Mississippi State Board of Medical Licensure Embraces Attestation Model

For decades, the Mississippi State Board of Medical Licensure (MSBML or Board) required physicians to acknowledge and document their mental health diagnoses and treatments on state licensure forms. In 2018, MSBML began revising its application process to reflect a better awareness of mental health needs and provide additional reassurances for the state's practitioners.

Although he was new to the role of Executive Director of the Board, Dr. Kenneth Cleveland had seen and heard of physicians who struggled with sharing any issues related to mental health. He knew the fears associated with these types of admissions were real.

“After becoming the Executive Director of the Board in 2018, I learned about the stigma of answering licensing and renewal questions while attending an Administrators in Medicine meeting” said Dr. Cleveland. “When I brought this issue back to the MSBML, our members were very receptive to potential changes. They recognized that we need to be proactive about these documentations and their effects on our physicians.”

A small committee was established to develop licensing language that would be more accommodating to any physicians who were experiencing mental health challenges. In addition to Dr. Cleveland and select Board members, a representative of the Mississippi Physicians Health Program (MPHP) also participated in the exercise. MSBML worked to adopt new wording in both the MD Permanent and Renewal Applications. Rather than asking if an applicant had been diagnosed with or treated for specific mental health conditions, the applicant was asked to attest to seeking help for any issues that involve their mental or physical health.

Before the current changes, an applicant submitting an initial licensing application was met with the question of “Have you ever been diagnosed as having, or have you ever been treated for, pedophilia, exhibitionism, or voyeurism, bipolar disorder, sexual disorder, schizophrenia, paranoia or other psychiatric disorder?” If a physician had sought any treatments for mental health issues, an answer of yes quite possibly could have drawn attention to their application.

For a renewal application, the original question was “From July 1, 2015, to the present, have you received treatment for psychiatric, addiction, or substance use related issues NOT known to the MPHP? (If you are an anonymous participant in the MPHP and are in compliance with your contract, you may answer NO to this question.)” Please see Table 1 for a comparison of the before and after language.

The edited language is responsive to the current needs of our practitioners and is as follows: “The Board recognizes that licensees may suffer from potentially impairing health conditions, just like their patients, including psychiatric or physical illnesses which may impact cognition, and substance use disorders. The Board expects its licensees to properly address their health concerns, both physical and mental, in a timely manner to ensure patient safety and to maintain the ability to meet the needs of patients. Licensees should seek appropriate medical care and should limit their medical practice, when appropriate and as needed. The Board encourages licensees to utilize the services of the Mississippi Physician Health Program, a confidential resource which provides advocacy for licensees who may suffer from potentially impairing illnesses. The failure of a licensee to adequately address any health condition which may impair their ability to practice medicine with reasonable skill and safety to patients, will likely result in the board acting against the licensee to practice medicine.”

In 2020, as the entire world navigated the COVID-19 pandemic, medical professionals bore the brunt of meeting the health needs of our citizens. They worked endless hours, navigated new and ever-changing protocols, and faced death like never before. These challenges wore on the mental health of everyone, and especially physicians. One in particular was Dr. Lorna Breen. Dr. Breen was the head of the emergency department at New York City's New York – Presbyterian Allen Hospital. She was the epitome of an overachiever. After graduating from medical school, she took on a longer residency to study both emergency medicine and internal medicine. She was a snowboarder. She played the cello. She enjoyed salsa dancing. Dr. Breen was enrolled in a dual degree master's program at Cornell University. She was an incredible physician. She was an exceptional person.

The endless stress of COVID weighed on her. She herself contracted the virus and was forced to be away from the work she loved to monitor her own physical health. She pushed through and returned to work. Unfortunately, her mental health, like many other practitioners in the dire circumstances they were facing, began to deteriorate. Dr. Breen agreed to and received treatment in a psychiatric facility. Still one of her fears was the reactions of her colleagues and the reporting guidelines she would face because of her mental health treatment.

Shortly thereafter on Sunday, April 26, 2020, Dr. Breen died by suicide. Change had to take place, and the change in the MSBML reporting requirements was a result of that needed change.

Dr. Michelle Owens, President of the MSBML, was a medical school classmate of Dr. Breen. “When I heard the news about Lorna, I was saddened and stunned. Her tragic loss highlights the humanity in each of us and the toll that our professional experiences can have on our mental health. We should extend to ourselves and one another the same care that we extend to our patients,” Dr. Owens said. “The promotion and preservation of our mental and physical health should not be seen as a weakness but rather as an essential component of our professional responsibility. Physicians should be encouraged to seek the care that they need unencumbered by fear or undue scrutiny. We can't be our best at work or anywhere else if we don't take time to care for ourselves.”

“Dr. Breen was a heroic, remarkably skilled, compassionate, and dedicated clinical leader who cared deeply for her patients and colleagues,” said a representative from New York – Presbyterian Allen Hospital.

The mental health disclosure changes made by the MSBML would have benefited Dr. Breen. “I am proud that Mississippi is considered a leader in this area. These small but significant changes create invaluable opportunities for physicians to seek the help that they need. It is my hope that more states will follow suit. While I know that Lorna would be proud of the changes taking place, I can't help but wish she were still here to see it,” said Dr. Owens.

Mississippi is not the only state to consider such changes to their licensing applications related to mental health. Several recent studies describe how several boards are addressing this important question.^1,2,3 

The greatest hope of MSBML is that our colleagues around the country will consider Dr. Breen and countless other physicians who have struggled with mental health issues. Simple language changes would allow these esteemed practitioners to seek and receive the help they need without fearing for their jobs. MSBML is proud of leading the way for the important changes that are needed for our practitioners. The physical AND mental health needs of physicians in our state are of the utmost importance, and our goal is to remove intrusive personal health scrutiny so that licensees feel free to seek treatment when those needs arise without the fear of professional licensing scrutiny.