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Physician Health Programs Are Important: Encouraging Early Referrals

(While addressing Physician Health Programs specifically in this blog, the same principles can apply to all types of professional health programs for all the other health professions (dentists, nurses, judges, attorneys, pilots, etc)).

Not everyone knows why Physician Health Programs are important. A medical board in a neighboring state without a PHP once asked me to meet with them. Their question to me was, “Why do we need a PHP?” In that particular state, the board was receiving referrals from hospitals and clinics, they were sending the doctors for evaluation and treatment, and they were monitoring compliance. They wondered what else a PHP could offer. My response to the board was, “You need a PHP to get early referrals.” To prove the point, they allowed me to compare their data to my state regarding the number of referrals over the previous 5 years. When compared, the numbers of referrals were over 3 times greater per capita in the state with an active PHP. Encouraging early referrals should be one of the primary goals of every PHP. Before addressing how to encourage early referrals, let’s review the functions of a PHP.

Important functions of an ideal PHP include:

  • Education (and marketing) – letting everyone know about the program and how it works, particularly stakeholders such as hospitals, large medical groups, universities and malpractice carriers while building rapport with these entities
  • Accepting and evaluating referrals – being available to take calls and evaluate whether referrals are appropriate
  • Intervention – interacting with the potential participant, encouraging them to accept assistance
  • Referral for evaluations and treatment – identifying quality programs that do a good job evaluating and treating professionals and monitoring these processes
  • Monitoring – developing a monitoring agreement and being sure the participant understands the terms and commits to it and carries out prescribed monitoring
  • Advocacy – documentation of compliance for stakeholders

The work of the PHP is important. If potential participants with possible substance use or mental health disorders are referred prior to patient harm or risk to the licensee’s career, the PHP has done a great service, protecting the public and the licensee’s career. Therefore, as all the functions of the PHP are carried out, it should be kept in mind at every step of the way that the ultimate goal is early referral. It is difficult sometimes because everyone is concerned about patient protection, so the PHP walks a fine line. The atmosphere at medical boards can sometimes seem adversarial with physicians. The PHP cannot succumb to this tendency. Patient safety and physician health are not mutually exclusive but rather they are synergistic. Healthy physicians provide better, safer care.

How are early referrals achieved?

Structure of the PHP – The PHP should be positioned at as much distance from the regulatory board as possible, physically and structurally. Many PHPs are independent 501(c)3 organizations and are located in their own facilities. The regulatory board is a judicial and regulatory body. The PHP should develop its own identity as a clinical program authorized to assist and not punish licensees. The program should be able to accept confidential referrals. The name of the program should suggest assistance, such as Physician Health Program. Names like Diversion Program suggest “diversion from punishment,” and should be avoided

Atmosphere of the PHP – Kindness and respect are paramount. Potential participants are ill and afraid and should be treated with the utmost respect, even when they misbehave. You can be kind while setting firm limits.

Good boundaries – The PHP should know its limits and let everyone know it is a voluntary program that has nothing to do with discipline. That being said, the alternatives to voluntary participation should be explained.

Style – Interventions should be performed in a supportive and loving manner, letting the licensee know that there are concerns and offering a path to resolving those concerns without accusation or force.

Referral out to evaluation and treatment programs should be made to programs that are competent and adhere to the same style of respect and kindness, while setting limits. The PHP will be judged in party by the evaluation and treatment programs it refers to.

Monitoring – Should be conducted in a supportive manner, setting appropriate limits and being fair and thorough. Expectations should be clearly defined, up front. Communication and reasonable rules are important (e.g. prohibiting all travel while undergoing monitoring is excessively rigid, vacations should be encouraged when appropriate).

Advocacy – The PHP should be happy to provide letters documenting recovery efforts (while identifying missteps, should they occur) in a fair manner.

It is a difficult task running a successful PHP. If the PHP develops a reputation of being coercive and punitive, if the PHP is not trusted, if the rules of the monitoring program are unreasonable, and/or if participants are treated as parolees, then referrals will dry up and early referrals will not occur. In this case, the PHP simply becomes an outsourced monitoring agency. The greatest value of a PHP, early referrals, will be lost.

The ultimate success of the PHP can be assessed in part by the frequency of early referrals. The gold standard is self-referral by a licensee who is in distress and seeks assistance prior to any workplace issue.

PHPs should be proud of the work they do upholding the good balance between assisting licensees who are having problems while at the same time protecting the public. Remember, the two are not mutually exclusive. Patient care is improved by improving physician health and wellbeing.

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