Accountable-Safe-Confidential: Moving Toward an Effective State PHP

By Robert J. Summerer, DO
SDSMA President

A Physician Health Program, or PHP, is a program designed to help physicians impacted by substance abuse or mental health issues. It is a resource that most states have developed for doctors to maintain their licensure while they work towards wellness. Successful PHPs are able to maximize participation of “at risk” physicians by ensuring confidentiality from disclosure, a safe haven from the threat of license revocation, and a plan to achieve individual  wellness while maintaining patient safety. It’s easy to understand the many challenges, especially when one considers the unique task of treating the physician patient who often knows all the best tricks.

Forty-seven states have met the challenges of setting up PHPs. Some have been more successful than others in doing so. National standards have been developed to advise the many state programs. The Federation of State Physician Health Programs (FSPHP) has been instrumental in setting guidelines for PHPs. These are the experts in addiction recovery and mental health for doctors. Organized medicine (AMA, AOA, ACP, ABMS, APA, and the Federation of State Medical Boards) has been the driving force behind the FSPHP to advocate for physician wellness.

An important concept regarding PHPs is that of the social contract. As described by FSPHP president-elect Dr. Chris Bundy, “The social contract is an agreement between physicians and governments that secures a physician’s privilege to practice in exchange for the benefit or right of citizens to expect safe care.” This contract is codified in state law by providing a mechanism for licensure. In most states, this contract is further supported by the provision of a PHP to serve the physician work force and protect patients. For the contract to work, government must provide a safe mechanism for a potentially impaired or impaired physician to find recovery.

The keystone of a social contract is accountability. The licensing board is accountable to the government and its citizens. The PHP is accountable to the board by providing a cost effective and therapeutic program in a confidential environment. The participants are accountable to the program by following the recommended treatment regimen to maintain their licensure and confidentiality. Their participation in the program is voluntary even though it may seem coercive to maintain their ability to practice medicine.

Since 1996, South Dakota physicians have had access to the Health Professions Assistance Program (HPAP). This program was designed by statute to meet the directives described above. In 2017, the SDBMOE, the medical licensing board, elected to end their participation with HPAP, and instead created the Medical Board Monitoring Program (MBMP). The SDSMA immediately became concerned about the loss of physician access to the HPAP program’s confidentiality and safe haven. These concerns were brought to the medical board and the Secretary of Health.

In the fall of 2019, the SDSMA commissioned an assessment of the physician wellness resources in South Dakota. An expert in the field, Dr. Lynn Hankes, former president of the FSPHP, interviewed all the stakeholders in our state. His report found many deficiencies in the programs available to South Dakota doctors. He pointed out the poor participation of PHPs in licensing board run programs due to perceived or real lack of confidentiality and that indeed the MBMP did not meet the standards of confidentiality. He noted the “firehouse concept,” in which fire stations should be funded based upon the potential for fires rather than the number of actual fires – in this case the potential number of impaired doctors (as high as 10 percent) vs. those identified (0.5 percent in South Dakota). Another concern identified was the lack of accountability of the PHP stakeholders. In most states. a board provides oversight of the PHP. These boards typically have members from the medical association. South Dakota has no such board. It is unfortunate that the oversight committee for our state’s HPAP program has no physicians, let alone members from the SDSMA.

With pressure from the SDSMA, the SDBMOE recently voted to rejoin HPAP program.  There are several pieces that need to be in place in order to execute an effective physician wellness program. These include confidentiality, safe haven protection, social contract adherence, and accountability among all stakeholders. The SDBMOE decision to leave the HPAP created a situation that has allowed scrutiny regarding the major players. It is clear that organized medicine needs to be present to look after the needs of physicians. Physician wellness is important, and thanks to strong involvement by the physicians of the SDSMA, we’re thrilled that we’ve been able to prioritize this effort. Evidence-based wellness programs improve the lives of physicians and in turn improve the care we provide to patients. As the SDBMOE rejoins HPAP, an opportunity exists to fix broken systems. Our goal is to have SDSMA involved in the selection of medical board appointments and the formation of administrative rules for the HPAP. Additionally, we’ll work to have SDSMA appointees at the table when it comes to the formation of a board to administrate the program.