What is the Federation of State Physician Health Programs (FSPHP)?

The Federation of State Physician Health Programs (FSPHP) is a national, nonprofit corporation whose mission is: To support physician health programs in improving the health of medical professionals, thereby contributing to quality patient care.

The FSPHP also provides education and exchange of ideas for physician health. The FSPHP develops common objectives and goals in order to promote physician health and to assist state programs in their quest to protect the public through the promotion of health and well-being of medical professionals. Funding for the FSPHP primarily comes from membership fees and revenue from educational events.  

What is a Physician Health Program?

A Physician Health Program (PHP) is a confidential resource for physicians, other licensed healthcare professionals, or those in training suffering from addictive, psychiatric, medical, behavioral or other potentially impairing conditions. PHPs coordinate effective detection, evaluation, treatment, and continuing care monitoring of physicians with these conditions. This coordination and documentation of a participant’s progress allows PHPs to provide documentation verifying a participant’s compliance with treatment and/or continuing care recommendations.   

Who are the members of the FSPHP?

The FSPHP currently has six categories of membership: State, Associate, International, Organizational, Individual and Industry Partner Individual. 

The FSPHP represents member PHPs in 50 states, and the District of Columbia.
There are currently 16 International Members from Canada (Ontario, Quebec, Alberta, British Columbia, Manitoba, Newfoundland and Quebec). 

What are the basic principles of the FSPHP?

The FSPHP has four basic principles:

(1) The FSPHP supports the early detection, evaluation and treatment of physicians and other licensed healthcare professionals suffering from addictive, psychiatric, medical, behavioral or other potentially impairing conditions. Appropriate evaluation and treatment of these physicians at programs experienced with the treatment of professionals in safety sensitive employment will ultimately enhance the health of the provider and better protect the public. 

(2) The FSPHP strongly opposes discrimination of a physicians during licensing, credentialing or at any time, based on a history of addictive, psychiatric, or other illness.

(3) The FSPHP supports the use of PHP services, whenever possible, in lieu of disciplinary action. When PHP services are not used, it is less likely that physicians will receive early intervention and appropriate treatment. It is well-known that illness often predates impairment by a period of years.  The FSPHP believes earlier intervention in potentially impairing illness to be more efficacious than intervention in later stages of disease. 

(4) The FSPHP believes privacy and confidentiality of a physician’s health and treatment history must be paramount in the relationships between PHPs and ill physicians or other licensed healthcare professionals to allow those in need of help to come forward without fear of punishment, disciplinary action, embarrassment, or professional isolation. Confidentiality enhances the opportunity for recovery, and incentive to participate in early intervention.

What services does the Federation of State Physician Health Programs offer?

FSPHP members offer experience and expertise in matters of physician health that is unique and specialized. The FSPHP annual meeting, serving as a national educational and informational resource, promotes physician health and provides a forum for the exchange of information about successful evidence-based approaches to physician health.

Why are Physician Health Programs important? 

In 1974, the American Medical Association (AMA) acknowledged physician impairment from alcoholism, and drug dependence occurs and recognized alcoholism and addiction as illnesses. With the advice and consent of the AMA and the Federation of State Medical Boards (FSMB), plans were launched for the development of therapeutic alternatives in lieu of automatic discipline of physicians who needed assistance.[1] By 1980, all but three medical societies in the United States had authorized or implemented physician health programs (PHPs).

In addition to caring for the individual physician, physician health programs also support a healthy physician workforce. By 2020, America will experience a shortage of more than 91,000 physicians, according to the Association of American Medical Colleges.2

The practice of medicine is an intensive, high-stress occupation. Burnout is present in over 35 percent of American physicians, and today’s physicians are increasingly less likely to recommend a career in medicine. [2], [3] PHPs have particular expertise in the recognition and prevention of burnout and enable thousands of physicians to safely practice medicine and provide care for millions of Americans. Without physician health programs, the services of these physicians would be lost, and access to care for patients would be limited.

PHPs also offer expedient interventions and are able to refer physicians to treatment quickly. The programs utilize specialized centers where experienced, expert and qualified staff can evaluate and treat physicians and other licensed healthcare professionals usually in a cohort of peers. PHPs have expertise in the oversight management of mental health illness and addictive disorders and employ state-of-the-art monitoring including screening for drugs of abuse and alcohol. The PHP model facilitates early intervention and appropriate management of behavior indicative of the potential for relapse and relapse itself.  

How many Physician Health Programs exist in the U.S.?

Physician Health Programs currently operate in 47 states and the District of Columbia.

How do you define “physician impairment”? 

Please read the FSPHP's public policy statement on physician illness versus impairment

The FSPHP recognizes that addiction, psychiatric disorders, and other medical conditions can potentially be impairing. By definition, impairment means that a physician is unable to practice medicine with reasonable skill or safety due to an illness. Professionals diagnosed with these conditions may or may not demonstrate “impairment.”   

Unfortunately, individuals equate “illness” (i.e., addiction or depression) as synonymous with “impairment.” Physician illness and impairment exist on a continuum with illness typically predating impairment, often by many years. This is a critically important distinction. Illness is the existence of a disease. Impairment is a functional classification and implies the inability of the person affected by disease to perform specific activities.

Most physicians who become ill are able to function effectively even during the earlier stages of their illness due to their training and dedication. For most, this is the time of referral to a state PHP. Even if illness progresses to cause impairment, treatment usually results in remission and restoration of function. PHPs are then in a position to monitor stability and continuing progress in recovery.

How prevalent is physician illness that could lead to impairment?

In the general population, substance use disorders and other psychiatric illnesses are common. More than 10 percent of Americans will develop an addictive disorder in their lifetime, representing over 30 million people. In the physician population, at least 10 percent of physicians will develop an addictive disorder over the course of their career, and approximately one-third of physicians will have a condition that could impact their ability to practice with reasonable skill and safety at some point in their career. [4,5,6,7]

How are physicians evaluated and treated for illness?

FSPHP encourages Physician Health Programs to use an evidence-based approach, whenever possible, in order to promote appropriate treatment of physicians suffering from treatable conditions. At times, physicians who are enrolled in a state PHP are sent out of state for appropriate comprehensive evaluation and treatment necessary to ensure the ability of the physician to safely return to the practice of medicine. Unfortunately, not every state has treatment programs that can facilitate these specialized services that are necessary for treatment of patients employed in safety sensitive positions.  

The treatment of physicians and other licensed healthcare professionals occurs with the knowledge that (1) addictive, psychiatric, medical, behavioral, or other potentially impairing conditions may be chronic, relapsing conditions; and (2) without appropriate treatment and ongoing support, individual health and public safety are at risk.

Consequently, the treatment of physicians and other professionals in safety sensitive employment is more intensive and extensive than the treatment of those in the general population. Because of this higher level of treatment coupled with PHP supported continuing care, the treatment outcomes of physicians and other professionals in safety sensitive employment are much better than outcomes in the general population. [4,5,6,7]

For the general public, treatment is typically recommended in a step-wise fashion, with an initial referral to the least intensive level of care that is effective, saving more intensive care for those who have been unsuccessful in the less-intensive settings. 

However, for those in safety-sensitive professions, such as pilots and physicians, illness creates consumer and patient risk as well as potential for discipline following a recurrence of illness. For this reason, a step-wise treatment approach with professionals in safety sensitive employment may prove to be insufficient. Put another way, it is too great a risk to put a pilot behind the controls of a plane or send a surgeon into the operating room with a minimal amount of treatment for a potentially impairing condition. [4]

Who is responsible for the treatment costs of physicians with illness?

PHP treatment recommendations may create significant financial challenges for physicians, and PHPs are mindful of this fact. Some states have access to “benevolent funds” to which physicians can be referred for financial assistance. Some treatment programs offer financial plans and are successful in obtaining some medical insurance reimbursements. The FSPHP is hopeful that more success can be achieved with medical insurance reimbursement in the future. The cost and convenience of physicians’ treatment must be factored in to PHP recommendations, but should never be the sole determinant of those treatment recommendations.

Do guidelines or standards of care exist for the treatment of physicians with illness?

The FSPHP has developed guidelines that identify the key elements of the evaluation and treatment needs of health care professionals. 

Additionally, the American Society of Addiction Medicine, a professional society representing over 3,000 physicians and associated professionals dedicated to increasing access and improving the quality of addiction treatment, has provided a different standard for those in safety-sensitive professions, clarifying that for health care professionals, including physicians, “the driving force behind the level of care chosen is the level that has the best chance of establishing stable recovery.” [12] The ASAM has established criteria to determine the appropriate level of care for individuals diagnosed with substance use disorders. [12]

The ASAM has clarified that, by definition, those in safety-sensitive positions have a responsibility to the public. [12] Also, it has been determined that safety-sensitive workers do best when offered cohort-specific residential treatment at facilities with specialized experience treating health care professionals. Such treatment has been shown to result in improved prognosis for physicians. [12] 

PHPs also follow standards of practice that are available from the specialty medical professions such as psychiatry. Standards are also available in physician health policies of many national organizations such as the Federation of State Medical Boards and the American Academy of Addiction Psychiatry and the American Psychiatric Association. Research is ongoing to create more evidence-based practice guidelines.

How successful are Physician Health Programs? 

Several long-term studies have reported recovery rates between 70-90 percent for physicians with substance use disorders monitored by PHPs. [9] Abstinence rates approaching 90 percent are reported for physicians in PHPs with substance use disorders, at the end of five years. [8,9,10] Physicians who have successfully completed monitoring with a PHP have been shown to experience a lower risk of malpractice claims after monitoring. [11]  

How do Physician Health Programs affect patient and public safety?

Physician Health Programs enhance early detection of potentially impairing illness, with documented long-term maintenance of remission with successful outcomes. [7,8,9,10] Physicians who have successfully completed monitoring with a PHP have been shown to experience a lower risk of malpractice claims after monitoring. [11]

Why is confidentiality so important in Physician Health Programs?

When confidentiality is endorsed and assured by PHPs and regulatory agencies, physicians with potentially impairing conditions are more likely to come forward and utilize a PHP service earlier, which reduces the likelihood of the illness progressing to overt impairment.

Physicians in states without a confidential, non-disciplinary recovery track are often fearful of the disciplinary process and hesitant to admit their need for help. Additionally, concerned third parties are often reluctant to report a potentially impaired physician until the illness has advanced to the point of overt impairment.

The FSPHP and PHPs support confidential and compassionate care for all people, including physicians suffering from addictive, psychiatric, medical, and behavioral or other potentially impairing conditions.  The FSPHP advocates for the privacy and confidentiality of a physician’s health and treatment history including participation in a Physician Health Program (PHP). 

What is the relationship between state medical boards and state PHPs?

Different relationships exist between state licensing boards and PHPs. Many PHPs are independent non-profit entities, and some are affiliated with the respective state medical association. Other PHPs may be operated by the respective state licensing board. Many PHPs have written agreements with their state licensing board to define their relationship.  

PHPs provide a safe, non-disciplinary mechanism for physicians to obtain assistance, guidance and support in a confidential, professional and respectful manner during their time of need. Earlier treatment is incentivized, enhancing the likelihood of the physician’s ability to return to the (safe, monitored) active practice of medicine without impairment, thereby contributing to patient safety.  While both PHPs and state licensing boards are engaged in patient safety efforts, PHPs primary focus is on improving the health of the physician, and the licensing board’s primary duty is to protect the public.

Is participation in a Physician Health Program mandatory for a physician who is considered or judged impaired? (i.e., can he or she seek individual treatment outside of a PHP?)

Only a medical board can compel a physician to participate in a PHP. An employer may also mandate a referral to a PHP if there are significant concerns about the health of the practitioner and patient safety. Depending on the rules and regulations of a particular state, other health care providers or colleagues may also be under obligations to mandate a physicians involvement in a PHP or instead to report a colleague to a licensing board if there is concern of patient safety. When a healthcare provider has a concern about impairment in a physician or other healthcare provider, it is important to understand the state licensing board reporting obligations and any exceptions to those obligations. 

Physicians may be able to seek treatment from health care professionals outside of a PHP on their own, just like anyone in the general population. However, they will not benefit from the professional oversight of a state approved PHP or the benefits of documented monitoring that a PHP provides.

What happens if a physician refuses to participate in a Physician Health Program?

If a physician is unwilling to participate in a PHP and is thought to have an untreated/potentially impairing condition, the physician will likely become known to the medical board. Although the specific rules and regulations vary from state to state, health care providers and/or physicians may have obligations to report a physician to their respective medical board in such instances.

What responsibility does the employer of an impaired physician have?

Although the specific rules and regulations vary from state to state, health care providers and/or physicians may have obligations to report a physician to their respective medical board in such instances when impairment exists.

For physicians with active PHP monitoring agreements, typically a workplace monitor would contact the PHP for consideration of reporting obligations. 

[1] The sick physician. Impairment by psychiatric disorders, including alcoholism and drug dependence. (1973). JAMA. 223:684-687.

[2] Annual Review of Medicine. (2012). Physician Workforce Projections in an Era of Health Care Reform. 63: 435-445. doi: 10.1146/annurev-med-050310-134634.

[3] Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, West CP, Sloan J, Oreskovich MR. (2012). Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Arch Intern Med. 172(+++                   18):1377-1385. doi:10.1001/archinternmed.2012.3199.

[4] Hughes PH, Brandenburg N, Baldwin DC Jr., et al. (1992). Prevalence of substance use among US physicians. JAMA. 267:2333–2339.

[5] DuPont RL, McLellan AT, Carr G, et al. (2009). How are addicted physicians treated? A national survey of Physician Health Programs.  J Subst Abuse Treat. 37:1–7.

[6] Bousaubin EV, Levine RE. (2001). Identifying and assisting the impaired physician. American Journal of Med Sci.322: 31-36.

[7] Leape LL, Fromson JA. (2006). Problem doctors: Is there a system-level solution? Ann Intern Med. 144:107–115.

[8] DuPont RL, McLellan AT, White WL, Merlo L, & Gold MS (2009). Setting the standard for recovery: Physicians Health Programs evaluation review. Journal for Substance Abuse Treatment. 36(2): 159-171. 

[9] McLellan AT, Skipper GE, Campbell, MG & DuPont, RL (2008). Five-year outcomes in a cohort study of physicians treated for substance use disorders in the United States. British Medical Journal. 337:a2038.  

[10] Institute for Behavior and Health. (2014). Creating a New Standard for Addiction Treatment Outcomes. Available at: http://www.ibhinc.org/newsandpubs.html

[11] Brooks E, Gendel MH, Gundersen DC, Early SR, Schirrmacher R, Lembitz A, & Shore JH. (2013). Physician health programmes and malpractice claims: reducing risk through monitoring. Occupational Medicine. 63(4):274-80. doi:10.1093/occmed/kqt036.

[12] Mee-Lee DE. (2013). The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions.  

[13] Federation of State Medical Boards. (2014) US medical regulatory trends and actions. Available at: http://fsmb.org/Media/Default/PDF/FSMB/Publications/us_medical_regulatory_trends_actions.pdf

[14] Earley PR. (2014). Physician health programs and addiction among physicians. In Ries RK, et al. (Eds.) The ASAM Principles of Addiction Medicine 5th ed. (602-603). Chevy Chase, MD: American Society of Addiction Medicine.