What Happens When Your Physician Health Program Fails to Exist and Three Options for Maintaining Sobriety by Robb Hicks, M.D.
Physicians are highly influential role models for their patients, colleagues, families and the public at large, and that esteemed status makes their personal well-being a key determinant in health promotion, as noted by the American Medical Association¹. Nevertheless, medical professionals are not immune to the risk factors which make the general population more susceptible to developing addictions, including but not limited to genetic predisposition, childhood trauma and the presence of anxiety, depression or other mental health issues. These risk factors are then combined with the intrinsic pressures of being a physician, and s/he may begin to feel that the only way to cope with the demands of the workplace and family life is to self-medicate with mood-altering substances like drugs and alcohol.
Synopsis of California’s Diversion Program’s Rise and Demise
As physicians ignore their own personal well-being, health becomes less important, his or her judgment becomes impaired and consequently risks bringing harm to themselves and/or their patients. It wasn’t until the publication of the article entitled “The Sick Physician” in the Journal of the American Medical Association in 1973, that the Federation of State Medical Boards acknowledged that disciplinary actions alone were not enough to help disease-stricken physicians who were displaying lower than usual performances or unprofessional behaviors². Due to increased knowledge and greater awareness, statewide physician health programs (PHPs) and physician support meetings were soon developed.
One of the first examples of such programs was California’s Diversion Program, which was established in 1982 by a group of physicians and dentists hoping to “divert” their peers to the appropriate resources to aid in recovery from addiction and maintain long-term sobriety. The clients were either referred by California’s medical board or self-referred, and they had to agree to a participation contract of between zero to five years. Committee members were met with continuous legislative and political resistance, chiefly from the Center for Public Interest Law (CPIL), and several audits were requested to test the effectiveness of the program. CPIL attorneys incorrectly believed the program was a means to protect “bad doctors” wishing to continue practicing medicine after completing treatment.
Final audits revealed some deficiencies, which were neither unexpected nor uncorrectable, and the program was allowed to expire in 2008 without renewal. Approximately 400-500 impaired physicians were turned away and had to fend for themselves as they struggled in new recovery³. The decision to close the program was polarizing to the medical community, but action would soon be taken to support those most in need of care.
One creative solution to emerge from this catastrophe was the formation of the Pacific Assistance Group (PAC), a group of California's PHP therapists who banded together to form their own advocacy group for physicians⁴. Another is the establishment of the California Public Protection and Physician Health, Inc. (CPPPH), a statewide entity independent of state government with sanctions to operate as an alternative for impaired physicians⁵.
Three Options for Maintaining Your Sobriety if Your State Does Not Have a Physician Health Program
While most states have active statewide PHPs, Wisconsin, California, Nebraska, North Dakota and Delaware do not have programs that are members of the Federation of State Physician Health Programs6. One must wonder, what is to become of the thousands of physicians without the advocacy, comprehensive treatment and monitoring that a PHP provides?
An individual has three options to assist him or her in the recovery process: one is to be a voluntary participant, the second is to choose a well-being path, and the third is to contact an existing group for available resources and assistance. A voluntary participant is one whom is self-referred and willingly acknowledges their need for help to overcome an addiction. S/he identifies the resources they need, usually some of type of alcoholic anonymous program, self-directs their treatment plan and, ultimately, “sponsors” their own recovery. While this approach may suffice for some individuals, it often ends badly because of a lack of accountability and monitoring.
The well-being path is one where a committee refers a participant for treatment. Hospitals, large medical groups and both state and county medical societies may have well-being committees to assist physicians battling additions. A downfall of this option is there are usually no authorities on the board to conduct a thorough, expert assessment, which is needed to prescribe a path of treatment for a physician. Well-being committee members should be clear of their role as a support system for an individual yet remain accountable to the medical staff and medical executive committee for patient safety. There also have been some issues regarding the levels of accountability, monitoring and follow-up, which all are components of long-term success in any program.
Lastly, some physicians may need legal assistance or advocacy for issues concerning practicing medicine and/or holding a license to practice medicine. These are examples of issues no alcoholics anonymous leader has the authority to assist in; hence, a physician should consider contacting a leader of an outpatient center with more knowledge of and experience with these processes. As previously mentioned, both the PAC and CPPPH have an array of resources for individuals and groups seeking physician health services. Although each of these three options presents some limitations in their scope and effectiveness, they all can be utilized as a form of support until a physician can be accepted into a professionally administered treatment program.
What You Can Do to Politically Support Physicians Recovering from Chemical Dependency
A commonly shared belief within the recovering medical community is “when you’ve seen one PHP, you’ve only seen one.” This idea reflects the reality of the constantly changing legislation of PHPs at both national and state levels. For this reason, I assert we need to work politically to establish guidelines and policies that ensure more healthy physicians and to further educate medical professionals about addiction among physicians, the risks of developing addiction and how to recognize the signs and symptoms of addiction in the workplace. The crucial steps of prevention, early detection and education also will help to heighten public safety and encourage more self-reporting⁸.
Another recommendation is to actively seek out individuals who have some “skin in the game” to partner with them and garner their increased participation; hospitals, private practices and insurance companies need healthy physicians. PHPs address physicians’ health and well-being as significant factors in the long-term preservation of physicians’ practices, overall quality of patient care and improving family dynamics and relationships.
Call to Action
We recovered physicians must make our voices heard if we are to prevent further loss of PHP programs. So I am donating $500 to the MPHP’s “500 Doctors:$500” campaign. I’m doing my part and now it’s your turn. Please join with me and write a check today to support the Missouri’s PHP and, in turn, you will be supporting both yourself and other physicians who so desperately need the assistance which our MPHP provides.
1. American Medical Association. Physician Health. Retrieved from http://www.ama-assn.org/ ama/pub/physician-resources/physician-health.page Accessed on September 3, 2013.
2. (No authors listed), (1973) The Sick Physician. Impairment by psychiatric disorders, including alcoholism and drug dependence. Journal of the American Medical Association, 223(6):684-687.
3. Tracy DDS, J., Vixie DDS, C., Specht MD, T. & Haroutunian MD, H., (2013, July 31-August 4). When your PHP fails to Exist International Doctors in Alcoholics Anonymous (IDAA) Annual Meeting. Lecture conducted from Keystone, Colorado.
4. Pacific Assistance Group. http://www.pacificassistancegroup.net/. Accessed September 3, 2013.
5. California Public Protection and Physician Health, Inc. http://cppph.org/. Accessed September 3, 2013.
6. Federation of State Physician Health Programs. http://www.fsphp.org. Accessed September 3, 2013.
7. Krall MD, E., Niazi MD, S. & Miller MD, M., (2012) The Status of Physician Health Programs in Wisconsin and North Central States: A Look at Statewide and Health Systems Programs. Wisconsin Medical Journal, 111(5): 220-227. Retrieved from https:// www.wisconsinmedicalsociety.org/_WMS/publications/wmj/pdf/111/5/220.pdf.