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Sept. 6, 2011  

Medical Schools Provide Their Students With Inadequate Coverage for Mental Health and Substance Abuse Treatment

Statement of Dr. Michael Carome, Deputy Director, Public Citizen’s Health Research Group

study published today in the Journal of the American Medical Association (JAMA) shows that medical schools in the U.S. provide their students with poor health insurance coverage for mental health and substance abuse treatment, imperiling the well-being of the nation’s future doctors and their patients. By doing so, medical schools are setting another bad precedent for their students and the rest of the country.

The study, conducted by researchers at the Harvard-affiliated Cambridge Health Alliance in Cambridge, Mass., found that fewer than 22 percent of the 115 medical schools included in the study provide their students with complete coverage – without co-payments or coinsurance – for mental health and substance abuse treatment. A small number of medical schools do not provide any coverage for inpatient mental health or substance abuse treatment.

Public Citizen concludes that the lack of provision of adequate coverage for mental health and substance abuse treatment to medical students is a serious problem for three reasons. First, a significant number of medical students experience mental health disorders, including burnout, depression and suicidal ideation, and substance abuse. Second, limits on coverage for mental health and substance abuse treatment and requirements for co-payments deter many of these students from seeking necessary treatment. Finally, untreated or poorly treated mental health and substance abuse disorders can adversely impact empathy and altruism among students and increase medical errors by doctors in training, placing patients at risk.

Moreover, untreated or poorly treated mental health and substance abuse disorders in medical students are likely to persist as the students advance to residency training and post-training clinical practice. Medical school graduates with persistent mental health and substance abuse ailments may experience impaired clinical judgment and functioning, increasing the chances for medical errors and inappropriate conduct while caring for their patients.

In 1998, Public Citizen’s Health Research Group published a study in JAMA documenting that discipline against physicians for sex-related offenses by state medical boards and federal agencies increased between 1989 and 1996. To the extent that some sex-related offenses, which include seeking sexual favors for drugs, result from physician impairment due to mental health and substance abuse disorders that originated in medical school, such unethical physician conduct is one example of how failure to ensure medical student access to needed care for mental health and substance abuse disorders could result in future harm to patients.

As institutional leaders within the nation’s healthcare system, medical schools should demonstrate their commitment to a healthcare system that ensures all patients with mental health and substance abuse disorders have unimpeded access to all necessary treatments. This can be achieved on a broad scale only by a national single-payer health insurance program that offers comprehensive benefits without co-pays or coinsurance.

In the meantime, medical schools should do a better job of ensuring full access to all necessary healthcare for their students. Public Citizen strongly endorses the recommendation by the authors of the JAMA study that U.S. medical schools move immediately to improve student insurance coverage for mental health and substance abuse disorders.

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