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• Physician Health in North America
  Paul H Earley, Brad Hall and Chris Bundy
  Published on: 2 August 2018
• Authors' conclusions not supported by results
  Nicholas D Lawson
  Published on: 31 January 2018

• Published on: 2 August 2018

  Physician Health in North America

  • Paul H Earley, Medical Director Georgia Professionals Health Program
  • Other Contributors:
    • Brad Hall, Medical Director
    • Chris Bundy, Medical Director

  [This is a revision of a submission from earlier today that contains references.]

  To the editor:
  We read Weenink, et al.’s review of remediation and rehabilitation programs for healthcare professionals with interest.1 It is among the most systematic and certainly the most internationally focused reviews to date. The article noted, “the aim of these programs is two-fold: to help professionals with problems and to protect patients from professionals who are unable to perform adequately.” This important point is in direct alignment with the Federation of State Physician Health Program’s (FSPHP) philosophy of supporting our member programs in their mission of early detection of potentially impairing illness. As members of the leadership of the Federation of State Physician Health Programs (FSPHP), we laud this review and believe additional commentary is worthwhile.
  In the U.S. and Canada, each Physician Health Program (PHP) is unique in its scope of services, funding and the types of healthcare professionals served.2 In the U.S., we trace our roots back to a seminal paper that appeared in the Journal of the American Medical Association (AMA) in 1973.3 As Weenink, et al. noted, all programs provide services for professionals with substance use disorders and other mental health conditions. PHPs do not provide treatment, rather, we provide care coordination and monitoring for health professionals with impairing illness. The FSPHP brings together PHPs in the U....

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  [This is a revision of a submission from earlier today that contains references.]

  To the editor:
  We read Weenink, et al.’s review of remediation and rehabilitation programs for healthcare professionals with interest.1 It is among the most systematic and certainly the most internationally focused reviews to date. The article noted, “the aim of these programs is two-fold: to help professionals with problems and to protect patients from professionals who are unable to perform adequately.” This important point is in direct alignment with the Federation of State Physician Health Program’s (FSPHP) philosophy of supporting our member programs in their mission of early detection of potentially impairing illness. As members of the leadership of the Federation of State Physician Health Programs (FSPHP), we laud this review and believe additional commentary is worthwhile.
  In the U.S. and Canada, each Physician Health Program (PHP) is unique in its scope of services, funding and the types of healthcare professionals served.2 In the U.S., we trace our roots back to a seminal paper that appeared in the Journal of the American Medical Association (AMA) in 1973.3 As Weenink, et al. noted, all programs provide services for professionals with substance use disorders and other mental health conditions. PHPs do not provide treatment, rather, we provide care coordination and monitoring for health professionals with impairing illness. The FSPHP brings together PHPs in the U.S. and Canada. We are working to expand and improve services we provide to healthcare workers.
  As noted, multiple studies confirm the PHP model’s remarkable remission rates from substance use disorders. The combination of sufficient initial treatment, often amongst a cohort of peers, with chronic disease management (comprised of frequent random substance screening, ongoing support group attendance and needed adjuvant pharmacotherapy, psychotherapy and psychiatric care) results in a five-year remission rate of approximately 80 percent. Remarkably this chronic disease management model shows exactly the same efficacy in opioid use disorders as other substance problems.4 This stands in sharp contrast to the suboptimal outcomes seen in the general population as we struggle to find solutions to the international problem of opioid use disorders. The outcomes achieved by PHPs have led to assertions this model of treatment should be considered for all addiction disorders, including opioid use disorders.5
  Outcomes for other behavioral health conditions have been less clear, with few papers addressing outcomes in this area.6 We believe this is partly due to the lack of a uniform systematic disease management model for treating depressive illnesses, stress and burnout among physicians and other healthcare workers. The FSPHP is the North American forum of evolving concepts in in the management of chronic mental health conditions.
  PHPs in the U.S. and Canada are less directly involved with medical skill dyscompetence per se, except in cases where the dyscompetence arises from, or is exacerbated by, interpersonal difficulties, behavioral or medical illness. In North America, such problems are more often addressed through credentialing bodies and medical boards (US) and colleges (Canada). A network of evaluators assess physician competency and assist PHPs, medical boards and medical colleges in determining individual needs and remediation strategies.
  Maintaining a healthy and competent healthcare workforce requires a collaborative effort by organized medicine inclusive of the multiple stakeholders that oversee and/or represent health professionals. We see Weenink, et al.’s fine paper as a call to action to do more. The FSPHP is eager to answer this call by sharing our efforts collaboratively with our international partners to enhance, expand and explore current and future pathways to a safe healthcare workforce around the world. Surely, we owe all those we serve in the day to day practice of medicine the “globalization” of effective models of remediation and rehabilitation for healthcare professionals.

  Paul H. Earley, M.D., DFASAM
  Brad Hall, M.D., DABAM, DFASAM, MROCC, AAMRO
  Chris Bundy, MD, MPH

  References
  1. J.-W. Weenink, R. B. Kool, R. H. Bartels, and G. P. Westert. "Getting Back on Track: A Systematic Review of the Outcomes of Remediation and Rehabilitation Programmes for Healthcare Professionals with Performance Concerns." British Medical Journal Quality & Safety 26, no. 12 (2017): 1004.

  2. R. DuPont, A. McLellan, G. Carr, M. Gendel, and G. Skipper. "How Are Addicted Physicians Treated? A National Survey of Physician Health Programs." J Subst Abuse Treat 37, no. 1 (2009): 1-7.

  3. AMA Council on Mental Health. "The Sick Physician: Impairment by Psychiatric Disorders, Including Alcoholism and Drug Dependence." JAMA 223, no. 6 (1973): 684-87.

  4. K. Domino, T. F. Hornbein, N. L. Polissar, G. Renner, J. Johnson, S. Alberti, and L. Hankes. "Risk Factors for Relapse in Health Care Professionals with Substance Use Disorders." JAMA 293, no. 12 (2005): 1453-60.

  5. R. L. DuPont, W. M. Compton, and A. T. McLellan. "Five-Year Recovery: A New Standard for Assessing Effectiveness of Substance Use Disorder Treatment." J Subst Abuse Treat 58 (2015): 1-5.

  6. J. R. Knight, L. T. Sanchez, L. Sherritt, L. R. Bresnahan, and J. A. Fromson. "Outcomes of a Monitoring Program for Physicians with Mental and Behavioral Health Problems." J Psychiatr Pract 13, no. 1 (2007): 25-32.

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  Conflict of Interest:
  None declared.

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• Published on: 31 January 2018

  Authors' conclusions not supported by results

  • Nicholas D Lawson, Former psychiatry resident and incoming law student Georgetown University Law Center

  Authors do not acknowledge some of the most common criticisms of these studies:

  (1) Physician health program (PHP) data may be suspect because PHPs benefit from presenting a rosy picture of their effectiveness.

  (2) Self-reports from those being evaluated by PHPs, which have much to lose from responding to surveys in ways that criticize these programs, may not be reliable.

  (3) There are considerable reasons to doubt that "programme completion," "return to practice," and "no relapse/recurrence" reflect treatment efficacy. Unwarranted referrals may also result in coerced treatment for physicians who do not have a substance use disorder or problematic performance, making "graduation" not meaningful for the purposes of drawing conclusions about PHP treatment effectiveness.

  Other concerns with this research will be addressed in forthcoming publications by the commentator.

  Conflict of Interest:
  None declared.

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