A physician health program, PHP, is a state agency that is responsible for advocating, treatment referral and physician monitoring, residents and medical students who have substance abuse disorders, psychiatric disorders and/ or boundary issues. There are two ways of becoming a part of these programs, self-referral or be reported. Currently, 47 states have a PHP, and the issue is that there is no set guideline and several variables in the programs.
To be honest, it wasn’t until I faced my DUI that I even thought of who I would go to for help. I never read the fine print stating: “As a physician, you have to disclose any issues with substances, mental illness or legal issues to the board or to a PHP.” The PHP is meant to be an advocate for providers protecting you from the board while assisting you in obtaining treatment.
Sounds good, right? If all PHPs were created equal, that would be the case.
In my experience, I was accused of multiple violations brought forward to the board. After an inadequate “investigation,” I was told to report to the PHP. Experiencing them years prior, although extremely nervous, I was very open and honest. Admitting my wrongs and attempting to clarify the other accusations. I was treated like a criminal already found guilty by the judge and jury. I was asked to voluntarily give up my license immediately and not to return to my private practice. A potential setup for a professional lawsuit, as I had the responsibility to give my patients at least 30 days’ notice and attempt to transfer their care to ensure continuity.
Through peer counsel, I retained a provider from a locums company and hired an NP to see my patients.
Within a couple of weeks, I was told that I had to go to a rehab center 12 hours from my home, away from my 5-year-old, where my insurance wasn’t accepted. Their terms deemed non-negotiable. From the beginning, the tone set was, do it our way or say good-bye to your license. After three months away, I was sent to another treatment center to focus on boundary issues, 15 hours away from my home.
Upon my return, despite completing 170 days of meetings, I continued 90/90 days of meetings — again another non-negotiable “recommendation.”
My therapist was over an hour away, cash-only at a rate of $250 per 45 minutes, weekly. Despite my discomfort with the psychiatrist, I was told I had to see him, yet another that didn’t accept my insurance, charging a cash rate of $250 per hour and $160 per 30 minutes. Forced to 30-minute sessions, unable to afford one hour sessions — he is 1.5 hours away from me.
I had two weeks to change my long time PCP, and sign over a medical release to them to be able to speak to my provider. With a history of childhood sexual abuse, this was uncomfortable for me, as they (PHP) were aware. The lack of control over who would do my pap, breast examinations, etc., this was anxiety-provoking. Again, another “recommendation” that was non-negotiable.
Upon informing my case manager of my inability to afford the excess of nearly $2,000 monthly ($600 per month fee for random drug testing), still unemployed, I was told, “If you can’t afford to follow our recommendations, you can’t afford your license.”
This statement was insulting and hurtful, I could never have told a patient, “If you can’t afford your medications, you can’t afford to be alive.”
I tapped into my 401K, maxed out credit cards, borrowed from family and friends, and was furthermore I was asked if I could take a second mortgage from my home.
As negative as this entire situation continues to be, I am thankful to have a better overall handle on my depression/anxiety, I finally received counseling to address my childhood abuse which contributed to me drinking more than I should have been.
After speaking to others in recovery from various states, there appears to be a great disparity amongst the PHPs. True advocating programs will do their best to find approved providers that will accept your insurance, advocate for you to get back to work sooner than later, with continued monitoring for a minimum of five years. Programs with providers in recovery are more empathetic and will have a “we” approach as opposed to a “you addict” approach.
As a participant of PHP, I am already going through a tough time in my life, support is priceless. For me, the biggest killer is not knowing when I will return. For providers claiming to be skilled in working with people with mental illness, it’s disappointing and provokes anxiety without a definitive date.
In conclusion, what I learned in rehab is that as the provider, we are held to a higher standard. The days when a doctor and nurse intimately date and get married are no longer accepted as a boundary violation. Be careful of the boutique clinic trends because there are a lot of traps that can cause violations.
Essentially, what one person does for years may never be brought to the attention of the board, may bring another person to lose everything. As for me, I have lost my practice. My credit card debit is over $100K. I am close to not being able to pay for my appointments that will cause me to be in non-compliance. Despite applying for 154 jobs, I am currently working at a retail store at $11 per hour, which barely covers the gas in my vehicle.
My advice: If you find yourself in trouble with drugs/alcohol, having an affair with a patient or even a friend of a patient, or battling mental illness, reach out to your PHP and ask for help before you are forced to.
I have chosen to keep myself anonymous as I am still in the midst of this but I will provide more incite to the PHP and the progress of my case.
The author is an anonymous physician.
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