One of the most invidious aspects of physician depression is the reluctance of physicians to seek help because of a very real perception that to do so might place them at risk for intrusive examinations and actions by their medical licensing authority, ostensibly to determine "fitness for duty" and thereby "protect the public safety".
However, studies suggest that the physician's clinical practice is the LAST life area affected by depression, so integral is the practice of medicine to a physician's sense of self worth and reason for continuing to function in the world. Therefore, a physician whose low level depression does not in any way impact his or her practice, may defer or bypass potentially life saving intervention for fear of loss of livelihood through exposure to punitive authorities. Here's a first person experience that is illustrative.
Here are reports from the literature about this phenomenon, and a small survey I conducted of emergency physicians which illustrates how pervasive the belief that: to seek help will greatly compound the problem, rather than helping to deal with it. A 2016 survey of women physicians by KT Gold affirms the same.
A survey published 6/2017 by Gold (Do US Medical Licensing Applications treat Mental and Physical Illnesses Equivalently? affirms that they do NOT. A survey by Dyrbe et al published 10/17 (Medical Licensure Questions and Physician Reluctance to Seek Care for Mental Health Conditions) confirms that not only are mental health related questions on medical licensure applications often not in compliance with the ADA, but that where they ARE in compliance, there is evidence of more mental health care seeking by physicians. This article revealed that the Federation of State Medical Boards (FSMB) actually has a 2006 policy regarding ADA compliance and licensure questions. That policy statement is not apparent anywhere on the FSMB site, but it is here.
Because they are so closely entwined, there is MUCH more on this site about the complex relationship between MLBs and their Physician Health Programs (PHPs) in the page entitled PHPs and MLBs.
A July 2016 Medscape article based on a BMJ survey confirms the profound psychological effects on physicians that can result from any kind of complaint investigation in a UK cohort. Moderate to severe depression and anxiety can result from the process alone, which is often perceived as punitive, prolonged, and one-sided.
A June 2016 BMJ article "Physician Health Programs Under Fire" by J Lenzer illustrates how the failure to differentiate between illness and impairment on the part of some physician health programs can result in unwarranted mandatory interventions, which then can be escalated into licensure actions if a physician dares to question an overreaching or totally insupportable diagnosis made by a PHP, a diagnosis sometimes made by non-physicians, and in some cases withheld from the physician client under the pretext that it constitutes "peer review". If a physician does not comply with every demand made by a PHP, for multidisciplinary diagnostic evaluations and inpatient treatment or such things as attendance at AA meetings, medical licensure boards are notified and can and do take action against the physician's license.
This comprehensive OpEd by Aaron Carroll on 1/11/2016 entitled "Silence Is the Enemy for Doctors with Depression" echoes the sentiments expressed on our Home Page: Silence can be Deadening for physicians.
This article on Physician Suicide describes the phenomenon in context.
Silent Treatment: Suicide and Depression in Emergency Physicians, Andrew L, EPMonthly December 2005
Survey on EP depression and suicide, EPMonthly December 2005
Readers Respond to Silent Treatment, Andrew L EPMonthly March 2006
Physician Suicide: Risk Factors and Prevention, Kaufman, I.M. Ontario Medical Review Sept 2000 20-22
Encouraging Treatment in Depressed Medical Professionals Physicians' Weekly Sept 2005
Legal Aspects of Mental Health reporting to licensure boards by physicians can be explored in this article from Journal of Law and Health Policy (1994).
A 2009 survey in Academic Medicine suggests that 69% of state medical license applications contain questions that are or are likely to be impermissible under the Americans with Disability Act. AMA also has policy relating to this issue.
Licensing and Physician Mental Health: Recommendations. Suicide Prevention International online article.
Hendin, et al. Licensing and Physician Mental Health: Problems and Possibilities from the Journal of Medical Licensure and Discipline 93:2 (2007) is an important study of policies of medical boards which may result in physician reluctance to seek help.
The References section contains more articles relating to this issue.