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If a physician has a substance use or mental health problem, it is in everyone’s interest — the physicians themselves, their patients and their families — for them to get treatment. And if they go for treatment, they deserve to be treated fairly, but given my six years of experience as an associate director in one state physician health program (PHP) and in working with physicians from all across the U.S. since then, their treatment is often anything but fair.
Consider what happened to Dr. Smith*: Dr. Smith was a board-certified physician working on a locum tenens basis for a hospital and had never had any complaints or allegations of misconduct. In fact, the hospital liked his work so much they asked him to work for them full time, which would require jumping through a few hoops, including obtaining a pre-employment physical exam and being drug tested. He lives in a state where marijuana is fully legal and freely told them he used cannabis twice a month on average, in the evenings after work, just in case it showed up on the drug test.
When he tested positive for cannabis on his employment physical, the hospital — just to be cautious — sent him to his state PHP to discuss the matter. The state PHP then promptly referred him for a four-day out-of-state evaluation at a cost of $5000 to $6000. If he refused to go, they’d be forced to report him to the state board of medicine as being non-compliant. At the conclusion of the four-day evaluation, he was diagnosed with “severe marijuana dependence” and told that he needed to stay for 90 days of inpatient treatment, which they just happened to offer on-site, at a cost of over $50,000. When he refused, the evaluation/treatment center tried to cajole and even coerce him into reconsidering, saying (among other things) “Isn’t your career worth $50,000?”
Dr. Smith remained steadfast in his refusal, at which point the center reported him as being non-compliant to the state PHP, which in turn notified the board of medicine. The board of medicine demanded that Dr. Smith sign a voluntary agreement not to practice, with the serious threat that they’d investigate him and respond very harshly if he didn’t. As most doctors do under these circumstances, Dr. Smith signed. That was over three years ago. Dr. Smith has not worked as a physician since.
As if this case isn’t troubling enough already, to compound matters state PHPs — including the one in Dr. Smith’s state —often have significant financial conflicts of interest with these evaluation and treatment centers, given that these centers financially sponsor state, regional and national meetings of PHPs. Many of these centers depend on referrals from PHPs in order to stay afloat.
When Dr. Smith later volunteered to be evaluated by one of two nationally prominent addiction psychiatrists that had nothing to do with the state PHP — the PHP refused, saying that these psychiatrists couldn’t be trusted to do the collateral work the way one of their “vetted” evaluation centers would (or, I’d wager, provide financial kickbacks to the PHP).
Dr. Smith ultimately has no real avenue of appealing the state PHP’s determination because in his state — as is true around the U.S. — the PHP has very little effective oversight or avenues of appeal. As such in many states, the only real means of appeal is through the courts, which generally is both slow and costly. And not surprisingly, once physicians aren’t able to practice they often can’t afford to hire lawyers to appeal their cases.
Stories like this are all too common. Given what I have previously written about PHPs, every several weeks I am contacted by a physician from around the country whose story might differ in its details from Dr. Smith’s but whose overall picture is similar in that they feel wrongly accused in some way but have little choice but to comply or else lose their ability to practice medicine.
This coercion is abusive and needs to stop. Physicians need to know that they can get treatment if they need it. The programs that they are referred to should be free of financial and other conflicts of interest. These programs should also have timely, inexpensive means of appealing their decisions and should also be subject to national standards and external oversight. Physicians — and by extension everyone in their orbit — deserve as much.
* This is a real case but “Dr. Smith” is a pseudonym for the physician.
