PRESIDENT’S MESSAGE: 
Scott Hambleton, MD, DFASAM, Winter 2022

Scott Hambleton, MD, DFASAM

It is apparent to me that individual state PHPs and the Federation will emerge from the COVID-19 pandemic weathered but stronger than ever and this is great news! Considering the horrific impact of the virus, finding any silver lining is a delightful surprise. With that in mind, I would like to talk about some of these silver linings and why I am excited about our future. 

Mark Twain popularized the saying, “There are three kinds of lies: lies, damned lies, and statistics.” And now, in the age of COVID, the saying is more apropos than ever. Americans have become even more skeptical about the validity of medical science, and medical advice, and often do not know what or whom to believe. The lasting impact of medical misinformation (defined as information or claims that are false inaccurate, or misleading) and spreading disinformation (defined as intentionally spreading misinformation to serve a malicious purpose, such as financial or political advantage) will be difficult to quantify. However, most agree that the public trust in medical science and healthcare providers has eroded. The Association of American Medical Colleges (AAMC) describes this as a crisis in credibility, and the forces and factors behind distrust include “a public overwhelmed by too much information, growing polarization, disinformation campaigns by domestic or foreign corporations and governments, a media environment that rewards outrage and outlandishness, and the increasingly public nature of scientific research.”1

The impact of medical misinformation and disinformation is exacerbated by other COVID related factors such as the Great Resignation, which resulted in millions of Americans quitting their jobs. The U.S. healthcare workforce, representing one in nine American jobs, was disproportionally affected, according to the U.S. Bureau of Labor Statistics.2 A 2021 Mayo Clinic Proceedings article based on a survey of over 20,000 healthcare providers reported that one in five physicians and two in five nurses intended to leave their fields of practice altogether.3 The AAMC projects a national shortage of up to 124,000 physicians by 2033, and more than 200,000 nurses will need to be hired each year to meet increased demand and to replace retiring nurses.1,2 Not surprisingly, there are also critical shortages of allied health and behavioral health professionals.

The incredible success of FSPHP and individual state PHPs in helping to protect the U.S. healthcare workforce represents a stark contrast to the chronic disease management of most Americans with potentially impairing illnesses such as addiction. Last year we witnessed the accidental overdose deaths of over 100,000 Americans, representing the highest number of deaths in a single year in our nation’s history. Solutions are needed, and the chronic disease management processes perfected by PHPs show that long-term recovery from addiction is not only possible but also can be expected. Physician participants with addictive disorders monitored by PHPs have achieved long-term recovery rates that approach 80 percent at 5 years,4–8 and this should be a cause for celebration!

Ironically, despite our role in protecting the healthcare workforce for several decades, the Federation and individual state PHPs have consistently battled misinformation and disinformation. Whereas PHPs have confidentiality limitations, the criticism is one-sided. Perhaps more commonly, the amazing services provided by PHPs are simply not widely known.

We have witnessed the incredibly successful efforts of Jennifer Breen Feist and Corey Feist, cofounders of Dr. Lorna Breen Heroes’ Foundation, which has resulted in a national focus on the needs of physicians and other healthcare professionals for confidential, non-stigmatized mental health care. The tragic death of their sister, Dr. Lorna Breen, by suicide powerfully illustrated the impact of stigma perceived by many healthcare professionals associated with seeking mental health care, which results in their suffering in silence. These efforts have reinforced the urgency to promote awareness of PHP services, which is one of our strategic goals as a Federation—to establish the Federation and PHP model as the unequivocal leader in the field. An example is the Research Committee’s upcoming survey to PHPs regarding the PHP model, scope of services, and educational and support services being offered to health professionals. Ultimately, the results of the survey will be disseminated nationally. The Public Policy Committee is extremely busy compiling an ever-increasing compendium of physician health-related literature on our website, www.fsphp.org.

Another idea being discussed is the Publication Committee’s eventual creation of a video for national distribution entitled Promoting Resilience and Mental Health Among Healthcare Professional Workforce. We are also in the process of developing and showcasing personal success stories of PHP participants whose lives and careers have been saved by PHPs. There are many other examples, and I will expound on these in future messages.

We are acutely aware of the need to propagate trust in our programs through effective educational outreach and the dissemination of accurate information about our services. This process of weathering storms of misinformation and disinformation has taught us that we must effectively differentiate our services, and perhaps, more important, we are learning that we need to keep our own houses in order. We have matured, organizationally, and the Federation is providing a way for all of us to examine our own houses, in every program, recognizing that we must reduce or eliminate unsustainable practice variation among our individual state PHPs, recognizing when practice variation is a liability.

The 2016 FSPHP Performance Enhancement Review Guidelines were created to optimize the efficacy and credibility of every PHP, and the publication of our 2019 FSPHP Guidelines furthered this process. Later this year, after a successful multiyear partnership with Metacred, the Federation will launch the Performance Enhancement and Effectiveness Review (PEER)™ for beta testing. After that, the FSPHP Evaluation and Treatment Accreditation (ETA)™ will launch. These efforts represent thousands of hours of time, freely donated by our members and other stakeholders, representing a diverse and robust consensus of nationally and internationally respected experts in the field. PEER™ will serve as an objective performance measure that will showcase PHP services, ETA will serve as an objective performance measure of our treatment providers, and all PHPs and PHP participants will benefit.

The tide appears to be turning, and the Federation’s partnerships with national organizations are reaching new highs. For example, in June of this year, the AMA House of Delegates unanimously voted to reinsert language into the Code of Medical Ethics that referenced physician health programs.9 This experience illustrated the critical necessity of individual state PHPs working closely and developing strong relationships with their respective state medical societies. This reversal could not have occurred without the successful efforts of our supporters representing the State Medical Societies in Pennsylvania, New York, Washington State, and others, culminating in powerful testimony during the AMA November 2021 Special Meeting in which the House of Delegates unanimously voted to ask the Council of Ethical and Judicial Affairs to consider specific amendments that referenced physician health programs. I want to acknowledge the efforts of our Executive Director, Linda Bresnahan, and our FSPHP AMA Observer, Dr. Chris Bundy, who both played a critical role in this complex process. In particular, the compelling testimony provided by Dr. Bundy at the AMA November 2021 Special Meeting was an inspiring contribution to this historic reversal. The fact that this occurred during the middle of a pandemic makes the victory even sweeter!

The efforts of our incredibly productive committees, combined with the guidance of our Board of Directors, Presidents, and committee chairs, are enhanced by our diverse and ever-growing family of members, volunteers, and partners. Additionally, we are blessed to have our Executive Director, Linda Bresnahan, whose energy, dedication, talent, and spirit are indomitable. Working with all of you has been the highlight of my career, and one of my primary goals as your incoming President will be to help the Federation battle misinformation and disinformation. I believe that our success will be contingent on our ability to execute our strategic goals, which are focused on three areas: (1) Research, Education, and Policy Development; (2) Accountability, Consistency, and Excellence; and (3) Organizational Management and Member Services. Ultimately, every decision we make will prioritize the creation and enhancement of benefits for our members.

We are living in exciting times, and despite the forces of misinformation and disinformation, we are amid a rising tide that will lift all boats!

References

1. Association of American Medical Colleges. Why do so many Americans distrust science? Available at: https://www.aamc.org/news-insights/why-do-so-manyamericans- distrust-science. Accessed July 1, 2022.

2. American Hospital Association. Fact sheet: strengthening the health care workforce. Nov 2021. Available at: https://www.aha.org/system/files/media/file/2021/11/strengtheningthe-health-care-workforce-II.pdf. Accessed July 1, 2022.

3. Sinsky CA, Brown RL, Stillman MJ, Linzer M. COVID-related stress and work intentions in a sample of US health care workers. Mayo Clinic Proceedings. 2021; 5(6): 1165–1173. doi: DOI: https://doi.org/10.1016/j.mayocpiqo.2021.08.007.

4. DuPont RL, McLellan AT, Carr G, Gendel M, Skipper GE. How are addicted physicians treated? A national survey of physician health programs. J Subst Abuse Treat. 37(1); July 2009: 1–7.

5. McLellan AT, Skipper GE, Campbell M, DuPont RL. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. BMJ 337; Nov 2008: 1–6.

6. Domino KB, Hornbein TF, Polissar NL, Renner G, Johnson J, Alberti S, Hankes L. Risk factors for relapse in health care professionals with substance use disorders. JAMA 293(12); March 2005: 1453–60.

7. Earley P. Physicians health programs and addiction among physicians. In American Society of Addiction Medicine, Principles of Addiction Medicine 5th Edition, Chapter 49; Edited by S Miller, D Fiellin, R Rosenthal, R Saitz, 671–92. Philadelphia: Wolters Kluwer, 2019.

8. Carr GD, Hall PB, Finlayson AR, DuPont RL. Physician health programs: the US model. In Physician Mental Health and Well-Being, 265–94: Springer, 2017.

9. American Medical Association. Report of the Council on Ethical and Judicial Affairs. Amendment to E-9.3.2, Physician Responsibilities to Colleagues with Illness Disability or Impairment. CEJA Report 3-A-22.

Read more on this in the Winter 2022 issue.