J. Wesley Boyd, MD, PhD

https://www.theguardian.com/commentisfree/2025/feb/28/texas-pediatrician-support-healthcare

Super proud that Rachel Conrad, colleagues and I just published this piece in the APA journal Psychiatric Services. You can find it here: https://psychiatryonline.org/doi/10.1176/appi.ps.20240225

The APA just issued this “Psychiatric News Alert” about our piece:

Many psychiatrists in states with regulations permitting them to treat patients who regularly move across state lines (such as college students) are unaware they can do so, according to a study in Psychiatric Services. The findings also revealed that once informed of state exemptions, psychiatrists are split on their willingness to treat patients outside their state.

Rachel Conrad, M.D., of Brattleboro Retreat in Brattleboro, Vermont, and colleagues contacted 901 psychiatrists during the summer of 2023. All these psychiatrists advertised their services on an online platform and practiced in a state that had a medical licensure exemption or telehealth registry that would allow them to care for a patient who moved out-of-state. The investigators simulated an inquiry from a student who attends college in another state but wants to initiate treatment for new-onset depression while staying with their parents in the psychiatrist’s home state during the summer.

After extensive phone and email attempts, the researchers established contact with 143 psychiatrists who were accepting new patients. Of these, just seven (5%) were aware of their state’s medical licensure and/or telehealth exemptions. In these instances, the “student” offered an overview of the relevant laws that would allow for continuity of care once they returned to campus.

Among the 136 psychiatrists initially unaware of state laws:

• Forty-three (30%) were willing to establish care with students attending college in another state regardless of state laws, while 51 (36%) were unwilling to do so even when permitted by law.
• The remaining 42 (29%) wanted to learn more about licensure exemptions, though nine of this group subsequently declined to provide care to the student.

Conrad and colleagues noted that most of the psychiatrists they attempted to reach were in private practice and may not represent the field as a whole.

Still, the high rates of noncommunication, lack of state legal knowledge, and unwillingness to rely on medical licensure exemptions highlight the many barriers facing college students seeking mental health care, the researchers continued. Citing a federal law passed in 2018 that allows clinicians traveling with a sports team to practice in any other state, they suggested further federal licensure exemptions may be more effective at improving access to care.

For related information, see the Psychiatric Services study “Availability of Outpatient Child Psychiatric Care During COVID-19: A Simulated-Patient Study in Three U.S. Cities.”

The emotional struggles veterinary technicians face are often hidden

https://www.psychologytoday.com/us/blog/almost-addicted/202501/the-mental-health-struggles-of-veterinary-technicians

Check out my AI search query and AI’s response below. Some of the points ChatGPT makes are damning of PHPs, to put it mildly.

AI Query: Why do physician health programs send doctors to residential treatment program when those physicians don’t meet criteria for residential level of placement given the ASAM criteria for what level of care individuals need for a substance use disorder?

Answer: Physician Health Programs (PHPs) frequently refer doctors to residential treatment programs even when they may not meet the traditional American Society of Addiction Medicine (ASAM) criteria for such placements due to a combination of factors:

1. Conservative Approach to Risk Management:
   • PHPs tend to adopt a cautious and conservative approach towards any potential impairment because of the high stakes involved in medical practice. The priority is often to ensure public safety and maintain trust in the medical profession, which can lead to more intensive treatments being recommended.
2. Regulatory and Liability Concerns:
   • PHPs may face regulatory pressures and liability concerns. By recommending comprehensive treatment, they mitigate risks related to future incidents that could arise if a physician relapses or if an underlying issue is more severe than initially determined.
3. Standardized Treatment Protocols:
   • Some PHPs might rely on standardized treatment protocols that emphasize intensive intervention, arguing that comprehensive care reduces the likelihood of recidivism and ensures thorough assessment and treatment.
4. Economic and Institutional Incentives:
   • There may be financial incentives for treatment facilities and PHPs, as residential programs can be profitable. Relationships between PHPs and specific treatment centers might influence the frequency of recommendations for residential treatment.
5. Lack of Tailored Assessments:
   • In some cases, PHPs may not conduct sufficiently individualized assessments, leading to a one-size-fits-all recommendation rather than a personalized plan based on specific medical and psychosocial needs.
6. Perception and Pressure:
   • There is often pressure to maintain high “success” rates for sobriety, and residential treatment is perceived as being more thorough or effective, despite the individual circumstances.
7. Institutional Routine and Culture:
   • Some PHPs operate within a culture that traditionally advocates for residential treatment as a first line of defense, aligning with established practices over personalized criteria evaluation.
8. Misalignment with ASAM Criteria:
   • In some cases, PHPs’ interpretations of the ASAM criteria may vary, leading to discrepancies in care level recommendations. This misalignment might arise from training differences, institutional policies, or varying understandings of the criteria.

While these factors can provide context, it’s crucial for PHPs to strive for assessments and recommendations that align with best practice standards and professional guidelines, ensuring that treatment plans are truly reflective of individual needs and conditions.

Available here.

Despite polygraphs being inadmissible in courts and being considered either full on junk science or just north of that mark, the federation of state physician health programs (FSPHP) and its member state physician health programs (PHPs) are routinely sending physicians to evaluation centers that employ polygraphs. And get this: These centers charge hundreds of dollars for a polygraph, and if a physician doesn’t pass the test, guess what? They can retake it until they eventually pass–as long as they pay for each and every time they took the polygraph.

And as troubling, FSPHP and state PHPs have bidirectional financial relationships–i.e. serious conflicts of interest–with the centers that they’re referring physicians to that are using polygraphs.

Why does this practice copntinue? Because almost no physicians know anything about PHPs or the evaluation/treatment centers that they utilize until they’ve been referred to a PHP. And once that happens and they see what is actually transpiring, if a physician then registers complaints, they’re seen as bellyaching and in denial about their issues, as opposed to perhaps having very real, legitimate complaints.

See my article in Psychology Today here about this bizarre, little known, sad, and unfair state of affairs.