Despite the rising prevalence of mental health conditions among physician trainees, fewer than one-third seek professional help. Most physicians avoid seeking care because of fear of professional consequences, stigma, and confidentiality concerns. Suicide is one of the leading causes of death, mainly among medical residents in the United States, which highlights the urgent need for better health support for physicians.
Previously, medical licensing applications asked intrusive questions regarding applicants’ mental health status. These questions often conflicted with expert recommendations as well as the Americans with Disabilities Act (ADA). Such questions discouraged physicians from seeking help. However, organizations like the Federation of State Medical Boards have recommended reforms, and licensure-related concerns remain a major barrier. A recent study published in the Journal of Graduate Medical Education aimed to examine medical licensing applications to identify barriers that still prevent trainees from seeking mental health care.
In this exploratory qualitative study, researchers analyzed the barriers present in initial allopathic medical licensing applications using constructive principles. Applications from all 50 U.S. states and Washington, DC, were collected in 2021 and again from 2024 to 2025, resulting in approximately 850 pages at each time point. An inductive content analysis of the 2021 applications detected emerging structural barriers that were not addressed by existing recommendations.
A total of five potential barriers were detected, such as scrutiny of training gaps, uncertainty about privacy protections, stigmatizing grouping of health questions with misconduct items, limited access to licensing applications, and unclear health questions. The same coding framework was then applied to the 2025 applications for assessing changes and mapping the geographical distribution of these barriers.
First, stigmatizing question grouping placed mental health questions alongside items related to unethical or illegal behaviour. This was observed in 27 applications during 2021, which declined to 20 during 2025. Second, the accessibility of licensing applications was limited in many states. In 2021, only 29 U.S. states’ applications were publicly accessible, and this count reduced to 18 by 2025, increasing uncertainty regarding mental health disclosure requirements.
Third, scrutiny of training gaps required explanations for periods not spent in the work or training. This requirement appeared in 35 applications in 2021, whereas 29 applications in 2025, potentially discouraging trainees from taking medical leave. Fourth, privacy concerns persisted. In 2021, 38 U.S. states lacked clear privacy protections or allowed disclosure of personal health information, which decreased to 28 states by 2025, but still represents a barrier to seeking care.
Fifth, the lack of clarity in mental health questions created confusion for applicants about what information must be disclosed. Approximately 11 states used ambiguous or unclear questions in 2021, and this number decreased to 6 states in 2025, partly due to some states removing mental health questions entirely.
This study’s limitations include its study design, which does not establish a direct causal relationship between identified barriers and help-seeking behaviour. This analysis was limited to publicly accessible licensing application content and excluded other components of licensure processes. Additionally, the findings may not be generalizable beyond U.S. allopathic licensing systems.
Despite these limitations, the findings are highly relevant to graduate medical education. This longitudinal analysis between 2021 and 2025 showed improvements in four of the five potential barriers studied, but some barriers remain. Notably, access to licensing applications has significantly declined.
Mentors, program directors, and deans may help trainees through complex state licensure processes more effectively. The results also offer evidence-based guidance for policymakers and medical boards to refine licensing applications in ways that support physician well-being and reduce barriers to mental health care.
To improve your chances of approval as a practitioner in a new specialty, it is essential to ensure that your documentation is complete, accurate, and error-free. One of the most effective ways to achieve this is by consulting the experts at medtigo Medical Licensing Service. Beyond application support, they provide excellent guidance on all aspects of medical licensing across multiple states.
Reference: Barrett E, Hicks K, Hunt L, Saddawi-Konefka D. A Qualitative Analysis of Underexplored Barriers to Physicians Seeking Mental Health Care in Medical License Applications. J Grad Med Educ. 2026;18(1):20-25. doi:10.4300/JGME-D-25-00710.1
