Who can I talk to about my depression without immediately going under the microscope and losing my license?
When it comes to physicians finding safe avenues for mental health council, state Physician Health Programs (PHPs) are a widely underutilized and misunderstood resource. They are available to physicians who are facing a variety of stressors, and they could provide lifesaving, confidential support to an EP. Currently 43 states are members of the FSPHP, but every state has a so called “Diversion Program,” a mechanism helping to identify, treat, document and monitor physicians who may have mental health issues. These programs are specifically concerned with health issues among physicians that could affect patient care or result in “impairment”. Impairment is the inability to practice medicine with reasonable skill and safety as the result of an illness or injury, including of course mental illness (a subset of which is substance abuse). There is a mistaken tendency to equate impairment with chemical dependency, which is not accurate.
State physician health programs may be independent, non-profit organizations, which may or may not be affiliated with the state medical society, and may or may not be administered by the licensing board. PHP’s function on an Employee Assistance Program model, meaning that they maintain a long arm relationship with the empowering authority, in this case the licensing board. Interactions between physicians and these programs are governed by several degrees of confidentiality, including therapist privilege, peer review protection, HIPAA, JCAHO and Federal Alcohol and Drug Confidentiality under 42 CFR. A physician can self refer to the PHP, or be referred by a colleague or family member, or by the state medical board. Only in the last instance is the participation mandatory, or linked necessarily with maintenance of licensure. PHPs typically provide referrals for assessment, therapy and counseling, intervention for substance abuse and dependence, including monitoring for compliance, workplace monitors, guidance for competency assessment and retraining if indicated, and some provide support meetings such as Caduceus, AA, and NA.
There are two important things to know about PHPs. One is that the physicians who administer these programs are very often in recovery themselves, and are both sympathetic to, and knowledgeable about, the various types of impairing conditions which can affect physicians. Due in part perhaps to their own experiences, many maintain a certain degree of aloofness from their associated boards. It is not an adversarial relationship, but it is certainly a “circumspect” relationship. The other point to note is that the services and providers to which the PHPs refer clients are both extremely knowledgeable about physician illnesses and impairment, and genuinely concerned about maintenance of physician competence or successful return to practice if there is an absence.
What Happens at the PHP…
As long as a physician is successfully addressing the condition for which the PHP is consulted and there is no evidence of current impairment, a PHP will not notify the licensing board about the physician’s consultation. Both parties document an understanding of this relationship early in the consultation, and there are no covert communications which would result in “exposure” or licensure review, as long as stipulated conditions are being met. Although not yet universal, there is a move afoot to make it possible for an applicant for licensure or renewal to check “NO” to the box regarding treatment for possible impairing conditions as long as the physician is addressing the condition under the supervision of a PHP.
So a physician who hesitates to report his/her depression to the state board can (and probably should) consult his PHP immediately regarding needed intervention for depression, and can do so without fear of reporting as long as he is truly not impaired and is seeking appropriate treatment.
If you are currently experiencing depression or any potentially impairing condition, please contact your physician state health program. A list of these programs can be accessed on the home page of my website, www.physiciandepression.com, or you can find your local program by contacting your state medical society (whether or not you are a member). Please send your thoughts, concerns or questions to [email protected].
A Note from Dr. Andrew
I was honored when Emergency Physicians Monthly asked to publish an article of mine in one of their very first issues. Interestingly enough, the topic of that first article was none other than litigation stress, a topic as timely today as it was a decade ago. Since that first article, I’ve grown closer in knowledge to the insidious problem of depression and suicide among emergency physicians. I’ve represented ACEP as liaison to the Federation of State Medical Boards, FSMB, which just last month held a conjoint session with the Federation of State Physician Health Programs (FSPHP) on the topic of Physician Depression and Suicide. This was an educational session, not a workshop, but I was pleased that the two groups had agreed upon this topic, and to learn that the Executive Director of the FSMB, Dr. James Thompson, will sit on a Task Force organized by the American Foundation for Suicide Prevention, AFSP, as part of its Physician Suicide Prevention Project.
I am a physician. All three of my children went to medical school. Justin (the youngest) committed suicide July 22,2009 – early in his fourth year. My wife and I have spoken to medical students about Justin’s story. We are trying to raise awareness about burnout, depression and suicide. We are trying to put together a seminar at the University of texas Medical Branch (Galveston) for this Fall. Do you do speaking engagements?
John Hughes M.D.
Dr. Hughes, I’m so sorry for your terrible loss. Depression, burnout, anxiety, grief, insomnia, pain, loneliness, frustration, anger, regret, abandonment, betrayal, … Physicians and their loved ones are not, of course, immune to any of these illnesses or forms of human suffering. Physicians (and physicians-in-training) need to be able to access competent, compassionate, and completely confidential help for mental/psychological/psychiatric illnesses. We also need to attend more to our own struggles, and become more cognizant of the struggles of our colleagues, so that we can seek help when we should and offer our support to colleagues when/where needed. Physicians (and physicians-in-training) are justifiably afraid to show personal weakness or to ask for professional help for stigmatized medical conditions or social/cultural/academic/economic problems, because in our current system the stigma of even asking for help can become career-ending. State medical boards and physician health programs (PHP’s) often erroneously equate “mental illness” with workplace impairment and/or unfitness to practice medicine. As physicians, we need to work to educate state medical boards and PHP’s on the realities of physician health — including the harms caused by stigmatizing physicians with mental illness and other forms of human suffering — so that they don’t respond by imposing additional burdens upon us. After all, our job is hard enough.
I was not notified of the comments on this article and found this by accident today.
Dr. Hughes, I sincerely empathize and I certainly have done some educational presentations to medical students and residents about this and related issues.
Also, I quite agree with Dr. Haney’s comments above. Let me know via my website if there’s anything I can do for either of you to help promote these efforts.