Most Physicians and Dentists Believe Disclosing Past Substance Use in Medical and Dental School Applications Could Hurt Admissions Prospects

More than four in five physicians and dentists believe applicants who disclose a history of substance use on medical or dental school applications risk hurting their chances of admission, according to a new study by researchers at Columbia University Mailman School of Public Health and the University of Miami Miller School of Medicine. The findings provide the first empirical evidence of how healthcare professionals perceive the admissions consequences of revealing a history of substance use or recovery. The results are published in the Journal of General Internal Medicine.

Although medical and dental school applications do not ask about substance use history, applicants are often encouraged to discuss personal hardships or transformative experiences in their personal statements. For applicants in recovery, deciding whether to disclose that history can be difficult, particularly in a profession where substance use disorders affect an estimated 10 to 12 percent of physicians during their careers. Yet until now, no published study had examined how physicians and dentists believe such disclosures might affect an applicant's chances of admission.

"Applicants in recovery often face a difficult decision about whether to disclose an important part of their personal history," said Rae Chang, lead author who conducted this research at the Columbia Mailman School of Public Health as an undergraduate student at Columbia. "Because stigma surrounding substance use remains widespread in healthcare, we wanted to understand how physicians and dentists believe those disclosures are likely to be received during the admissions process—and whether framing recovery as a source of motivation for pursuing a healthcare career changes those perceptions."

Researchers surveyed 1,240 physicians and dentists nationwide—including 349 emergency medicine physicians, 506 primary care physicians, and 385 dentists—using a nationally representative sample drawn from the American Medical Association and American Dental Association.

The researchers found that:

• 82.5 percent of respondents believed that disclosing a history of substance use would pose a moderate or significant risk to an applicant's chances of admission. 
• Even when applicants described their recovery as a motivating factor for pursuing medicine or dentistry, 50 percent still believed the disclosure carried moderate or significant admissions risk. 
• Respondents who reported having a friend or patient with a history of substance use were more likely than their colleagues to perceive disclosure as risky. 

The study measured healthcare providers' perceptions of the admissions climate rather than the decisions of admissions committees themselves. Even so, the findings suggest that concerns about stigma remain deeply embedded within the healthcare professions.

"Whether or not these perceptions reflect actual admissions decisions, they reveal a widespread belief among physicians and dentists that disclosing a history of substance use carries professional risk," said Lisa R. Metsch, PhD, dean of the School of General Studies at Columbia University, professor of Sociomedical Sciences and a co-author of the study. "That perception alone may discourage applicants from sharing an experience that has profoundly shaped their lives and their commitment to caring for others."

The findings also point to broader challenges surrounding stigma in healthcare. People with substance use disorders often experience discrimination when seeking medical care, and stigma has long been recognized as a barrier to treatment and recovery. The researchers say reducing stigma within the healthcare professions is essential not only for supporting future physicians and dentists in recovery, but also for building a workforce equipped to provide compassionate, evidence-based care for patients with substance use disorders.

"These findings extend beyond the admissions process," said James Colgrove, PhD, professor and interim chair of Sociomedical Sciences at Columbia Mailman School of Public Health, dean of the Postbaccalaureate and Premedical Program at the Columbia School of General Studies and co-author. "They underscore the need to address stigma throughout healthcare education and practice so that individuals with lived experience of recovery are not discouraged from entering the professions—and so that all patients receive respectful, high-quality care."

Co-authors are Nicholas Ganek, Columbia School of General Studies and Tulane School of Medicine; Margaret R. Pereyra and Carrigan L. Parish, Columbia University Mailman School of Public Health; Petra Jacobs, National Institutes of Health; Viviana E. Horigian and Daniel J. Feaster, University of Miami Miller School of Medicine; and Harold A. Pollack, University of Chicago.

The research was supported by the National Institutes of Health/National Institute on Drug Abuse Clinical Trials Network (award 5UG1DA013720-23).