The articles titled “Programs and Resources to Alleviate Concerns with Mental Health Disclosures on Physician Licensing Applications” and “The Effect of State Medical Board Action on ABMS Specialty Board Certification” (Vol. 105, No.2, pp 24–41) were excellent. When I was Chair of the FSMB in 2012–13, a special committee produced a policy paper on return-to-practice for the ill physician (Report of the Special Committee on Reentry for the Ill Physician, 2013). It addressed both of these issues within the broader issue of return to practice. Since then I have had the experience of working with recovered/recovering physicians who still are confronted with barriers, even though a medical board has deemed them fit to restore their license. Insurers, including Medicare/Medicaid, have been the most unbending. Specialty boards vary considerably in their treatment of a returning physician. The response to the FSMB's 2013 policy paper has been disappointing, to say the least. I hope these articles and continued emphasis on understanding of illness and recovery in this era of physician burnout will move us forward. We cannot afford to lose the services of able physicians or withhold their services from the public. Please keep up the pressure for reasoned action and understanding.

Lance A. Talmage, MD

FSMB Chair, 2012–2013

More than a year has now passed since the House of Delegates of the FSMB unanimously approved the recommendations of the Workgroup on Physician Wellness and Burnout in April 2018.

This policy — which calls for a shared-accountability approach to addressing many aspects of physician wellness — is among the FSMB's most comprehensive, with a long list of recommendations for improving physician wellness. Among those that focus most directly on state medical boards are recommendations about the medical licensing process and questionnaires that boards require licensees to complete when they apply for initial licensure and license renewal.

Since the adoption of the new policy, progress has been made on several fronts with respect to physician wellness, especially in the area of medical licensure. Nearly half of state medical boards have formally discussed the FSMB's recommendations or the issues of physician wellness and burnout, and others have begun making changes to their medical licensing processes and the wording of their licensing-related questionnaires.

A recent review by the FSMB of state medical board meeting agendas, minutes and draft legislation showed that at least eight boards are in the process of discussing and drafting potential revisions to licensing application questions, and at least nine more boards have actually implemented such changes.

A variety of approaches are being used to reduce or eliminate barriers to treatment-seeking. The State Medical Board of Ohio, for example, has proposed rules establishing a confidential monitoring program for licensees with mental and physical illness. The New Mexico Medical Board and Vermont Board of Medical Practice have changed their licensing application language to focus solely on current impairment that affects the licensee's ability to practice medicine safely. The North Carolina Medical Board now includes a statement in its licensing application materials about the importance of adequately addressing health conditions that impede safe practice — which potential licensees are required to acknowledge. The North Dakota Board of Medicine and Washington Medical Commission have made significant changes to the physician-health questions on their licensing applications, as well. These are just a few examples of the activity that is occurring.

With such significant progress being made in the first year since the FSMB's new recommendations were adopted, there is great optimism that additional boards will implement their own strategies for removing barriers to treatment-seeking among licensees. There is now broad recognition among state medical boards that our collective duty to protect the public includes a responsibility to ensure physician wellness.

Scott A. Steingard, DO

FSMB Chair, 2019–2020