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Two alumnae of the SWAG��Ƶ College of Osteopathic Medicine (SWAG��Ƶ COM) have had their research on mental health and medical licensing published in The Journal of the American Osteopathic Association (JAOA), the premier scholarly publication of the osteopathic medical profession.

The article, “Osteopathic Medical Licensing Compliance with the Americans with Disabilities Act of 1990,” was penned by Katherine Lincoln, D.O. ’05, M.H.A., FAAFP, FACOFP, and Beth Wagner, D.O. ’09. Together, Lincoln and Wagner evaluated the compliance of state osteopathic medical licensing boards with requirements regarding mental health as set by the Americans with Disabilities Act (ADA) of 1990.

Physicians have an increased rate of depression and suicide compared with their non-physician peers, according to the authors, and state medical licensure questions about mental health may deter physicians from seeking mental health care.

“Depending on the state, your license may be granted conditional you meet certain criteria, like meeting with a therapist, for example. But, depending on the statutory mandate in that state, you may be denied an application,” said Lincoln, a wound care specialist who works in rural Pennsylvania. “And state boards vary on their questioning: some states ask if you have a current mental health affliction, and some are more invasive and ask if you have ever been diagnosed with any kind of mental health problem.”

According to Lincoln and Wagner, several previous studies have examined state medical licensing board compliance with the ADA, but none have included osteopathic licensing boards.

The authors reviewed state medical licensing applications for all 50 states, plus Washington, D.C. — including 16 states with osteopathic licensing entities — for ADA compliance in questions about mental health. They also compared questions and compliance in states where both osteopathic and allopathic applications were available.

Through their research, Lincoln and Wagner found that 14 of 51 states, including D.C., were grossly out of compliance with ADA statutes and that, in states where osteopathic and allopathic licensing were both available, seven of 16 asked different mental health questions of osteopathic physicians than their allopathic counterparts. Of those seven states, six of the osteopathic boards were out of compliance with ADA, while their allopathic counterparts were either compliant or intermediately compliant.

The researchers concluded that, to improve physician well-being, corrective action must be taken to create ADA-compliant language in medical licensing so physicians can seek treatment for mental health conditions without discrimination by licensing boards.

“Physicians should not be discouraged from pursuing treatment for fear of professional stigma and disciplinary action,” the authors wrote. “Armed with the data that probing questions about mental health history on licensure applications is actually a deterrent to a physician seeking mental health treatment, medical licensing boards should encourage physicians to seek the help they need without regulatory board oversight and focus on the identifying and helping [of] impaired physicians.”

The research, Wagner hopes, will inform licensing boards to adjust their questions to be more consistent from state to state.

“The main point of our research is for states to see this information and become more compliant with the recommendations from the Federation of State Medical Boards,” Wagner said. “I remember during my residency in Alaska, we often didn’t want to get treated for depression or go to other doctors and have an actual medical report because we knew that the licensing language was so intrusive in that state.

“I just want states to recognize that the language they have, which they probably think is benign, is actually really challenging for physicians,” she continued. “It actually affects physicians in their ability to take care of themselves.”