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justine dembo • 3 years ago

Hello all. I am so grateful for this posting. This is SUCH an important issue. I certainly felt more despairing when, due to a history of depression alone (no other significant illness, no substance abuse, no malpractice, excellent reviews by supervisors and colleagues during residency etc.) I was required to enroll in a 2-year PHP contract in order to get my license to practice following residency. The program required monthly visits with a case manager who asked me the same questions each time: had I abused substances, had I gotten in trouble with the law, had I complied with my psychiatrist's suggestions, etc. - even though none of these had been the issue to begin with. They were asking the wrong questions. It also required reports every 3 months from a "workplace monitor" (a colleague), my therapist, my family members, and my psychiatrist, on my "behavior." I was being treated as though I had committed a crime, when all I had done was voluntarily disclose on my licence application that I suffered from depression and had VOLUNTARILY chosen to take medical leave twice for a few months during residency, for more intensive treatment. I had an impeccable professional record and still do. This was extremely humiliating and the restrictions I had on my license (the fact that I had to comply with this monitoring program) have followed me every time I have had to apply for hospital privileges, or a license in a new place. Certainly the demoralization of this process exacerbates/exacerbated my depression, and exhaustion. I think we certainly do need programs specifically designed for physician mental health, but that these programs need to be there for the purpose of helping physicians - NOT for the purpose of policing them. I realize some physicians with mental health issues can at times be a risk to patients, but most are not. PHP's need to match the services they provide to each individual physician based on individual issues/risks/needs.

PamelaWibleMD • 3 years ago

Given your experience, what program would you wish that you had available to you? What would you suggest that we offer to support (rather than punish or police) med students and docs. Thanks.

Ron Smith • 3 years ago

Thanks, Pam.

Now in my fourth decade, I can tell you that if I had mental illness, chemical dependency, or practically anything that could threaten my medical practice I would not tell anyone, including my one good physician friend who is my primary care doc. I don't have any of those conditions mentioned, but I am very sensitive to those who do. In my mind, the most untrustworthy physicians are the ones on the state medical boards. They seem to have one and only one goal... protect the public at all costs and toss physicians who show any weakness. I never get any communications from them when they want me to shell out my yearly fee or remind me that I need to have a certain amount of CME hours.

Our privacy is invaded by them even before we have a chance to declare it. Why is it that everyone in the world can know most everything about us as physicians from where we live to, but patient's information is rabidly protected with the HIPPA maul?

Thanks for your caring. Perhaps it is because a physician's story would be safe with you? Ours is truly one of the lonliest professions. I don't think we can trust anyone much, and am extremely careful about sharing myself as a person with anyone even though I have no mental illness or substance abuse issues.

Now I'm in my 33rd year...my goal is maybe 45 years and I'm done.

Warmest regards,


Chantal Oicles • 3 years ago

This is terrible. We need to bring more public awareness to these issues!

Kernan Manion MD • 3 years ago

You're absolutely right. Many very talented and compassionate physicians' and nurses' and PA's careers are being destroyed by these self-righteous state-protected psychopaths. And this malignancy is soon to move to broader professional horizons - lawyers, counselors, teachers ... just about anybody who needs a license to practice. All done under the virtuous banner of "protecting the public," all the while depriving the professional of due process and operating without any oversight or accountability! And ... all the while, these programs turn a handy profit by using their state-sanctioned authority to refer to their friends running "preferred programs."

EricMD • 3 years ago

I don't tell m doctor that I'm a doctor or even in healthcare. I make a point of going further out of town to get any major treatment. The only time my doctor knew who I was is when I had to have some orhto surgery.

I don't trust any of them. Actually I don't trust most doctors when it comes to these type of things. They will sell you out. They sell their own out for less.

PamelaWibleMD • 3 years ago

Doctors have gone into hiding, Cruel "health care" system.

Michael L. Langan • 3 years ago

I understand comments are closing soon. Hopefully this will be a stepping stone to a larger discussion as the comments seen here show that the current management of the PHP system is causiing grave, far reaching and sometimes permanent consequences. No more doctors should die from this institutional injustice and organizational fraud. Naom Chomsky said "I think it only makes sense to seek out and identify structures of authority, hierarchy, and domination in every aspect of life, and to challenge them; unless a justification for them can be given, they are illegitimate, and should be dismantled, to increase the scope of human freedom."

Doctors need to stand up and challenge the current paradigm. As seen here these challenges will be met with silence because they cannot justify their actions. As an illegitimate authoity it is necessary we dismantle them and replace them with a transparent, just, accountable and fair system that actually does help doctors and protect the public. If we don't do this decisively and urgently then darker clouds lie ahead for the medical profession and all of us.

Michael L. Langan • 3 years ago

Physician Health Programs are not the problem. The problem is the Frankenstein PHP's have become over time. With no oversigjht, regulation or accountability the usual checks and balances that self-govern any group of individuals are not in place and Power without restraint follows an inevitable course. That is what we are seeing here. The historical precedents are many and we still fail to learn. Groupthink has poisoned the well and a Lord of the Flies free-for-all has evolved. Original intentions are lost. Those of decency and conscience are removed. Evidence-based science and critical reasoning are replaced with ideology and dogma. Empathy and moral compass give way to intolerance, injustice and fear to increase the grand scale of the hunt under the banner of "protecting the public'"

Be it the "impaired," "disruptive" or "aging" physician these witches are real, these witches are dangerous and we know how to find them.

Wha remains in many state PHPs is a mix of self-appointed experts with personality disorders ((narcissism, sociopathy), bullies collectively mobbing ( previously insecure doctors of low to mediocre reputations fueled by first time Power who derive pleasure at wielding it - this ranges from bystander indifference to outright cruelty), and lastly 12-step recovery zealots blinkered by black and white thinking who believe their ability to make authoritative pronouncements over others is a divine grant bestowed on their own "recovery" and consider any use of substances "addiction" in need of lifelong abstinence and fundamentalist devotion to their creed. From the point of view of these "like minded docs" drinking a beer is a spiritual malady commensurate with an IV heroin addiction. Any resistance to AA is deemed "relapse without use" or in AA parlance "Stinkin thinkin,". As with standards of care, professional ethics and the law, the Establishment Clause of the 1st Amendment does not apply to them.

The biggest problem here is that the PHPs are diagnosing doctors with problems they do not have and mandating unneeded treatment and monitoring. This is taking place because no one oversees them. They have been given carte Blanche authority and power and when the animals are running the zoo that's a big problem.

Patient Kit • 3 years ago

Some of these self-appointed experts need to be profiled -- their medical careers previous to working at a PHP, their personalities, their lavish lifestyles, their connections, their intimidation tactics, their conflicts of interest. Every bit of dirt you can dig up on them and document and expose. Heh. Is my background in investigative research showing? But seriously. Find the worst offenders and expose them. But of course document everything to CYA before going public with it.

Michael L. Langan • 3 years ago

Let's take a look at a typical scenario.

In 2000 when this doctor who had a revoked license requested it be reinstated two board members were opposed due to his long term history of manipulating the system.


These include the following statements: “The twice weekly random, observed urine screens imposed upon petitioner by the 1992 and 1994 Consent Agreements were insufficient to detect his then on-going substance abuse. Petitioner WAS QUITE ADEPT AT MANIPULATING The SYSTEM TO AVOID DETECTION.” (my emphasis).

How did he get it back?

Advocacy of his state PHP of course.

Many in the current abusive PHP system got their licenses back using the 12-step salvation card and reinvented themselves as specialists in "addiction medicine." They are given a "clean slate."

This doctor is now running the entire Health Professionals Program in Florida–nurses, doctors, and any licensed medical practitioners from acupuncturists to veterinarians are referred to this program.

Brilliant! Let’s not just give him his license back but how about we put him in a leadership position with no transparency, regulation or accountability and put all the medical professionals careers and lives in his hands. You can read some of the reviews on the vitals.com website for examples. They are very similar to what are being reported here. Of course the majority of the comments are probably true but in this sick system are considered the bellyaching of sick doctors and ignored.

Here is a recent comment that tells it all:

"Every single available website has years of overwhelmingly negative reviews, accompanied by similar stories of abuse, coercion, and damage, all for this physician. Enough. Please join us in our promotion of public awareness and help end the injustice at stopscottteitelbaum.com."

Even with a petition out no one is listening as they consider the whole chorus of doctors condemned here for trivial issues a bunch of bellyaching dangers to the public.

It is this same route that felons, double-felons, Doctors who stole IV pain medication and replaced it with saline from dying cancer patients, pedophiles, and a guy who got caught selling industrial quantities of the date-rape drug to undercover cops are now practicing medicine while those who got a single DUI, borrowed their husbands ativan to help them sleep, had a little too much at the christmas party or sometimes nothing at all are losing their licenses and some are dying.

Label the accused as deviant to disregard the claims of the accused. It is hard to wrap ones head around the thinking here.

How about we just apply Occam’s razor or a little bit of common sense? It's time to WTFU.

Jesse Cavenar • 3 years ago

I agree completely

Karen Miday • 3 years ago

I find it interesting that the FSPHP continues to compare doctors to pilots. Also interesting that, on the whole, it is likely that both pilots and doctors routinely perform their tasks with a serious lack of sleep. No cause for concern here? Frankly, I would rather have my surgeon or pilot drink a beer before work than reporting for work after only 2 or 3 hours sleep. Interesting that the house of medicine, at least during training years, has actually been designed to keep doctors awake all night and all day and then expect them to perform well. This is institutionalized impairment. What about protecting the public from this? Where's the outcry?

Michael L. Langan • 3 years ago

They often use the nuclear power, airline and railway industry as examples of "safety sensitive" occupations that use drug testing in their push to randomly test all physicians. The big difference is that these three agencies follow strict Federal Workplace Drug Testing Guidelines and use only certified labs and FDA approved tests. These industries follow strict procedure and protocol using strict chain-of-custody procedures and MRO review. There is accountability and oversight. In addition, these industries have unions or other groups looking out for the best interests of their employees. Doctors do not. This is how non-FDA approved laboratory testing with no FDA oversight has been introduced into these programs. There are no safeguards. While government drug testing uses only certified labs the PHP system uses commercial labs using these "Laboratory Developed Tests" (LDTs) that they themselves pitched to the labs. The conflicts-of-interest are unimaginable and it is unconscionable that the medical profession has allowed their own to be tested with what is essentially junk-science. Just look at the history of the EtG introduced by Greg Skipper who was director of the Alabama PHP at the time. He claimed 100% specificity at an arbitrary cutoff level of 100, then raised it to 250, 500, 1000, 2000 to unknown as the test was shown to be unreliable and with no evidence base. Any rational authority would have taken it off the market but the PHPs just kept raising the cutoff leaving a wake of ruined lives behind them as they arbitrarily changed the cutoff and claimed it to be valid. This is not science but snake-oil carney hucksterism.

Jonathan Dillard • 3 years ago

The Airline Pilots Association has been complicit in all of this. They are not a union, but an association, that frequently, if not always, works against the interest of the pilots they purport to serve. ALPA is a paper tiger; a political behemoth, if you will.

John Doe • 3 years ago

I'm an early career doctor. I got mixed up with a PHP due to an error. PHP tried their best to label be dependent on alcohol. It didn't work because I don't drink and I had strong supporters and testimonies.

The PHP director gave me a choice: spend all my money or ruin my career. I have no reason to be involved with the PHP. I have wonderful documentation of everything. I would love to see a few PHP directors in jail.

I had committed lawyers, great documentation, and powerful supporters, and I am lucky to be out of PHP's reach now. I can get back to my patients now. I can easily see how another doctor in my position could be murdered by coercion from the PHP.

Michael L. Langan • 3 years ago

This is unusual as the PHPs have taken a Machiavellian and "stand your ground" approach to their decisions. They usually do not negotiate or back down unless they have their backs to the door. As I am sure they did not reconsider the facts or have a change of heart. Something must have threatened them. Could you tell us what it was that caused them to retreat?

PamelaWibleMD • 3 years ago

Sad. So how did you prevail when others do not?

MMK • 3 years ago

Pam in your own state the PHP program has been contracted out to a private company who have very little knowledge or caring about the job of physicians. It is 12 step based and frighteningly incompetent, but gee whiz, they got the contract. They treat physicians like street people and make demands on their time that are unrealistic. The medical board argued with me that care by a licensed board certified addictionologist was inappropriate so they sent a physician patient to Rush Medical Center. The result? Gee whiz, I actually knew what I was doing! I had been threatened qwith losing my own license for treating a fellow physician for his addiction. A system run by "Investigators" who again in your state are former police with no training in medicine.

PamelaWibleMD • 3 years ago

Oh no.

Wow! That is incredible! I had no idea it had gotten so bad.

PamelaWibleMD • 3 years ago

To be clear: I am certainly no expert on PHPs. My video raises a question based on conversations I’ve had with suicidal docs. Many developed suicidal thoughts during their PHP treatment. I had no idea about any of this until hearing about Greg Miday’s death.

Just raising the question. I am not one to demonize anyone. I do feel medical students and physicians are not receiving the mental health care they need in training (unrelated to PHPs). My focus is humanizing medical education and preventing physician and medical student suicides.

I thank all of you who have participated in this heated conversation. I hope this will be the first of many conversations. We certainly need to heal as a profession. And I will echo Karen Miday that "we cannot afford to lose another physician to shame."

Michael L. Langan • 3 years ago

One of the architects of the current system, Dr. Robert Walzer, M.D., J.D. who was instrumental in tinkering with administrative and medical practice laws to remove the due process and appeal rights of doctors surrendered his license in 2001 due to inappropriate sexual relationships with patients. He was the co-author of the current physician health program paradigm. It is important to look at some of the backgrounds of those involved in this system as a number of them have histories of manipulating the system. Many were doctors who had their licenses revoked and got them back through the support of their state PHP. Many are felons and some are even double felons who had been convicted of criminal acts. This system often returns doctors to practice who should not be practicing medicine yet ends the careers and ruins the lives of many good doctors for little reason and without justification. It is as if the animals have been put in charge of the zoo.


PamelaWibleMD • 3 years ago

How did your interview go Michael? Love to know!

Michael L. Langan • 3 years ago

They are currently reading through all of my blogposts and looking at the more than 700 comments here and on Medscape that make it crystal clear the current system is causing damage to doctors on a large scale. The comments raise specific and serious questions that are not being answered.

Silence from authority is an acceptable stance when the criticisms are unreasoned and unfounded ad hominem attacks and generalizations based on bias and prejudice. But that is not the case here. The testimonials and criticisms are articulate, specific and remarkably similar. I'll let you know as soon as I hear back.

Michael L. Langan • 3 years ago

“At times to be silent is to lie. You will win because you have enough brute force. But you will not convince. For to convince you need to persuade. And in order to persuade you would need what you lack: Reason and Right”
― Miguel de Unamuno

The first “step into the breach” is to question and challenge authoritative opinion and that is being done here and on Medscape. The FSPHP is used to making authoritative pronouncements without opposition or scrutiny. When challenged directly with specific questions and facts they simply do not answer the questions.

It is clear there is a big problem with PHPs as currently being managed by the FSPHP. What is being described is abuse of power not unlike the political abuse of psychiatry seen in the Soviet Union. Doctors are being diagnosed with illnesses they don't have while those who do need help are getting improper treatment in a rigged system of friends referring to friends. Others are afraid to get help for fear of being ensnared by the PHP. How many good doctors are we losing every year unnecessarily? How many suicides?

Although the comments here are alarming it is just the tip of the iceberg. Even under guaranteed anonymity and not having to provide any identifying information the majority of doctors I talked to who are being monitored by the MA PHP would not call the state auditor to tell their stories. They were too afraid of the PHP finding out. A 3-month stay in an out-of-state "PHP-approved" facility for "relapse prevention" keeps most doctors silent. The PHPs use the accusation of substance abuse or behavioral problems as a means to delegitimize doctors and remove their power and this is a hole hard to crawl out of when an outside facility confirms a problem. It is a rigged system and the ideological and financial conflicts-of-interest are significant. The FSPHP is both illegitimate and irrational authority.

An evidence-based scrutiny of the literature would reveal their research to be invalid and of little probative value.

A public policy analysis would reveal the logical fallacies involved in trumpeting their positions including exaggerated rhetoric and fear monitoring strategies designed to inspire moral panics and exploit fears to further an underlying political agenda

A critical analysis of authoritative opinion would reveal cherry picking. proof by anecdote, deceptive propaganda, double talk, contradictory, illogical and incomprehensible jabber, unprovable and un-disprovable statements and a panoply of logical fallacy.

These groups misrepresent, censor and suppress. They nit pick and split hairs. The concept of denial is not just used to force people into treatment and justify abuse during treatment but to suppress specific questions and deliberately avoid key facts.

The next step needs to be exposing the Emperor has no clothes. Once this is acknowledged it would not take long to address directly the specific problems and erroneous assumptions of this paradigm through the lenses of science, critical reasoning, ethics and common sense. If this were to be done the entire Potemkin village would fall like a house of cards.

Thomas D Guastavino, MD • 3 years ago

Once again, I don't believe the working conditions for residents and med students are any worse now then they were 30 years ago. What has changed is how uncertain are the goals and potential rewards for tolerating the abuse. Military recruits are willing to undergo the rigors of boot camp if the rewards are clear. If one wants to avoid potential drug abuse, depression or even suicide while undergoing medical training then one needs to be honest with themselves about the potential risks and benefits.
Personally if I had to do it again today given what I know and where I started I would never do it. Motivation alone is often times not enough and one has to be realistic or face the consequences.

Michael L. Langan • 3 years ago

State Physician Health Programs (PHPs) were originally developed by competent and caring physicians to both protect the public and help sick colleagues who developed problems with addiction or substance abuse. The current system does neither. These programs have been taken over by a group that does not represent the best interests of doctors or the patient public. Physician health programs are not the problem. We need PHPs. What needs to be addressed is the current management of them under the FSPHP. This group has created a culture of impunity and harm.while effectively removing due process from doctors while removing answerability and accountability from themselves. There is no oversight, regulation or accountability. They are a power unto themselves with carte blanche managerial control. The horror stories are real and mounting. They are also consistent. Egregious ethical violations, forensic-fraud, diagnosis rigging, and other crimes are being reported. It is a system of institutional injustice and organizational sham-peer review. They have also convinced medical boards to give them complete autonomy when it comes to physician assessments. There is absolutely no oversight.

Kernan Manion MD • 3 years ago

It would seem that a system that has no oversight would also have no enforceability. If the source of their power is the legislature, then we need to reverse that legislation. I recognize that's a long-term solution (and to necessarily even accomplishable). Then next step it would seem is to make it clear that certain states are to be avoided at all costs. Effectively, a physician embargo.

PamelaWibleMD • 3 years ago

So PHPs were well run until recently? When did the "current management" and institutional injustice begin? Do you have a timeline?

Michael L. Langan • 3 years ago

In 1973 the AMA Council on Mental Health published The Sick Physician: Impairment by Psychiatric Disorders, Including Alcoholism and Drug Dependence in JAMA. recommending that physicians do a better job of helping colleagues impaired by mental illness, alcoholism or drug dependence. The AMA defined an “impaired physician” as “a physician who is unable to practice medicine with reasonable skill and safety to patients because of mental illness or excessive use or abuse of drugs, including alcohol." This led to the development of state "impaired physicians programs" Often staffed by volunteer physicians and funded by State Medical Societies, these programs served the dual purpose of helping sick colleagues and protecting the public. PHPs are the equivalent of Employee Assistance Programs (EAPs) for other occupations. PHPs meet with, assess, and monitor doctors who have been referred to them for substance use or other mental or behavioral health problems.

Most EAPs, however, were developed with the collaboration of workers unions or some other group supporting the rights and best interests of the employees. PHPs were created and evolved without any oversight or regulation.

At this same time specialized treatment centers for doctors were being developed by members of the "impaired physician movement" such as G. Douglas Talbot who claimed physicians are unique because of what he called the “four MDs.” “M-Deity”, “Massive Denial” “Militant Defensiveness” and “More Drugs.” This was used to justify the thrice lengthy stay of doctors compared to the rest of the population.

Doctors admitted to these programs complained of false diagnoses, coercion and abuse all under threat of loss of their licenses and in 1987 the Atlanta Journal constitution did a series of reports after five inpatients died by suicide during a four-year period at one of Talbott's facilities (Ridgeview) and at least 20 more did so after being discharged.

Critics of these boot-camp like programs included ASAM President LeClair Bissell and former Assistant Surgeon General John C. Duffy.

But in 1995 The Federal Bulletin: The Journal of Medical Licensure and Discipline, published by the Federation of State Medical Boards published articles reporting the 90% success rates of PHP programs directed by ASAM physicians in 8 separate states. This formed an alliance between the FSPHP and the FSMB. This is when they gained a seat at the table of power and the FSMB accepted their offer of "rehabilitation" as an alternative to "discipline." Since that time the FSPHP has duped the FSMB (as well as others) into accepting public policy and changing medical practice law to gain power and immunity. They also pushed for changes that removed due process and rights of doctors. To see how far this has gone one only has to look at the 2011 FSMB Public Policy Statement on Physician Impairment. The FSMB accepted "potentially impairing illness: and "relapse without use" as definitions and agreed not to second guess the PHPs. Medial Boards have agreed not to question their decisions. They have also introduced non-FDA approved drug and alcohol testing (LDTs) and these are being used by the PHPs. The conflicts-of-interest are immense both financially and ideologically.

Karen Miday • 3 years ago

The following is a quote from an article on physician suicide by W. Clay Jackson, MD featured on the PsychCongress Network this morning:

“Clinicians' risks for suicide mirror those of general society in many ways, but differ in one critical area: the
intense sense of personal identity tied to the professional role,” said Dr. Jackson. “When that identity is threatened, physicians are at high risk of depression and self-harm.”

Need I say more?

FutureDoc • 3 years ago

"Greg’s mother, a psychiatrist"

This does not surprise me one bit. And while this article is about "physician health programs" doing more harm than good, I would also argue that psychiatrists are also guilty. Partly by self-selection and partly by virtue of psychiatry training, they have this desire to "fix" people. They pick up on verbal and non-verbal queues to figure out what people are "really thinking", and they know how to influence people and change behaviors. One can not stop being a psychiatrist when they go home, it's part of who they are. This weighs on people and may cause irreversible harm to those who spend a significant amount of time around psychiatrists. Anecdotally, out of all of my friends who I grew up with, only 1 has ever had a significant physiological problem, this actually required hospitalization during high school. Not surprisingly, one of his parents is a psychiatrist.

On the other hand, short 15 min appointments every few months are beneficial for many people with mental health problems, I will always refer these patients to the experts if needed.

PamelaWibleMD • 3 years ago

Assembly-line psychiatry not the answer for most. In fact, treadmill medicine fails us all. My mom's a psychiatrist too :)

Karen Miday • 3 years ago

Please post directly to Doris Gundersen, FSPHP response, Medscape. She needs to hear from all of you.

Kernan Manion MD • 3 years ago

One gets the sense that she and her affiliates don't particularly want to hear critical feedback. Interrupts their firmly held notion that anyone who objected was just in denial or a defiant troublemaker who hadn't done their 12 steps of submission. It's very difficult for people like this who live in an insular world of magical thinking to accept information that challenges their fundamental assumptions. It literally blows their mind.
It's best they adapt quickly, because what truly is going to blow their mind and their pocketbook are the suits for intentional misdiagnosis, operating without a medical license, involuntary detention, denial of due process, deprivation of civil liberties, physician patient endangerment, and patient endangerment (patients of victim physicians of these gulags). Every state that has let these programs run under state authority and immunity will face incomprehensibly huge punitive damages.

Let's get started! Please advise what is best to do right now...Gail

happy_5 • 3 years ago

While the title of the article borders on the sensational, some states' physician health programs (PHPs) do drive some health professionals crazy! I agree with the sentiment of the article - PHPs need to evolve. They seem to be very good when a person has an addiction problem (e.g daily reporting online and via phone) and provide major legal cover so a health practitioner can keep his/her job... they may be addicted to pain meds and be stellar ER physicians, but they still need to work.

Like some of the comments here already mentioned - read through your state medical board's "monthly newsletter" about whose licensed got yanked or suspended. Nearly all of them have been relapses in egregious moral (and/or criminal) behavior, such as signing pain meds like candy (with inadequate record keeping), being drunk AND causing harm (car accidents, showing up drunk to hospital).

For mental health conditions (that can indeed drive someone to drink, use drugs, gamble, etc) such as anxiety, depression, adult ADD, I recommend getting a thoughtful mental health team and keeping your "game face" on. Do not let anyone except your boss know, and only if he has to. Your colleagues will use it against you and if you DID NOT REPORT the "impairment", you're dead meat. That ADHD may sound minor but he's not gonna like it when you have 55 patients in the office and you're getting behind, or risk being called "moody", "chronically late", "disorganized", or "dysfunctional". INVEST TIME in your kids, family, exercise and relaxation time, and tell your family (esp parents and siblings, if alive) that even the strongest need to be held and pampered. A confidant in the same profession is a godsend...just make sure to keep this private.

I have a med license in 2 states. What did they do for me (adult with longstanding history of depression, ADD and associated anxiety)? Nothing. I asked for a psychologist referral and told me to ask "my" health provider. The PHP of one state does nothing (unless you REALLY screw up more than once) and the other does nothing, but charges an arm and a leg, and threatens the physician with license restrictions and/or an investigation, which will stay in your records.

And for the one who asked if a psychiatrist has to report a health professional to a state's PHP. The answer is "it depends". From my own experience - if you are showing signs of impairment and that has, or is causing harm to patients, he does have a responsibility to do something (urge you to get help, medical and legal, speak to your boss and HR staff and maybe take a leave, etc). In other words, he should serve as an advocate for your care, especially if he/she is finally seeking care. This is usually substance use/abuse. At least two academic physicians (one a psychiatrist) have told me "depression, anxiety, ADHD - those are OK to keep private or not disclose if someone has been in treatment for a long time and is medically/mentally stable". However, if you have schizophrenia and bipolar disease, you should probably disclose as it may affect your decision-making process if you relapse.

Lastly, I'm sorry about Greg Miday. His psychiatrist may have been more forceful and specifically tell him to forget about the PHP - he is the mental health provider and HAS to report the admission to the state PHP. However, Greg had a history of alcoholism dating back to his college years, and at several times was "enabled" by his friends and even his family at one point or another. You all know the individual - popular at med school, good looking, high grades, well-liked by everyone and seemingly unable to get into any real trouble. The guy's designated friend/mentor to keep him sober committed suicide - a BIG red herring. Alcoholism and depression can co-exist, but are VERY different things. I have a history of depression, but not alcoholism. "Going out for drinks" is great to "smooth things out" after a hard day's work. This guy rarely gets reported. The one with a history of depression that is showing signs of overwork, fatigue, and emotional lability? He's the one with the problem. I would counsel doc with a mental health problem or chemical dependency problem to take their time when going "up the ladder" academically. Literally take 6-12 months and work as locum tenems or at the max 3/4 employed. Being a resident is a lot harder than being a med student, and being a fellow even tougher than a resident. Just my two cents guys. Now, gonna ride my bike with the kiddos.

Chantal Oicles • 3 years ago

Thank you, Dr. Wible, for bringing awareness to this problem. It is clear that our healers are in crisis and need help. I'm surprised the media, is being so quiet. Physician suicide should be brought out into the open and addressed. I think the silence surrounding this issue is making physicians feel even more isolated. Let's continue to discuss, tweet and share this information online--so that it gets the attention it deserves!

PamelaWibleMD • 3 years ago

Thank you Chantal for bravely taking on this issue! Our interview was another step toward healing our profession. https://www.remindercall.co...

Michael L. Langan • 3 years ago

@Dr Pamela Wible

Pamela this is a culture of harm that operates on coercion, control, fear and intimidation. As you know I have been trying to expose the criminal activity at the Massachusetts PHP for some time. I am happy to say that it looks as if state Auditor Suzanne Bump is going to proceed with an investigation.

I have been told that they now have enough statements from doctors and are going to proceed but this took some time as doctors who reported abuse were afraid to talk to a state agent even with guaranteed anonymity. Over 50% refused to make an anonymous call to the investigator even after being told they could withhold their names, hospital and any other identifying information. They were too afraid that the PHP would find out and punish them. One doctor I have known for 20 years who was Chief of his Department told me he just could not bring himself to do it because it could be a set-up. "I only have one year to go and don't want to blow it." This is the type of fear they have instilled in their victims. Most have developed a learned helplessness. There is no lifeline. Many probably have PTSD. This is understandable because they are used to no one listening to their truth.

Doctors have been reporting misconduct and obvious crimes to medical boards, departments of public health, medical societies, law enforcement, the media and the ACLU only to be turned away. These agencies don't believe the reports once they hear they have substance use or behavioral issues.

In addition PHPs utilize "point people' who are "like-minded" friends positioned at state agencies, ethics committees, boards and other places. These people block, dismiss and otherwise bury complaints. Physician Health and Compliance Committees on state medical boards are simply extensions of the PHP. Although they give an appearance of legitimacy they are simply lackeys of the PHP directed by the PHP. Board proceedings are simply sham peer-review.

The policy of many states Attorney Generals Office is to blindly support the position of he Medical Board without consideration of the facts. They also will not investigate complaints of Boards and this apparently extends to PHPs as contractors of the boards. I am unsure how this has been established but complaints to AGO's are invariably rejected without investigation no matter how serious or obvious the accusations. Complaints are simply ignored. Reports to the DOJ have also been unsuccessful. Political abuse of psychiatry, diagnosis rigging, lab fraud and Establishment Clause violations are simply ignored.

Those who should and should be investigating are not and we need to find out why. It is most likely not an agency issue in most cases (with the exception of some medical boards) but a bottom up blockade specifically intended to bury complaints and prevent exposure. The usual channels are simply blocked. We need to circumvent the usual channels and make those of conscience and integrity cognizant of this public health emergency.

PamelaWibleMD • 3 years ago

I've been studying physician psychology for nearly 50 years (both my parents are docs) and I now believe that doctors (with the exception of a few like my mom) are the most fearful group of people I have ever met in my life. Absolutely petrified to stand out, speak out, stray from the group. I implore you all to come forward and share your stories (even anonymously) here. Silence will not save us.

DZ-015, M.D. • 3 years ago

I agree at least in the developed world.

The therapeutic state tempts the citizen with compassion then stabs him in the back.

Jesse Cavenar • 3 years ago

It will be great if the Auditor will do an audit. In NC we found that to be a tool to get the ball rolling.

joehospitalist • 3 years ago

Thank you Dr. Wible for your continuing efforts to care for doctors. Anecdotally, I have many close friends who have been treated for anxiety or depression throughout their medical careers, or have seen a mental health provider at some point. Luckily, it's never gotten to the point of substance abuse in their cases.

Have they had involvement with PHP programs? If so, was the experience a positive or a negative one?

joehospitalist • 3 years ago

Actually, it worked out okay. I saw a psychologist briefly in medical school and just talked to my PCP. My wife and several friends have seen a psychologist for depression that was provided by the residency program (the campus mental health program i think). I don't think that these were true physician health programs, and the medical board was never involved.

It's actually been a good experience for me and my wife (who's also a doctor). If our close friends have issues we tell them about our experience and have recommended they see psychologists (sometimes the same one). I've never heard of any negative repercussions from them.

PamelaWibleMD • 3 years ago

So your care was handled locally by a therapist you trusted? That makes all the difference. I think that is all many docs wish they had the opportunity to experience for themselves. A safe place to go.

PamelaWibleMD • 3 years ago

I would like to hear from supporters of PHPs please. Recent articles on Medscape are filled with tragedies from those who have been injured by PHPs: http://www.medscape.com/vie... and http://www.medscape.com/vie...

It is my objective to hear from both sides. If you are a doctor, please comment if PHPs have helped you with your mental health. As a physician who is extremely concerned about all these physician suicides (just off the phone with another doc who lost her colleague) and I need to know what we are doing (or not doing) as a profession to help or harm our vulnerable colleagues.

rjp225 • 3 years ago

This is sad, and not limited to the healing professions. Aspiring lawyers must go through a bar admission process that in many jurisdictions still requires disclosure of any past mental health issues. I've known cautious law students who have discontinued seeing psychiatrists and stopped taking medication so that they could honestly answer "No" to these types of invasive inquiries. Regulators might say that this is an unwarranted over-reaction, but try explaining that to risk-averse-by-nature law students who are spending more than $100,000 for a professional education that will be useless in the absence of a license to practice. These types of mental health inquiries by licensing boards (which have no particular expertise or competence in these areas) are useless and counter-productive, and should be prohibited by law, in my opinion.