How Impaired Physicians Can Be Helped

An Underused Resource

Physician health programs (PHPs), which exist in every state but California, Nebraska, and Wisconsin, have an impressive track record in helping physicians with alcoholism, drug addiction, mental health disorders, and other health problems save their careers, keep their licenses, and return to treating patients safely.

Yet PHPs continue to be an underused resource. Too many doctors are still unaware that PHPs exist—or they are only vaguely aware and don't understand what PHPs do. Many other doctors are loathe to notify a PHP that a colleague is suspected of being impaired, for fear of jeopardizing that colleague's career.

"Addiction is a common illness," says Paul H. Earley, MD, an addiction medicine physician in Atlanta, Georgia, and director of his state's PHP. "Ten percent of the American population will develop an addiction over their lifetimes. Physicians are the same. So one in 10 of your colleagues will get the problem. We're not talking about some odd, unusual disease state."

P. Bradley Hall, MD, a family physician and addiction medicine specialist, is president-elect of the Federation of State Physician Health Programs (FSPHP) and executive medical director of the West Virginia PHP in Bridgeport. Dr Hall objects to use of the term "impaired physician." The correct term is potential impairment, he insists. That's because, even among physicians with substance use disorders, work is generally the last to go. A doctor's family may be falling apart, his or her physical health may be deteriorating, but that doctor is still typically delivering adequate patient care.

Dr Hall prefers the term "ill physician."

"Addiction and mental illness are both illnesses," Dr Hall asserts. "But we have a hard time looking at it that way. It's a stigma we have in our society. Now that we have a national epidemic, it's made it a little more understandable that people with degrees after their name are going to get cancer, diabetes, and everything else at the same rate as everyone else."

Differences in PHPs

Some PHPs are run by independent nonprofit corporations, and others by state medical societies; still others are under the aegis of state medical licensing boards. Some are well funded; others "are asked to provide champagne performance on a beer budget," Dr Hall says.

"The relationship of each PHP to the medical board varies," explains psychiatrist and addiction medicine specialist Steven Adelman, MD, director of Massachusetts Physician Health Services, the state's PHP. "Here in Massachusetts, we are completely independent of the medical board. We're not an arm of the board. We are not funded by the board, by the state, or by licensure fees. We've positioned it this way because we believe it's cleanest that way. When the PHP is viewed as in any way an arm of the board, that's a disincentive for physicians to self-refer. It feels too close for comfort to them. We are in this safe zone—or safer is probably the way to put it—between the doctor; the employer; the board; and sometimes the courts, if, say, a DUI was involved."

"Physicians in this era of regulation and malpractice are a suspicious lot," Dr Earley agrees, "and so they might be less prone to report to a PHP that is under the auspices of a board. I think in reality, there are fewer differences," he adds, "but the perception is there. Perception is a powerful thing."

"Being completely independent of organized medicine, which a sick physician may fear in terms of punishment, retribution, and career-ending stigma, all get in the way of a doctor's ability to reach out and ask for help," Dr Hall believes.

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Cite this: Neil Chesanow. How Impaired Physicians Can Be Helped - Medscape - Feb 24, 2015.