Physician health programs in most states are designed to help doctors with substance-use and other problems get the care they need and, when appropriate, return to work while protecting patient safety. But two Harvard doctors who have been involved with the Massachusetts program say there is too little oversight of operations in programs across the country and no clear standards.
Doctors who are referred to such programs have no choice but to participate in evaluation and treatment in order to preserve their careers, so the programs are “coercive,” Drs. J. Wesley Boyd and John R. Knight, both of Harvard Medical School and Boston Children’s Hospital, said in a review published this month in the Journal of Addiction Medicine. While the programs are highly successful, helping a large majority of doctors they serve to become abstinent and return to work, they also have the potential for abuse, they wrote.
“The physicians who are referred to these programs are often so compromised professionally by the time they get to them that, even if they feel that their treatment is not ethically sound, they’re often not in a position to voice them,” Boyd said in an interview.
The programs often refer patients for evaluation to specialty centers that fund regional and national conferences for the field, the authors wrote. The centers rely on state referrals for their financial viability and may be inclined to recommend treatment, which typically lasts 90 days—far longer than inpatient programs for the general population—and can be expensive.
The review also raised questions about data collected from such patients and whether physicians truly have the ability to opt out of research projects, when their participation in treatment is obligatory. And it questioned the relationship between physician health programs and state medical boards. Some programs are authorized by boards or receive funding from them, Boyd and Knight said.
Most programs “are beholden to the licensing board and might act in ways to keep the board satisfied, rather than risk loss of financial support or even closure,” the authors wrote. While both have experience working as associate directors of the Massachusetts program, the paper took a national view.
The Massachusetts Physician Health Services is a nonprofit subsidiary of the Massachusetts Medical Society. About 80 percent of its funding comes from the medical society and two major malpractice insurers. In the 12 months ending in May, 130 Massachusetts providers sought help from or were referred to the service by colleagues, employees, or others.
Dr. Luis Sanchez, the director, said he doesn’t see much potential for financial conflicts here. Patients are given several choices of treatment centers, and there are assistance programs available for some who cannot afford treatment. He said the organization is sensitive to conflicts.
“We’re always working on that,” he said. “Our mission is to be supportive and helpful and to assist physicians in getting the care they need but might not want.”
Sanchez said he doesn’t think it is possible to set firm national standards because each state medical board and health program operates under different laws. Several organizations, including the Federation of State Physician Health Programs, have laid out guidelines.
Boyd and Knight say addiction medicine groups should launch a discussion to establish standards, and they call for a national licensing program.