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A National Analysis of Medical Licensure Applications

Dr. Polfliet is a former Forensic Fellow in the Psychiatry and the Law Program, University of California, San Francisco, CA. Address correspondence to: Sarah J. Polfliet, MD, 912 Cole Street #381, San Francisco, CA 94117. E-mail: polflietmd{at}sbcglobal.net

The 1990 enactment of the Americans With Disabilities Act (ADA) and subsequent case law have established that medical board screening of physician licensure applicants for histories of mental illness or substance use may constitute discrimination. This study examines how physician licensure questionnaires have evolved since the enactment of the ADA. Specifically, we requested medical licensure applications in 2006 from all U.S. affiliated medical licensing boards (n = 54) and analyzed their mental health and substance use inquiries comparatively with application data from 1993, 1996, and 1998. Response rates were 96 percent (n = 52) for initial registration applications and 93 percent (n = 50) for renewal applications. Our results indicate that applicants in 2006, compared with applicants in the 1990s, were questioned more about past, rather than current, histories of mental illness and substance use. These findings revealed medical board practices that seem to run counter to existing court interpretations of the ADA as well as licensure guidelines established by several professional organizations.