What Florida physicians should know about seeking help for mental well-being
By Rebekah Bernard, MD
While physicians are becoming increasingly aware of the importance of treating burnout, many of us are still reluctant to seek help for our mental well-being, in part due to concern over licensing or other professional repercussions. A 2023 FMA webinar, Physician Mental Health & Wellness, sought to dispel those concerns, with representatives from the Florida Board of Medicine and Professionals Resource Network (PRN) insisting that physicians will not face repercussions for seeking help for burnout and to improve wellness.
According to Hector Vila, MD, a member of the Board of Medicine since 2016, the Board's goal is to ensure that physicians with potentially impairing conditions are receiving proper treatment. “We are not here to seek out your personal business, to be intrusive, and to take away your practice,” Dr. Vila said. He noted that questions about mental health on the Board’s licensure application are not intended to be punitive, but to identify physicians who need treatment, especially with an increase of physicians from other states into Florida.
“Questions are asked so that we can seek out those who might be so impaired that they are a danger to themselves or to their patients so that they can receive treatment,” Dr. Vila said. “Just because you seek treatment for a mental health issue or even an addiction issue doesn't mean that the Board is going to take your license away.”
He also emphasized that reporting pertains to impairing conditions and that physicians seeking emotional help for burnout “don’t need to be worried about being disciplined or reported to the Board.”
Changes to mental health questions
Before April 2021, the Florida application for physician licensure required an applicant to answer six questions related to health history, said Mary Thomas, JD, former FMA assistant general counsel and current executive director of the Council of Florida Medical School Deans.
“Essentially, it was a five-year look-back for drug or alcohol abuse treatment and mental or physical disorders that impaired your ability to practice medicine,” she said. “Physicians answering, ‘yes’ to any of these questions were required to submit substantial documentation regarding their treatment.”
At the 2017 FMA Annual Meeting, delegates approved Resolution 17-106, directing the FMA to seek a change to medical licensure health questions, focusing on current impairment rather than past history. Working together with the Council of Florida Medical School Deans and the Florida Psychiatric Society, the FMA submitted updated questions following templates from other states. In response, the Board of Medicine and Board of Osteopathic Medicine created a Mental Health Workgroup to study the impact of licensure question changes on public health and considered alternative language provided by the Florida Department of Health (DOH) that would apply to not only physicians, but all licensees under the DOH. Thomas noted that negotiations with the Board were complex.
“The Board of Medicine is not just tasked with protecting physicians, but they're also tasked with protecting the general public, and that's a duty that they take very seriously,” she said.
Thomas went on to explain that DOH’s uniform language was initially concerning because of the uniquely stressful nature of physician training. Practicing medicine requires years of rigorous education and clinical training significantly beyond that required to become, for example, a licensed acupuncturist. This contributes to a higher prevalence of mental health issues in the physician population compared to other groups of healthcare providers.
By fall 2020, language changes were approved to take effect in April 2021, streamlining the questions from six to just two:
- During the last two years, have you been treated for or had a recurrence of a diagnosed physical or mental disorder that impaired or impairs your ability to practice medicine?
- During the last five years, have you been treated for or had a recurrence of a diagnosis of an alcohol or drug disorder that impaired or impairs your ability to practice?
In addition, the license application now includes a disclaimer that physicians do not need to report receiving treatment for certain emotional issues, including, “assistance with stress, mild anxiety, situational depression, family or marital issues.” Thomas said that the FMA hopes that including this clarifying language will help to destigmatize physicians receiving help for emotional well-being.
Defining ‘impairment’
With the change to current licensure health questions to focus on impairment, experts on the FMA webinar explained the meaning of the term. According to Alexis Polles, MD, medical director of the Professionals Resource Network (PRN), impairment is defined in Florida statute as a “potentially impairing health condition that is the result of the misuse or abuse of alcohol, drugs, or both, or a physical or mental condition that could affect a practitioner’s ability to practice with skill and safety.” Dr. Polles clarified that having a condition or illness does not necessarily equate to being impaired.
“Often, an impairing condition is temporary and treatable,” Dr. Polles said. “It’s a state in which a physician is unable to practice to the capacity and standards of their specialty and training and interferes with their ability to deliver consistently and safely the care that they agreed to provide to the public.”
For physicians who may be facing a potentially impairing condition, Dr. Polles said that participation in a treatment plan can prevent Board discipline. “PRN has been around since 1981. We are an alternative to discipline that is completely confidential.”
Dr. Polles said that while some physicians are referred from the medical board, over 85% of program attendees self-refer. “It may be a practice partner or a facility where the person has privileges and they have been noted to be struggling with some kind of issue,” she said, noting that the most common condition for referral is substance use disorder, followed by psychiatric conditions that affect the physician’s ability to function in daily life. “The first thing to establish is whether an impairing condition even exists, and if so, participation remains voluntary as long as the person is following through with what they've agreed to.”
Dr. Polles said that PRN has worked with over 9,000 licensed professionals in the state of Florida, “and there are many, many, many success stories.” She encouraged physicians to view a video on the
PRN website with testimonials from Florida physicians. “Several of our success story physicians volunteered so that other people who are in the position of being scared, unwell, and not knowing which way to turn could hear directly from them about the benefits and what they've received in terms of mental health and to support the community of other physicians.”
What if I have to check ‘yes?’
For physicians who have faced an impairing condition, the Board of Medicine now requests just one letter from a treating practitioner to explain the situation. This is a contrast from previous requirements, which were more onerous, said Allen Grossman, JD, an attorney who represents physicians coming before the Board of Medicine. Depending on the documentation provided, Grossman said that physicians may be required to appear before the Board of Medicine’s Credentials Committee.
“On occasion, there will be individuals who show up and the information that is presented isn't quite as positive and helpful,” he said. “In those cases, the committee will usually suggest to the applicant that they contact PRN.”
Grossman said that when he is representing clients in this situation, he encourages them to enroll in PRN before even appearing before the Board. “The Board has developed a very helpful position where, if the applicant is already participating in PRN, it remains more of a confidential agreement between PRN and the applicant. So, you go on to life in your practice without any kind of blemish on the record.”
Thomas said that physicians often contact the organization for guidance about reporting current or previous treatment for mental health issues. “I want you to know that you are not alone — I get these calls all the time,” she said. “Sometimes I can help, but other times it may require retaining counsel with the skill and competence to walk you through that journey, and we can make those recommendations.” Thomas encouraged physicians with questions to contact the FMA for help and assistance with resources.
Preventing impairing conditions
The FMA webinar shared resources to help physicians struggling with mental wellness, with a goal of preventing progression towards an impairing condition. Signs of psychological distress may include anxiety, insomnia, change in usual behavior, social isolation, and anhedonia, or not caring about things that used to be enjoyable. It is essential that you do not ignore these symptoms. Instead, reach out for support.
The Physician Support Line (
physiciansupportline.com or 1-888-409-0141) offers free, confidential peer support by volunteer Board-certified psychiatrists from 8 a.m. to midnight Monday through Friday. Psychiatrist Mona Massoud, DO, founder of the Physician Support Line, participated in a CME educational panel about physician wellness at the 2023 FMA Annual Meeting. She explained that she created the resource after realizing that physicians have become increasingly isolated and in need of support.
“One of the most common things that happens when doctors call is they apologize for bothering me,” Dr. Massoud said. “I want doctors to know that it’s not a bother or a burden. This is a service that was created to help doctors.”
Dr. Massoud encourages physicians and medical students to call for any reason. “It doesn’t have to be a crisis.”
While the Physician Support Line offers peer counseling, some physicians may need more active treatment to manage mental health struggles. For this reason, psychiatrist Nicole Washington, MD, created the website
physicianmentalhealth.com , a central repository of psychiatrists with experience treating physicians. The site allows doctors to find psychiatrists licensed in their state and may include virtual/telemedicine sessions. Dr. Washington, who also participated in the FMA’s CME panel on physician wellness in 2023, hopes to destigmatize mental health support for physicians and prevent physician suicide.
Many county medical societies in Florida also offer support and therapy through physician wellness programs. These programs generally provide a certain number of free, confidential psychology sessions to society members. Check with your local medical society, and if your county doesn’t offer one, encourage leadership to start a program to support the community. A free toolkit is available at
physicianwellnessprogram.org .
Regardless of where you seek help, don’t let concerns over licensure stop you from getting the support and care that you need. The updated Board licensure application makes it clear that seeking help for burnout and well-being is not reportable. As Dr. Vila said, “It's really important for physicians that if you feel some of those symptoms (of burnout) coming on, notice it in yourself, talk to somebody. Those don't have to be reported to anyone at any time. You can seek assistance before it becomes an issue. That's the best thing in the world.”
FMA Board of Governors member Rebekah Bernard, MD, is a family physician, author, and physician wellness expert whose practice, Gulf Coast Direct Primary Care, is located in Fort Myers. She is also Chair of the FMA Women’s Physician Committee. Raised in rural Clewiston, Fla., Dr. Bernard earned her medical degree from the University of Miami Miller School of Medicine and completed her residency at Florida Hospital in Orlando. She is the author of four books, including “Imposter Doctors: Patients at Risk,” and has written frequently for Medical Economics and KevinMD.