Despite increasing mental health diagnoses among physician trainees, fewer than one-third seek help due to stigma and fears of professional consequences. While national organizations have successfully advocated for licensing application reforms, trainees continue to cite licensure as a primary barrier, suggesting that additional deterrents may persist within application structure and content. To identify and quantify potential barriers to seeking mental health care within initial medical licensing applications beyond current recommendations regarding impairment-based questions and supportive language. This exploratory qualitative study analyzed initial allopathic medical license applications from all 50 US states and Washington, DC at 2 time points: in 2021 and between 2024 and 2025. Using inductive content analysis, authors identified emergent themes representing potential barriers and applied a coding scheme to quantify changes over time. Five potential barriers were identified: application inaccessibility, unclear health question wording, scrutiny of training gaps, stigmatizing question grouping (mental health questions co-located with illegal/immoral activities), and uncertain privacy protections. From 2021 to 2025, improvements occurred in 4 domains: unclear language (11 to 6 states), training gap scrutiny (35 to 29 states), stigmatizing grouping (27 to 20 states), and privacy concerns (38 to 28 states). However, application accessibility worsened substantially (29 to 18 publicly accessible applications). Five distinct potential barriers persist in state medical licensing applications. Longitudinal analysis from 2021 to 2025 showed improvements in 4 domains, though application accessibility worsened substantially.
Barrett et al. (2026) studied this question.