As our profession struggles with rising rates of physician burnout, dissatisfaction, depression, and suicide, one solution comes in the form of Physician Health Programs, or PHPs. These organizations are often run by hospitals for use by their own employees, or by medical societies, often with state licensing boards. While they can provide a gateway to help for a troubled doctor, they may operate with some controversy and cause for concern.
Physicians find their way to PHPs in a number of ways. A doctor whose behavior signals impairment can be referred to the PHP by his employer, or by a licensing board, following a complaint. In these instances, participation is often a condition of employment or of continued licensure, and the PHP serves as an agent of the hospital or the state. Doctors may also be referred to PHPs for monitoring if they ascribed to having a diagnosis of psychiatric illness or substance abuse, now or in the past, and with or without obvious impairment; here, the intrusion of the PHP may not be welcome by the doctor. Finally, PHPs serve as a portal to treatment for physicians who self-identify and self-refer in an effort to get help. Their use is encouraged in an effort to prevent bad outcomes from mental health conditions, stress, and substance abuse, in those who are suffering in ways that would not otherwise call attention to their plights. In these situations, the PHP may serve as the agent of the patient or client, but there may remain dual-agency issues if the physician says something that leads the PHP to be concerned about the doctor’s fitness.
Louise B. Andrew, MD, JD , served as the liaison from the American College of Emergency Physicians (ACEP) to the Federation of State Medical Boards in 2006. In an online forum called Collective Wisdom , Dr. Andrew talked about the benefits of PHPs as entities that are helpful to struggling doctors and urged her colleagues to use them as a safe alternative to suffering in silence.
More recently, Dr. Andrew has been concerned that PHPs have taken on the role of what she calls “diagnosing for dollars.” In her May 2016 column in Emergency Physicians Monthly, Dr. Andrew noted, “A decade later, and my convictions have changed dramatically. Horror stories that colleagues related to me while I chaired ACEP’s Personal and Professional WellBeing Committee cannot all be isolated events. For example, physicians who self-referred to the PHP for management of stress and depression were reportedly railroaded into incredibly expensive and inconvenient out-of-state drug and alcohol treatment programs, even when there was no coexisting drug or alcohol problem.”
Dr. Andrew is not the only one voicing concerns about PHPs. In a Florida Fox4News story , Katie Lagrone and Matthew Apthorp wrote: “Are FL doctors and nurses being sent to rehab unnecessarily? Accusations: overdiagnosing; overcharging” (Nov. 16, 2017). The two reporters investigated the same concern, noting there are financial incentives for evaluators to refer doctors to inpatient substance abuse facilities.
“Medical professionals who enter the programs must pay for all treatment out-of-pocket, which could add up to thousands of dollars each year. There are also no standards on how much treatment can cost.”
In Michigan, three physicians have filed a class action suit against a PHP. The Chapman Law Group website states, “The Health Professionals Recovery Program, intended as a voluntary treatment program by the legislature, has become a highly punitive and involuntary tool designed to circumvent due process … However, according to the complaint, Carole Engle, the former director of the Bureau of Healthcare Services, implemented a policy that any person who does not voluntarily submit to this unnecessary treatment would be immediately suspended without a hearing and prevented from practicing as a health professional.” The complaint goes on to note that health care professionals could be mandated to years of monitored treatment based on a single anonymous tip.
The American Psychiatric Association has made it a priority to address physician burnout and mental health. Richard F. Summers, MD , APA Trustee-at-Large noted: “State PHPs are an essential resource for physicians, but there is a tremendous diversity in quality and approach. It is critical that these programs include attention to mental health problems as well as addiction, and that they support individual physicians’ treatment and journey toward well-being. They need to be accessible, private, and high quality, and they should be staffed by excellent psychiatrists and other mental health professionals.”
PHPs provide a much-needed and wanted service. But if the goal is to provide mental health and substance abuse services to physicians who are struggling – to prevent physicians from burning out, leaving medicine, and dying of suicide – then any whiff of corruption and any fear of professional repercussions becomes a reason not to use these services. If they are to be helpful, physicians must feel safe using them.
Dr. Miller is coauthor with Annette Hanson, MD, of “Committed: The Battle Over Involuntary Psychiatric Care” (Baltimore: Johns Hopkins University Press, 2016).
