based on an analysis of 51 allopathic licensing applications from 50 states and the District of Columbia. It was conducted in 2005 by researchers from the University of Medicine and Dentistry of New Jersey in Newark.

Of the 49 applications with questions on physical or mental health or substance abuse, 34 contained at least one "likely impermissible" or "impermissible" question under the ADA, according to researchers. Impermissible questions were defined as those that did not provide information that would shed light on an individual's professional competence.

AMA policy urges licensing and specialty boards and others who evaluate physician competence to inquire only about conditions that impair a physician's current ability to practice medicine.

Some state medical board officials expressed concern about the study. The West Virginia Board of Medicine worked to bring its application into compliance with the ADA nearly a decade ago, said Robert C. Knittle, the board's executive director. "We had been given a green light, so we were a little taken aback when this group said one of our questions was impermissible."

One item on the Texas application was identified as such by the study. Although the authors include a breakdown by state as to how many items are "permissible" or "impermissible," the specific items are not included.

After reviewing the study, Mari Robinson, executive director of the Texas Medical Board, said via e-mail, "All of our questions have been considered by the board and their lawyers, and we believe they are fully compliant with the law."

Lisa Robin, senior vice president of the Federation of State Medical Boards' Member Services, said in a statement that the group's policy calls for medical licensure applicants to be "physically, mentally and professionally capable of practicing medicine in a manner acceptable to the board" and does not rule out requiring a physical or mental examination or a chemical dependency test.

Robin said the federation had not performed a legal analysis of the study, and she was unable to comment on its validity. But she said medical board applications may have changed since the study data were collected in 2005.

Rewording questions

Lead author Robin Schroeder, MD, director of the Student Health and Wellness Center at UMDNJ, said she would like application questions reworded to focus on an applicant's current ability to practice medicine. She hopes the study will focus new attention on the need to encourage physicians to seek help for medical conditions.

She points to physicians' high suicide rate as evidence that such assistance is needed. Each year, 300 to 400 physicians commit suicide, according to the American Foundation for Suicide Prevention.

In a commentary in the same issue of Academic Medicine, Steven Altchuler, MD, PhD, assistant professor of psychiatry at the Mayo Clinic in Rochester, Minn., said the study's researchers raised important issues. "They point out that many medical boards, in their efforts to understand which physicians have illnesses that may limit their practice, may have overstepped the legal bounds of the ADA with questions on licensure applications," wrote Dr. Altchuler, former president of the Minnesota Board of Medical Practice. "The challenge lies in reconciling boards' responsibility to identify applicants with illnesses that prevent them from practicing safely with its obligation to uphold the ADA and not prohibit the licensure of physicians whose illnesses do not affect their practice."

In an interview, Dr. Altchuler said that challenge can be resolved. "The bottom line is we want a solution that simultaneously allows every person who is competent and capable of practicing medicine to be able to do so, but we also want a way that protects the public from people who are not able to do so safely."