For many people, enrolling in med school represents the culmination of a long-term dream. Medical training can certainly be highly rewarding and fulfilling. However, there’s also a dark side. Depression and anxiety are staggeringly common among med students and residents.
Many studies have shown that med students have higher rates of depression than their age-matched peers. Residents are also at an increased risk, and rates of depression have been found to increase over the years of residency training. And the problem doesn’t end when medical training is over. Practicing physicians have significantly increased rates of depression and even suicide compared to the general population.
Doctors know better than anyone how important it is to seek help for mental health conditions. Almost all physicians would counsel a patient to seek treatment for depression, particularly if suicidal thoughts are involved. Yet many med students and residents don’t take this advice themselves. Unfortunately, this means that we lose people to suicide unnecessarily every year.
There are many reasons why med students may avoid getting help for mental health concerns, but one reason that’s commonly given is that they’re worried that it will hurt their careers in the future. So is there anything to worry about? If you’re struggling with depression, will getting help actually hurt your chances on your residency application? Will it affect your ability to get a medical license when the time comes?
For many med students, residency applications are foremost on their mind almost from the moment of entering med school. The Match can certainly be competitive (particularly in certain specialties), and it often feels like your whole future career is riding on it. If seeking help for depression would constitute a disadvantage on residency applications, then many med students will avoid seeking help for this reason.
Keep in mind that if you haven’t taken a leave of absence for the purposes of dealing with your mental illness, then there’s really no reason that you need to disclose it on your application. You have no obligation to discuss any of your personal medical information when applying for residency. If you go to counseling or take SSRIs, there’s no need for your residency program to know that unless you choose to disclose it.
In some cases, however, the disclosure may not really be optional. If you’ve taken a leave of absence in order to deal with the effects of a mental illness, then you’ll need to explain that leave of absence on your application. This will require being honest about what happened and how you dealt with it.
One study sought to find out whether a disclosure like this would have negative impacts on a student’s residency application. The researchers sent fictitious student narratives to the directors of residency programs. Some of the students were described as having taken a leave of absence during med school, while others were not. Of those who took a leave of absence, some had done so because of diabetes mellitus, while others had done so for major depression. The researchers also varied the performance of the student – average, good, or outstanding.
They found that there was in fact, a negative effect of disclosing depression on a residency application. Fortunately, however, the effect was not huge. Outstanding students with a leave of absence for depression were still invited for interviews at higher rates than average students with no leave of absence. So although it could count against you, you can certainly overcome any disadvantage that this causes.
There’s actually no national medical license. Rather, each state has its own board that grants licenses to practice medicine in that state. Because of this, the exact questions on the licensure application vary from state to state. There is generally some type of question about mental illness, but the specifics vary widely.
On the one hand, state medical boards have an obligation to protect the public. If a doctor is suffering from severe mental illness, and it makes them unable to practice medicine safely, then certainly it makes sense for a state medical board to deny that person a medical license. Physicians must function at very high levels, and it’s important that they be capable of doing so in order to keep their patients safe.
At the same time, if mental illness doesn’t interfere with a doctor’s ability to practice, then there’s really no reason that a mental illness should affect a doctor’s licensure. Many organizations argue that asking about mental illnesses on the licensure application serves only to discourage doctors from seeking help, while doing nothing at all to protect the public.
Some states do simply ask whether you’ve had a mental illness in the past two years, or even whether you’ve ever had any current or past mental illness. As we’ll explore later, this question is not actually legal, but many states ask it anyway. If you’ve ever sought treatment for depression or anxiety, then you would have to answer “yes” to the question. This doesn’t automatically disqualify you from receiving a medical license, but the board would ask for more specifics so that they can look into the situation and decide whether they believe you’re impaired. You would then need to submit your health records in order to allow the board to investigate. Unfortunately, there have been some instances where treatment for mental illness was an issue in a doctor’s licensing. However, in most cases, if you received treatment but your ability to provide patient care was never affected by your illness, then you would likely be able to get your license.
Many states have been moving to a slightly different question on the licensure application. Instead of simply asking whether or not an applicant has a mental illness, they ask instead whether or not an applicant has a mental illness that impairs their ability to practice medicine. The Federation of State Medical Boards recommended in 2018 that licensing boards limit asking about mental illness to an “only if impaired” question. As of 2021, 39 states were following this recommendation. If you’re applying for your license in one of them, then there’s no real need to worry that seeking mental health care will cause any problems with your licensure, as long as you’re still able to function well in patient care. You likely won’t even need to disclose it. In fact, seeking help while you’re still functional could avoid a situation where your condition worsens and does start to affect your patient care – which would then become a problem for your licensure.
HIPAA does protect you from unauthorized disclosure of your medical information. However, if a licensing board has questions about your fitness for practicing medicine, then HIPAA won’t really help you. You’ll need to submit whatever health records are necessary to satisfy the board that you’re capable of caring for patients. If you invoke HIPAA and refuse to turn over the records, then they’ll simply deny your application.
Not all doctors are aware of this, but the Americans with Disabilities Act (ADA) protects people from discrimination in their employment on the basis of a variety of different conditions – including mental illnesses. In fact, the Department of Justice has repeatedly affirmed that asking applicants for medical licensure whether they have any current or past mental health conditions is in violation of the ADA. This question is illegal.
Many states are now moving towards language that is ADA-compliant and that does not penalize people with mental illness. The question on the licensure application asks not simply whether an applicant has mental illness, but whether they have any medical conditions that would impair their ability to practice medicine. This question is definitely legal – the medical board does have a duty to protect the public from impaired physicians, and so they’re allowed to ask about anything that might impair you. If your condition has never impaired your ability to care for patients, then you don’t need to worry about having sought treatment for depression or anxiety.
Despite the DOJ’s rulings on the subject, some states continue to ask directly about mental illness. There’s reason to believe that this will change over time, although it may do so slowly. Some doctors choose to live (and practice) in a state where the question is asked in an ADA-compliant way, so that they don’t have to worry about this. If you wanted to, you could certainly check before you decide where to apply for residency or where to live and practice afterward.
We don’t want to put too fine a point on it, but this is the unvarnished truth. It would be better to lose your license than your life. If you’re struggling with suicidal thoughts, you really need to seek help. If you die by suicide, then your medical license won’t matter anymore. If you’re really on the edge, please reach out to someone who can help. We don’t need to lose any more medical professionals to suicide.
If you’re struggling with milder symptoms of depression or anxiety, keep in mind that these can easily progress. Many people can still function well while their symptoms are relatively mild, but when the symptoms get more severe, then performing at the high level required of physicians may become difficult. Seeking treatment earlier in the course of the disease could help to keep you functioning well, and as long as your ability to perform patient care never suffers, it’s unlikely to be a problem for your residency application or your licensure. Waiting until it gets worse might result in your needing to take a leave of absence to deal with the situation, which will certainly be more of a negative than simply seeking treatment.
In addition, the risk of seeking mental health care might not be as high as you think. Unless you’ve taken a leave of absence that you need to explain, there’s no need for you to disclose it on residency applications. Even with a leave of absence and the resultant need to disclose the illness, there’s only a small negative effect on your application. And as far as your license, in many states you won’t have to worry about reporting it unless your ability to perform patient care has suffered.
Most therapists offer a free initial phone call. This is the perfect time to ask questions about their experience, the type of therapy they practice, and any other questions that help you determine if they are the right fit. Before you write off the idea of starting therapy, find a qualified therapist and at least have that phone call. Speaking to them frankly about your concerns will improve the likelihood that you feel comfortable engaging in therapy. They should be able to tell you what kind of information they keep in their notes, and how that documentation is protected. Many therapists, especially those who accept insurance, keep both psychotherapy notes and progress notes. Psychotherapy notes are intended to be the therapist’s own notations that they use to assess how therapy is going and what issues you are working through. Progress notes may be more detailed and are intended to stand up to audits. If you have concerns about who will have access to your therapy record, be up front about this. If they answer questions to your satisfaction, they are likely a good fit.
As doctors, we’re highly trained to care for others, but we must also learn to care for ourselves.
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