Ethical Issues in State Physician Health Programs

In our Journal of Addiction Medicine piece just published online, co-author John R. Knight MD and myself discuss ethical and managerial considerations regarding state physician health programs (PHPs).  These are programs that work with physicians who have various kinds of health related issues, including substance use disorders and mental health issues.  As we note, “For most physicians, participation in a PHP evaluation is coercive, and once a PHP recommends monitoring, physicians have little choice but to cooperate with any and all recommendations if they wish to continue practicing medicine.”  As we note, the fact that they have high success rates does not obviate the need for scrutiny of PHPs and does not excuse abusive practices when they exist.  Such an argument is a weak utilitarian argument.  Separately, to argue by analogy to airline pilots does nothing to alter the facts that some PHP practices are abusive and ethically indefensible.  (See’s-blog/asam-president’s-blog/2012/10/16/how-to-achieve-an-80-percent-recovery-rate)

What are some examples?

For one, as we point out in our essay, some PHPs report physicians for positive test results when the PHP knows that these test results do not indicate relapse or ANY problematic behavior by physicians.  What’s the big deal?  Well, getting reported to one’s board of medicine is almost uniformly terrifying and can require retaining legal help to address the issue, coming out of practice while the “false positive” test is being investigated, and significant psychological distress.  One physician told me that one of these days a physician is going to commit suicide after one of these reports.

In addition, as we point out in our piece, PHPs often have complicated, financially intertwined relationships with the programs they send physicians to for evaluation and treatment.  And these are just a couple of the problematic issues about PHPs.

As we conclude in our Journal of Addiction Medicine piece, “Since PHP practices are unknown to most physicians prior to becoming a client of the PHP, many PHPs operate outside the scrutiny of the medical community at large. Physicians referred to PHPs are often compromised to some degree, have very little power, and are therefore not in a position to voice what might be legitimate objections to a PHP’s practices.”  Because of this, to argue as some have that we can just let the legal system deal with any potential abuses of PHPs is either naïve or an attempt to allow some unethical practices to continue without scrutiny.  We conclude our piece by recommending that the broader medical community begin to reassess PHPs.

The time for action is upon us.

Here is a PDF of our piece:


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US News and World Report article

Thank you to US News and World Report for the article they wrote here detailing our findings about how hard it is to find a psychiatrist.

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The Difficulty in Obtaining an Initial Psychiatric Appointment

Reuters reported on our recent study about how difficult it was for us to secure an initial appointment in 3 major US cities:  Boston, Chicago, and Houston.

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Radio Boston–WBUR: Mental Health Issues in the Startup World

I was a guest on today’s show:

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Revisiting Marijuana Addiction

In my latest Psychology Today blog I discuss recent medical literature which highlights the likelihood of becoming addicted to marijuana as well as the various consequences for those who over consume it, especially those who do so in adolescence.

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Help for Physicians who have Substance Use Disorders

Most states have physician health programs (PHPs), and physicians who are referred to them are generally bound to do whatever the PHP tells them in order to continue practicing medicine.   Thus, PHPs wield a lot of power.  The problem with them, however, is that despite their great power, many PHPs operate with little real oversight and as a result the rights and well-being of physicians who are referred to them can suffer.

Read my blog post at Psychology Today here.

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Psychology Today Blog–Psychiatrists Waste Millions of Hours Obtaining Prior Authorizations from Insurers

It is a travesty that insurance companies single out psychiatric patients for this kind of scrutiny.  Your physician doesn’t have to call an insurance company to admit you if you are a woman in labor or a kid with appendicitis.


See my blog post here:

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My book Almost Addicted won an award for excellence in medical writing!

Several days ago I received notice that Almost Addicted won the Will Solemine Award for Excellence in Medical Writing by the American Medical Writers Association.  This is an award for medical writing that is geared toward a general audience.  I am delighted to receive this award and take my hat off to Eric Metcalf whose writing and experience made the book what it is.

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Healthcare in the US–In Need of a Booster Shot, if not Replacement Surgery

Some claim the US has the best health care in the world but even a cursory review of data suggests otherwise.  Unfortunately, Obamacare is neither going to help or hurt the reality of the healthcare status of the US, despite the hilarious and dire predictions of the Fox News Business correspondent on this video:

The solution, like all of the countries with better health outcomes than us, is a nationalized health care system that is non-profit and guarantees integration of services.  Kind of like the VA healthcare system or Medicare . . .


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When May I Shoot A Student?

Op-ed in today’s New York Times says it all:

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What To Do If a Family Member is Abusing Drugs

See my latest Psychology Today post here for my thoughts on this topic.

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