The following article is a part of conference coverage from the American Academy of PAs 2021 Conference (AAPA 2021), held virtually from May 23 to May 26, 2021. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading PAs. Check back for more from AAPA 2021


Less than half of all states are compliant with the Americans with Disabilities Act (ADA) on physician assistant (PA) licensure applications regarding questions on mental health or substance use health, according to research presented at the American Academy of PAs 2021 Conference (AAPA 2021).1

Across the health care spectrum, clinicians have been found unlikely to seek treatment for mental health conditions.2,3 Among PAs, “pointed” questions on licensure applications that address mental and emotional health have been identified as barriers to receiving treatment. These types of questions may also violate the ADA, according to lead author Christopher Roman, PA-C, associate professor, department chair, and program director of Physician Assistant Studies at Butler University.

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The researchers reviewed initial (n=51) and renewal licensure (n=47) applications for PA candidates and conducted a pass-through survey on PA attitudes on mental health that followed the APPA 2021 Salary Survey. Of the 2697 PAs sent the survey, 1588 responded (response rate, 58.9%).

Men were significantly more likely than women to demonstrate concerns regarding repercussions in licensure due to mental health issues (P <.05). Only 18 of 50 states and the District of Columbia were consistent with the ADA in terms of questions regarding physical health, mental health, and substance use in both initial and renewal applications; 1 state (Michigan) had no data available.

Overall, 35% of PAs who responded to the survey indicated that they would be reluctant to seek help or treatment for either mental health or substance use disorder issues, stemming from concerns that their licensure would be affected. This is in contrast to 12% of respondents who indicated they would be reluctant to seek help for a physical health condition.

In states where licensure applications were inconsistent with the ADA, including much of the South and Midwest, PAs were significantly more likely to be reluctant to seek help for health concerns (P <.05), the researchers found.

“Advocacy is needed to reduce [the] stigma of mental health and substance use disorders, and to modernize licensure applications,” the presenters concluded.

Visit Clinical Advisor’s meetings section for complete coverage of AAPA 2021.


1. Roman C, Neary S, Nettesheim E, Zorn J. PA licensure questions and help-seeking for mental health conditions. Presented at: American Academy of Physician Assistants Annual Meeting; May 22-26, 2021. Poster 50.

2. Mihailescu M, Neiterman E. A scoping review of the literature on the current mental health status of physicians and physicians-in-training in North America. BMC Public Health. 2019;19(1):1363. doi:10.1186/s12889-019-7661

3. Aaronson AL, Backes K, Agarwal G, Goldstein JL, Anzia J. Mental health during residency training: Assessing the barriers to seeking care. Acad Psychiatry. 2018;42(4):469-472. doi:10.1007/s40596-017-0881-3