A physician health program is a state agency that monitors physicians, residents and medical students who have substance abuse disorders, substance dependency and psychiatric disorders. Their purpose is to allow doctors to practice medicine while going through rehabilitation and at the same time, to protect their patients and maintain a safe standard of care. The theory behind the programs is that illness is not the same as impairment — in other words, a doctor may have a medical condition and yet still be able to practice medicine. Nearly every state has a physician health program, and policies differ by state.
While some state programs are concerned only with drug addiction and alcoholism, most states cover not only substance abuse, but all psychiatric problems including disruptive behaviors, sexual misconduct, cognitive and physical impairment, eating disorders, stress and burn-out. Physicians can enter substance abuse treatment voluntarily and pay for it themselves, but most enter after being reported to their state medical associations by a patient or colleague.
The length of time a physician is monitored depends on the severity of the substance abuse problem. A substance dependency diagnosis, such as alcoholism or cocaine addiction, usually requires five years of monitoring. A one-time incident in which a doctor practiced medicine while impaired by drugs or alcohol may require only one year of monitoring. Monitoring includes drug tests, worksite surveillance, records of the physician’s compliance with his treatment center and counsellors and relapse management. In some states physician health organizations require doctors in treatment to attend Alcoholics Anonymous (AA) or Narcotics Anonymous at least once a week.
Missing counseling sessions or support meetings or non-compliance with treatment programs are considered “Level I” relapses. “Level II” relapses are using alcohol or drugs, and if that happens, the doctor has to suspend medical practice and undergo reevaluation. By working through a physician health program, a doctor can maintain complete privacy during treatment for substance abuse or dependency.
In 2002, a series of newspaper articles in California exposed the fact that many doctors impaired by drugs or alcohol were committing malpractice, and the California Medical Board was doing nothing about it. The articles caused the state legislature to investigate California’s 27-year-old program for monitoring physicians with substance abuse problems. In 2008, the program was eliminated after investigators found incidences of medical malpractice and cover-ups. Today if a doctor in California violates the State Medical Practice Act, the case is referred to the Attorney General’s Office, and the doctor can have their medical license revoked or be placed under probation where they must undergo drug screening, a psychiatric evaluation and refrain from using drugs or alcohol.
California’s elimination of its diversion program has its critics, who believe that doctors are unlikely to enter any treatment program unless they can do so with complete anonymity, and that too many doctors try to manage their own illnesses, which produces an even greater danger to their patients.