Why physicians delay therapy: the licensing question.
Most physicians who postpone therapy are not doubting that it works. They are weighing what a record of it could mean on the next license renewal or credentialing form. Martha's review of 297 physicians puts numbers on that delay.
Martha Fernandez, LCSWLead author. Licensed Clinical Social Worker, California license 127918
Clinical review of 297 consecutive physician clients, January 2025 to July 2026
The barrier is a form, not a feeling
Stigma gets most of the blame, but the paper argues the real barrier is paperwork. Licenses, hospital privileges and malpractice coverage are renewed on cycles, and some of those forms have asked about mental health history rather than current impairment. A physician deciding about therapy is often deciding whether they will have to declare it later.
Published research points the same way. In a national survey of 5,829 physicians, 39.9 percent said concern about their medical license would make them reluctant to seek mental health care, and the reluctance was higher in states whose application questions went beyond current impairment.
What the review found
- The delay is common. Six in ten physicians in the review put off starting therapy because of licensing or credentialing concerns.
- The fear is specific. More than half named consequences for their career or hospital privileges as the main reason, not general stigma.
- It is long. Almost half waited more than a year, and the median gap from recognizing the need to a first session was 22 months.
Care that creates no insurance claim, no employer record and no diagnosis code moving through a system you will later declare.
Book your first sessionWhat removes the delay
The paper's conclusion is practical: remove the structural exposure first. When therapy generates no insurance claim, no employer record and no diagnosis code traveling through a payer, the reason for waiting disappears, without any change in the physician's willingness. That is how Martha's practice is built: private pay, by secure video, with nothing filed with an insurer.
For physicians in Southern California, see therapy in Los Angeles or San Diego.
Frequently asked questions
Does private-pay therapy stay off insurance records?
Yes. Nothing is billed to an insurer, so no claim or diagnosis code is sent to a payer.
Will therapy have to be reported to a medical board?
Requirements depend on each board's and each hospital's questions, which increasingly ask only about current impairment. Read your own forms, and ask Martha about documentation in your first session.
Who was in the review?
297 consecutive physician clients who sought care at the network Martha co-founded between January 2025 and July 2026: a help-seeking sample, not a population survey.
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