Physician Health Programs (PHPs) – A Critical Look
Does anybody know what these non-overseen, non-accountable impairment assessment entities do? Should that be a concern?
I gave a short talk as part of a keynote panel recently at a physicians’ national gathering where our focus was on a heinous form of career harm known as “sham peer review.”
As my co-panelist Dr. Lawrence Huntoon was the editor of that association’s journal and had written extensively on sham peer review, many in the audience were familiar with the concept. In corresponding with him, I’d introduced the concept of sham FFDE (fitness-for-duty-exams) as a lesser known but perhaps more toxic, irreparably crippling variant of sham peer review.
Given that I’d been studying the axis of medical regulatory powers for a solid decade by that time, I thought for sure the audience would quickly see the similarity. So I asked for a show of hands, first for “how many people are familiar with medical boards?” Well, of course, everybody raised their hands.
Then I asked “and how many of you know what a PHP is, a physician health program?” And out of the audience of about 400, maybe 2 hands went up.
I was then a bit flustered. It can give a speaker pause when you realize that nobody knows what you’re even referring to as you begin your talk, your having presumed that they had some working understanding. But I realized 2 things: 1) maybe it’s a good thing they didn’t; and b) no wonder nobody has a clue what the concerns about this unusual assessment entity are as they’ve not only had no direct experience, they have no knowledge even of its existence.
Clearly, if you want to raise people’s concerns about the potential dangers of something, they first have to have a rudimentary understanding of the ‘something’ itself.
Now, I know that followers of CPR – The Center for Physician Rights are more familiar with the initials PHP and MLB and the life-and-death power these entities hold in the physician career universe. But just as with the sham peer review audience, I thought this would be a great opportunity to catch everybody up on this chameleon PHP enterprise and their board-ordered fitness-for-duty- exams so that you can best appreciate the concerns.
PHP stands for Physician Health Program, an unusual breed combining a sort of EAP (employee assistance program) with an official state psychiatrist having involuntary detention authority that conducts mostly board-ordered psychiatric exams. It is notable that many PHPs overtly deny that they conduct such exams, this despite being sent by their affiliated medical board explicitly for such a mental / FFD exam.
MLB stands for a state medical licensing board, the regulatory agency that approves licenses to practice medicine in a state (you need one for each state you plan to practice in) and disciplines the physician licensees under its jurisdiction. (Another head-scratcher – surprisingly I’m sure to many, some MLBs may not actually be state agencies but are rather contractor entities performing state administrative functions. One excellent legal article referred to them as cartels. )
Admittedly, most people outside of the field of medicine know nothing of these entities except that, like any profession, the government’s involved in some way.
But even 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 or so per year of continuing medical education offered by an officially approved institution, generally at an exorbitant sum.
Similarly among the physician community, there is almost no awareness or understanding of the activities performed by the contracted PHP and its frequent “recommendations” for extensive assessment and treatment at that board’s and PHP’s specially selected facilities.
This “don’t know what you don’t know” unawareness is something that catches many docs by surprise.
As we pondered this sort of blase’ blindness in the preparation of our paper “Systematic Abuse and Misuse of Psychiatry in the Medical Regulatory Therapeutic Complex (MRTC),” we realized there’s an invisible regulatory system – consisting of MLBs, PHPs, and hospital-based “peer review” and “performance appraisal” entities. And it exerts tremendous power, in some cases unfairly if not tyrannically, over the professional and personal lives of physicians. But because of this lack of awareness, those who enter into its web can become hopelessly ensnared.
Like the docs at the above conference, it’s good - and bad - news 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 the normalized tsunami of forces affecting practice today – 3rd party payer hassles (health insurance plans); the assaultive para-judicial malpractice system; psychopathological hospital politics; the deranged dynamics of group practices and the corporatized healthcare system, etc.
But the “bad” news is twofold. First, 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 career-threatening journey they find themselves on, one from which escape is virtually impossible short of career suicide via license self-amputation.
And compounding that, explaining to these docs – before death star laser lock occurs – 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 essentially futile as they have no awareness even of its existence. What little awareness a scarce few others might have is basically counterproductive as they hold the implicit belief that, surely, the unfortunate docs ensnared in the board / PHP / sham peer review complex must’ve done something wrong to have gotten ensnared.
As PHPs operate in the shadows of the MLB and under the appearance of state-authorized incontestability, their mental health assessments and further work-up and treatment 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 legally challenging these twin entities’ asserted authority are nearly nonexistent.
It’s precisely because so many physicians (and nurses, dentists, and veterinarians…) have such little understanding of PHPs’ roles in assessing mental health and substance abuse impairment and the career harms that can ensue can be so irreparable, that I and colleague Louise Andrew, MD, JD in conjunction with physician advocacy organization PJE (Physician Just Equity) are offering a free two-part webinar entitled “Physician Health Programs (PHPs): A Critical Look.” Part 1 is this Wednesday March 8th, at 8pm EST . Part 2 is the following Wednesday March 15th, at 8pm. (Yes, both free, and one registration gets you a seat for both.)
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. It IS a critical look.
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 with the PHP system, we do have increasingly urgent concerns about this non-overseen and non-accountable movement’s potential for irreparable harm to physicians’ careers.
Some of the areas we’ll cover will include:
The blurred boundaries of the relationship of a medical board to a PHP.
What a PHP WAS and DID originally, and what it IS and DOES now.
What happens when a medical board orders a physician to submit to a “mental evaluation” at a physician health (or similar state-authorized “fitness-to-practice”) entity.
What happens when a PHP arrives at a diagnostic conclusion and “refers” that physician for 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 are often 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?”1
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 legal and medical 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 dump 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 and have learned from many one-on-one physician conversations, share our concerns and some preparatory recommendations; and where we have the opportunity for Q&A and hopefully the opportunity for continued dialog and problem-solving.
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.
It’s a lot of territory, at that on material you’ll not hear anywhere else. So don’t miss it! And besides, we know that everyone in medicine is so frenzied that very few actually take the opportunity to sit down and actually listen to the replay.
This is a unique opportunity to learn about this chameleon creature, the PHP, one of the key elements of the Medical Regulatory Therapeutic Complex, that previously invisible coalition that exercises 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’s 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 and staff medical boards; those who run PHPs; those who represent physicians as counsel; leaders of healthcare entties and Graduate Medical Education programs; 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 here, I would welcome hosting 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 (this newsletter and podcast), 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.
You might also see British Medical Journal editor Jeanne Lenzer’s piece “Physician health programs under fire.”
As a sort of corollary to the PHP process is the whole addictionologist issue, that also illustrates the “follow the money” paradigm.
If your MLB (or local law enforcement) comes down on you for “drug” issues, an addictionologist will review your charts/case and give paid testimony before the board (or in court). Then you may be directed for treatment in a PHP facility wherein the addictionologist renders care and/or evaluation (for a fee). And then you may be directed to a reeducation program (given--for money--by the addictionologist) before you can practice again. Of course, much of the literature utilized by the drug rehabilitation program is authored or coauthored by … the addictionologist.
It’s a nice gig if you can get it.