Impaired Physicians Get More Attention

The Federation of State Medical Boards first identified alcoholism and drug addiction among physicians as a disciplinary problem in 1958 and called for a model probation and rehabilitation program to be adopted by individual state boards.

The AMA did not formally recognize physician impairment as a serious problem until the 1970s, when the AMA Council on Mental Health issued its landmark policy paper “The Sick Physician: Impairment by Psychiatric Disorders, Including Alcoholism and Drug Dependence.”

By 1974, the AMA had acknowledged that substance abuse was an illness and devel-oped model legislation that offered a therapeutic alternative to discipline for physicians with alcoholism and drug addiction, according to an AMA statement.

The AMA in 1975 held its first conference on physician health to address issues of impairment. At a 1977 conference on the issue, the AMA officially recognized that physicians can also be impaired by psychiatric problems.

By 1980, 51 of the 54 U.S. state and jurisidictional medical societies had authorized or implemented impaired physician programs, according to the AMA. Today, all medical societies have impaired-physician programs “that operate within the parameters of state regulation and legislation.”

The AMA initiatives and the success of several state physician health programs focusing on rehabilitation and monitoring of impaired physicians led to the creation of the Federation for State Physician Health Programs (FSPHP) in 1990.

The FSPHP's members represent 42 states. Psychiatrists are medical directors of at least seven impaired-physician programs, FSPHP officer Terrance Bedient told Psychiatric News. He is also executive director of the New York program in Albany.

Every state has some mechanism to address physician health, said Bedient. They range from committees on physician health operated by the state medical society to programs operated by the state medical licensing board. Some programs, such as the one in Texas, are set up to address chemical dependency, mental health, behavioral health, sexual misconduct and/or boundary violations; physical illness; and stress management. Others, like the program in Vermont, address chemical dependency only, according to their online profiles.

FSPHP President and forensic psychiatrist Michael Gendel, M.D., told Psychiatric News that physician health programs are designed primarily to conduct comprehensive assessments, make recommendations regarding treatment, and monitor physicians' compliance.

John Fromson, M.D., chair of APA's Corresponding Committee on Physician Health, Illness, and Impairment, told Psychiatric News that the number of referrals to the Massachusetts Physician Health Services program, which he directs, has increased dramatically in the last five years.

“This shows that health care leaders are less willing to tolerate aberrant behavior by physicians, are more concerned about medical errors and patient safety, and know about state physician health programs,” Fromson said.

A history of the FSPHP is posted online at<www.ama-assn.org/ama/pub/category/print/5706.html>. A list of state physician health programs is posted at<www.ama-assn.org/ama/pub/category/6020.htm1>.