Only 18 states have questions consistent with the Americans with Disabilities Act (ADA) when asking about mental and physical health on PA license applications or renewals.1,2 This is an overlooked and potentially harmful deficit.
As a PA in Texas, I experienced firsthand the isolating effects of an application that did not conform to ADA guidelines about mental health. Upon starting my first job after PA school, I had to ask my supervising physician to fill out forms about my mental health. This burden fell on me because of a single question on the Texas Medical Board (TMB) application for my initial PA license: “Are you currently being treated for, or have you ever had a diagnosis of, major depressive disorder (MDD), bipolar disorder, anxiety disorders, or another mental health condition?”3
Yes, I answered honestly. I submitted additional information with my answer as requested: I was diagnosed with MDD at age 16 years and take a stable dose of a single antidepressant. My symptoms remained in remission throughout PA school and I did not believe MDD had any effect on my ability to practice medicine.
The consequences of my answer made me regret my honesty. The TMB granted a temporary PA license and required my psychiatrist and supervising physician to submit quarterly assessments for 1 year to the Texas Physician Health Program (TXPHP) with any concerns about my mental health, behavior, or ability to practice as a PA.4 My supervising physician and I were just getting to know each other and I yearned for approval and mentorship. I doubt many people are required to share such private information at their first job with their supervisor. TXPHP's vow to keep my information confidential seemed ironic.
I imagined a litany of worst-case scenarios. My supervising physician would treat me differently once he knew about my history of depression; he would view me as less competent; my colleagues would find out I had depression. When I finally worked up the courage to ask about the TXPHP forms, my supervising physician was very kind and said of course he would fill them out. He assured me that he would not tell anyone what I had divulged to him and that his door was always open if I felt symptoms of depression returning. I was relieved and grateful for his professionalism.
My supervising physician and my psychiatrist dutifully completed forms for the TXPHP each quarter. After 1 year, I was required to go in person to the Capitol in Austin, Tex., to review my file. The board member tried to make light of our meeting, as if I had not just used one of my vacation days and driven more than 3 hours to be released from this burden. I was in his office for less than 10 minutes before he officially signed off on my PA license and I finally stepped out of the shadow cast over my young career.
That was 2014, just months before the TMB revised its PA licensing questions to comply with ADA guidelines for asking about physical or mental health conditions only as they influence current ability or impairment. The initial licensure application now asks, “Are you currently suffering from any condition for which you are not being appropriately treated that impairs your judgment or that would otherwise adversely affect your ability to practice medicine in a competent, ethical and professional manner?”3 This simple change in wording would have allowed me to avoid the personal embarrassment of revealing a medical diagnosis to my job. It can prevent damage to the confidence and professional identity that is crucial as PAs begin practicing, and decrease reluctance to disclose mental health conditions because of fear of licensure consequences.
PA licensing boards must recognize the weight of the wording they choose for initial and renewal applications, and revise them if they are inconsistent with the ADA. To encourage the continued growth of the PA profession and PAs' willingness to seek help when they need it, PAs in all 50 states must feel comfortable and confident in their ability to practice medicine despite the presence of a mental or physical health diagnosis.
REFERENCES
1. Dyrbye LN, West CP, Sinsky CA, et al. Medical licensure questions and physician reluctance to seek care for mental health conditions.
Mayo Clin Proc. 2017;92(10):1486–1493.
2. Roman C, Neary S, Nettesheim E, Zorn J. PA licensure questions, the Americans with Disabilities Act, and seeking medical care.
JAAPA. 2022;35(1):49–52.
3. Texas Medical Board. Physician assistant licensure application.
www.tmb.state.tx.us/idl/671D845A-1A27-67F8-A217-1F61533E5492. Accessed December 6, 2022.
4. Texas Physician Health Program. Work site monitor (WSM) report form.
www.txphp.state.tx.us/Resources/Files/TXPHP%20Work%20Site%20Monitor%20Form.pdf. Accessed December 6, 2022.
