In a recent article published in the journal Psychiatric Times (8/10/21), Dr. Steve Adelman, M.D., a series of FAQs he raises about the nature of Physician Health Programs (PHPs) clarifies for readers some aspects of these state-run programs, especially as they concern psychiatrists who may treat addicted physicians. However, in order to bring greater relevance to a larger audience, we’ve tried here to highlight some of the essential points raised by the author. Hopefully, readers will have a better understanding of what makes PHPs unique in their ability to help doctors with substance use disorders get treatment and find recovery and freedom from their chemical dependency, while increasing the likelihood they may retain their medical licensure and ability to practice medicine.
First, though, let’s answer the question (for those who don’t know), “What is a Physician Health Program”?
According to the Federation of State Physician Health Programs (FSPHP), “A Physician Health Program (PHP) is a confidential resource for physicians, other licensed healthcare professionals or those in training suffering from addictive, psychiatric, medical, behavioral or other potentially impairing conditions. PHPs coordinate effective detection, evaluation, treatment and continuing care monitoring of physicians with these conditions. This coordination and documentation of a participant’s progress allows PHPs to provide documentation verifying a participant’s compliance with treatment and/or continuing care recommendations. State member programs have a confidential diversionary role allowing for a therapeutic alternative to disciplinary action.“
And since the word “confidential” is used twice in the above description of PHPs, let’s allow the question of confidentiality to lead us directly into some frequently asked questions about PHPs.
Do PHPs maintain non-disclosure of the identity of a patient (i.e., a physician seeking treatment for chemical dependency)? In some (but not all) states, the PHP may be “hard-wired to the licensing board, with the unintended consequence that an informational query may turn into an inadvertent medical board report that has the potential to (confront the) physician patient.” Therefore, Adelman says, it’s essential for a physician seeking treatment for a substance use disorder to “carefully review the details of your PHP’s relationship with your state’s medical board.” This can be done by making a thorough of your state’s PHP website (search www.FSPHP.org for links to each state PHP), talking about this (and any other issue) with those in your state medical society or state chapter of the APA who have knowledge of these matters, or by calling the medical director of a PHP in your state and asking “hypothetical questions” about the nature of client confidentiality and how the state PHP interacts with the medical licensing board. There are many PHP’s that offer a “safe harbor” approach; that is, a report or self-report to the PHP may, in many circumstances, substitute for a report to the State Medical Board or Department of Health. The Florida PHP (known as the Professionals Resource Network or PRN) is such a program.
How can a PHP help improve the care a chemically dependent physician patient receives? State PHPs typically refer physician patients to treatment facilities that staff medical doctors trained in addiction medicine, and oftentimes, as well, psychiatrists trained in addiction medicine. As Adelman observes, “Informational conversations with a PHP help (attending medical doctors and psychiatrists) identify physician-savvy evaluative and therapeutic resources that will help deliver the best care to (a) physician patient.”
Indeed, PHPs have a rich and documented history of assisting physicians struggling with addiction find and receive the help they’re seeking. This includes one of the most common patient goals: to stabilize and regain the ability to practice medicine competently. Depending upon the specifics of the patient’s situation, the PHP can recommend a period of ongoing monitoring for recovering physicians returning to the practice of medicine.
How does involvement with the PHP improve a physician patient’s prognosis? According to Thomas McLellan, PhD, an eminent addiction scientist, as well as the cofounder and CEO of the Treatment Research Institute, “We know how to effectively treat addiction in this country,” explaining that “State PHPs represent a best practice for the treatment of addiction, as they utilize highly structured accountability and monitoring structures to promote long-term abstinence and prevent relapse.” In fact, a significant percentage (75% to 80%) of those doctors who complete treatment for their chemical dependency and who stay in their agreed upon aftercare programs are found to be “clean and sober” five years later.
In conclusion, the countless successes brought forward by state PHPs enrolling addicted physicians demonstrate they are valuable, life-giving resources that can help doctors with substance use disorders get the care and treatment they need to recover and find new life, while maintaining their credentials to practice medicine.
DuPont RL, McLellan AT, White WL, et al. Setting the standard for recovery: Physicians’ Health Programs. J Subst Abuse Treat. 2009;36(2):159-171.