Physician Health Programs – A Critical Look - Part 1

Or as Medscape asked “More Harm Than Good?”

(Heads up - here’s a link to an upcoming two-part webinar on this topic - details below. If interested, register now as space is limited.)

Followers of CPR and The Rhythm Strip are more familiar with the initials PHP and MLB and the power these entities hold in the physician career universe.

PHP stands for Physician Health Program, an unusual breed combining a sort of EAP (employee assistance program) with an official state psychiatrist with involuntary detention authority that conducts mostly board-ordered psychiatric exams.

MLB stands for a state medical licensing board, the regulatory agency that approves licenses to practice medicine in a state and disciplines the physician licensees under its jurisdiction. Surprisingly, it may not actually be a state agency but a contractor entity.

Most people outside of the field of medicine know nothing of these entities except that, like any profession, government’s involved in some way.

And within medicine itself, the only interaction the majority of docs have with their state MLB is via their initial license application and their bi-annual renewal where they document that they’ve participated in 50 hours per year of continuing medical education offered by an officially approved institution.

And even among the physician community, there is almost no awareness or understanding of the affiliated PHP and its MLB-enforced “recommendations” for extensive assessment and treatment at its specially selected facilities.

And yet, as we discovered in the preparation of our paper “Systematic Abuse and Misuse of Psychiatry in the Medical Regulatory Therapeutic Complex (MRTC),” an invisible regulatory system – consisting of MLBs, PHPs, and hospital-based peer review and performance appraisal entities – exists and rules, in some cases tyrannically, the professional and personal lives of physicians who become ensnared in its web.

The good - and bad - news is that most licensees have no awareness of these MRTC powers’ workings. “Good” in that they are able to practice and focus on their practices and just dealing with the tsunami of other overwhelming forces affecting practice today – 3rd party payers (health insurance plans), the para-judicial malpractice system, hospital politics, the deranged dynamics of group practices and corporatized healthcare systems etc.

The “bad” news is twofold. First, explaining to these docs the existence of a non-overseen system that affects perhaps as many as 10% of physicians and that rules with a Stalinist iron fist is futile as they have no preliminary understanding of its existence and further hold the belief that the unfortunate docs ensnared in it must’ve done something wrong to have gotten ensnared. And second, having no knowledge of the reality, when that time comes that they themselves are locked onto by the MRTC death star’s laser, they are wholly unprepared for the surreal and life-threatening journey they find themselves on and from which escape is virtually impossible short of career suicide.

As PHPs operate in the shadows of the MLB and under the appearance of state-authorized incontestability, their mental health assessments, and recommendations are treated as infallible. And backed by the MLB with which they may have the equivalent of an exclusive contract, in some cases statutorily established, the chances of prevailing in challenging these twin entities’ asserted authority are nearly nonexistent.

Because so many physicians (and nurses, dentists, and veterinarians…) have such little understanding of how a medical board (or other professional healthcare licensing board) handles matters pertaining to concerns that have been raised about a physician possibly having an impairment, especially in the mental health and substance abuse realm, we are offering a free two-part webinar entitled “Physician Health Programs (PHPs): A Critical Look” this Wednesday March 8th, at 8pm EST and the following Wednesday March 15th, at 8pm.

Register for “Physician Health Programs (PHPs): A Critical Look”.

Given that both presenters have examined the PHP issue over a span of years (myself more than a decade) and have been increasingly critical of it in various postings in our separate domains, this is not, as you might gather, going to be a PHP promo puff piece.

While we will strive to stay as fact-based as possible in our presentation, each of us - having spoken with hundreds of physicians who’ve been involved as detainees of the MRTC’s PHP system – have increasingly urgent concerns about the movement’s potential for irreparable harm.

Some of the areas we’ll cover will include:

• The relationship of a medical board to a PHP.

• What a PHP is and does.

• What happens when a medical board orders a physician to submit to a mental evaluation at a physician health, or similar fitness-to-practice, assessment and referral entity.

• What happens when a PHP arrives at a diagnostic conclusion and “refers” that physician to an extended evaluation at an affiliated program.

• What happens at that evaluation, and after?

While the majority of physicians will never be ordered to be evaluated by a PHP, for those who are, the experience and ensuing cascade of career and life consequences can be more traumatic than any potential impairment concern that was originally raised. Which is why Medscape’s Pauline Anderson titled her article “PHPs: More Harm than Good?”

As we set out designing the two-part series, we recognized immediately that we had to trim down the equivalent of a multi-chaptered book to a Cliff notes summary. So the way we’re dividing it up is this:

In Part 1, we’ll explore the PHP movement and its evolution, the roles PHPs play relative to medical boards, some of the key concerns that have emerged, and what physicians can - and should - do to protect their rights.

In Part 2, we’ll drill down on a few key concerns of major import such as the nature of a PHP evaluation; HIPAA – and other – confidentiality; board-mandated compliance with a PHP’s “recommendations;” and duration of licensee involvement with a PHP, amongst others.

This is not intended to be a traditional “medical presentation” where teachers throw a truckload of factoids and students leave cross-eyed with mental indigestion. It’s more like an interactive OpEd where we present what we know, share concerns and recommendations, and have the opportunity for Q&A and participant comments.

Yes, it’s time-compressed, and that’s often frustrating for many (including us).

In both Parts, we have reserved approximately 20 minutes for attendee Q&A and panelist/audience discussion.

If you are, might in the future be, or have been involved with a PHP, or know someone who has or might be … you need to attend this.

So if you are, might in the future be, or have been involved with a PHP or know someone who has, this is a unique opportunity to learn about one of the major elements of the MRTC – the Medical Regulatory Therapeutic Complex, that coalition of powers that regulate medicine and exercise life and death power over your career.

Again, here’s the link to register: http://bit.ly/pjephp2023

One registration covers you for both webinars. But keep in mind, seats are limited

Please note: on the registration page, there’ll be a link to a short pre-webinar questionnaire. It’s entirely anonymous - no email is collected and it’s not in any way connected to your registration. It’ll really help us - the two presenters and moderator - get a sense of our audience’s experience with PHPs.

And p.s., this is an open webinar - free - so please forward this to all whom you think might benefit. And we’d welcome attendance from any who are involved in some capacity with the MRTC – those who sit on boards, who run PHPs, who represent physicians or boards, and therapists and coaches who counsel physicians who’ve become involved in some way with PHPs.

And a p.p.s., in the event that either co-presenter says something that the participant believes is factually incorrect, we would welcome hearing from you so that we might examine your concern. And further, speaking for myself only and not my co-presenter, I would welcome doing a podcast or webinar with any medical board, physician health program, or organized medicine leaders. I’d be happy to have you as my guest on Physician Interrupted, and I’d gladly be a guest on yours.   

Again, the link to register: http://bit.ly/pjephp2023

We look forward to having you join us.