Whereas drug rehabilitation centers treat the disease of addiction, physician health programs serve an important case management function in which they oversee and manage care. They support the addicted physician throughout the recovery process, from evaluation through treatment and long-term monitoring, and seek to achieve the best outcome for the physician and their patients. Some of the functions the PHP performs include:
• Consulting experts, family members, colleagues and treatment service providers to create a treatment and monitoring plan
• Coordinating specialist services based on the needs of the physician
• Providing screening, intervention services, referrals to treatment, risk management, care planning, long-term monitoring and advocacy
• Offering educational programs to hospitals, medical groups, medical societies and other groups to promote early referral
The process of participating in a PHP typically proceeds as follows:
1. Report. The process begins with a report, typically from an impaired physician, a colleague/employer, a family member, or a licensing board, hospital, malpractice insurance or other agency.
2. Preliminary Assessment. Upon referral, PHP staff conducts a preliminary assessment to verify that the referral is legitimate and appropriate.
3. Intervention. If the initial assessment points to a substance abuse problem, PHPs facilitate a supportive, non-confrontational intervention that presents the concerns and asks the physician to complete a formal evaluation. Physicians who voluntarily follow the PHP’s recommendations receive protection and advocacy and in many cases preserve their licenses while completing addiction treatment.
4. Formal Evaluation. The formal evaluation takes place at an authorized, pre-screened evaluation site, often on a residential basis, that is chosen by the physician from a small group of reputable providers. PHPs carefully select the most respected evaluation and treatment providers, based on an assessment of the physician’s particular needs and any co-occurring disorders. If the evaluation fails to identify a problem, this fact can be used to exonerate the physician. If a problem is identified, the evaluation serves as the foundation for an individualized treatment plan.
5. Treatment. At the completion of the formal evaluation, when appropriate, referrals to high-quality, patient-oriented treatment centers and long-term contingency monitoring are made, taking into account any family of origin issues and co-occurring disorders that have been identified. Based on the summary of findings, the PHP staff may answer questions for physicians, describe the consequences of non-compliance and offer referrals to treatment as appropriate.
Physicians complete detoxification and intensive treatment, ideally designed specifically for addicted physicians and lasting 90 to 180 days. Treatment often includes therapy, education, 12-Step support, family involvement, and peer-based recovery support groups such as Caduceus meetings. Once treatment begins, treatment centers provide regular updates so PHP staff can be involved in the treatment process and communicate progress to the physician’s workplace, families and others.
6. Long-Term Monitoring. One factor that sets PHPs apart from other types of interventions is long-term monitoring. Once stabilized, physicians typically sign a recovery contract with the PHP that includes random drug testing, reports from a worksite monitor, documented group therapy and other recovery-oriented activities for five years or more. Through ongoing monitoring, the PHP can document proof of recovery, minimize the risk of relapse and advocate on behalf of the recovering doctor.
7. Relapse Prevention. PHPs expect participants to maintain lifelong abstinence, and relapse levels are typically low. If a relapse occurs, most PHPs respond with a renewed evaluation and intensified treatment and monitoring. In cases where relapse is associated with an active risk to patients or recommendations are not followed, most PHPs immediately report the participant to the licensing board. However, once physicians enter PHPs studies suggest they do not harm patients even if they relapse.