The stresses on the medical professional have never been greater. There is the uncertainty of pending federal health care laws, the shifting landscape of insurance reimbursement and the confusing maze of maintenance of certification and licensure. And these don’t even include what, for most of us, is a constant stressor—ensuring that our patients receive the best possible care. How many hours of sleep have each of us lost reliving an encounter with the day’s most challenging patient, wondering whether our clinical decision making was sound?

To maintain balance in our lives, it is paramount that we find healthy outlets. Some of us recharge through travel, exercise, reading or hobbies (I think I have finally convinced my husband of the beneficial aspects of “shoe therapy!”).

Sadly, though, some choose a path that, like Odysseus’ Sirens, entices with immediate gratification while bringing them ever closer to destruction. National data suggest that the incidence of substance abuse and addictive behavior is somewhat higher among health care professionals when compared to the general population. The resulting impairment puts patients at risk for irreparable harm and endangers careers that are often a lifetime in the making.

We are extremely fortunate in this state to have the North Carolina Physicians Health Program (NCPHP). Originally established as a committee of the North Carolina Medical Society, it began seeing impaired physicians in December 1988. Changes to state law have since enabled physician assistants (PAs), anesthesiologist assistants (AAs) and licensed perfusionists (LPs) to receive services as well.

One of my goals as NCMB president is to raise awareness of NCPHP and its services, so that any licensee who needs assistance will know that help is available, and how to get it. Licensees who are concerned about a colleague should remember that it is the Board’s position that licensees have a professional obligation to act when they suspect a colleague may be impaired or incompetent to practice. If we don’t care for each other, who will? Often, NCPHP is the best way to help your friend get the help he or she needs. Referrals can even be made anonymously, if you prefer.

I have had a personal interest in NCPHP from the very beginning. In 1988, one of my colleagues developed a substance dependence problem and entered into a contract with NCPHP. This program saved his career. Today, he is a successful physician who finds tremendous satisfaction in helping others in their own recoveries.

For those of you who may be unfamiliar with NCPHP, its mission is this: To improve the quality of health care for the people of North Carolina through assurance of healthy medical professionals. NCPHP assesses individuals to determine abuse/addiction, assists with referrals to appropriate treatment, if needed, and monitors individuals in recovery to ensure their compliance. In addition, NCPHP is an advocate for its participants and an intermediary between participants and the NCMB. NCPHP does not provide treatment services.

A guiding principle of NCPHP is that early identification of substance abuse or dependence, coupled with appropriate intervention and treatment, is the best way to prevent harm, both to patients and to health care practitioners’ careers and personal lives. Dr. Warren Pendergast, the nationally respected addiction psychiatrist who serves as NCPHP’s medical director, says it best, “People have two choices: They can get help early, or they can wait until they get worse and things come crashing down around them.”

Yet I suspect many physicians who are struggling with alcohol or substance abuse, or colleagues who suspect a friend or practice partner is veering out of control, fail to seek assistance early because they fear the consequences. I’ve heard that many licensees believe seeking help from NCPHP will result in their automatic “outing” to the NCMB and, possibly, the loss of their medical license.

This is just not the case. Most licensees who seek assistance early—for example, before they have had an arrest for DUI or a loss of hospital privileges that would make both their identity and their substance problem known to the NCMB—are able to participate in NCPHP on a confidential basis. The Board does not know the names of all participants, and affords licensees with alcohol/substance abuse problems or other health issues the opportunity to remain anonymous at license renewal, provided they are participants in good standing with NCPHP.

There are some important exceptions. Under state law, no one who is determined to be an imminent danger to the public or to him- or herself can participate in NCPHP anonymously. In addition, individuals under contract with NCPHP who refuse to fully cooperate with that organization, who refuse treatment when treatment is needed, who remain impaired after treatment or who demonstrate professional incompetence cannot remain unknown to the medical board. And while this article deals principally with licensees with substance/alcohol issues, no one who is referred to NCPHP for professional sexual misconduct may remain anonymous. It’s also important to recognize that NCPHP deals with an array of issues beyond alcohol and substance abuse, including stress, depression and behavioral difficulties such as disruptive behavior. Licensees may seek help for these issues while remaining anonymous to the NCMB, as well.

Virtually all of the individuals whose identities are unknown to the NCMB at the time of initial referral to NCPHP are able to remain anonymous as they proceed with assessment, treatment and recovery. NCPHP requires health care practitioners who are unsafe to practice to sign binding nonpractice agreements, which they must comply with in order to remain anonymous to the NCMB.

The NCMB also deals with a significant population of licensees whose alcohol and substance abuse problems are well known to the Board. Often, these practitioners have experienced an adverse event, such as an arrest, termination of employment or privileging action that brought them to Board attention. The vast majority of these licensees are referred to NCPHP as part of remediation ordered by the NCMB and, thus, cannot be anonymous to the Board.

Through my role on the NCMB, I have seen NCPHP in action and I truly believe it is one of the greatest assets North Carolina has to help health care professionals in need.

I have been on the NCPHP Board of Directors for the past three years and currently serve as its Chair. In addition, for the past three years I have been a member of the NCPHP’s Compliance Committee, which is composed of three members of the NCMB, including a public member of the Board, as well as other physicians and PAs. The Compliance Committee discusses all new NCPHP participants, including new anonymous NCMB licensees, as well as all current participants who are struggling. The committee then makes recommendations to the NCMB, including whether it is necessary to make an anonymous licensee known to the medical board.The decision to break anonymity is never made lightly and is made infrequently, for noncompliance issues that have the potential to threaten a participant’s recovery, and thereby, patient safety. In some cases, breaking anonymity can serve as the clarion call that focuses the licensee’s attention on taking the necessary steps to get better, helping their recovery process in the long run.

There is objective evidence to support that North Carolina’s approach is working. A chart review of NCPHP participants seen for substance impairment during the years 1995-2000 concluded that 91 percent of physicians and 59 percent of physician assistants had a good outcome. These results meet or exceed national standards for similar monitoring programs, according to a 2005 article in the Journal of Addictive Diseases.

It has been my personal experience that the overwhelming majority of NCPHP participants are able to maintain good recoveries and regain productive lives, careers and personal relationships.

The North Carolina Physicians Health Program aids your colleagues and their families when addiction, depression or work-related stress is adversely affecting their lives.

If you, or someone you know, is in need, I hope you won’t hesitate to get help.

For more information, visit www.ncphp.org.

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DID YOU KNOW?

Each time a physician renews his or her license, $21 of the $175 fee goes to NCPHP. For PAs, AAs and LPs, $15.75 of the renewal fee goes to NCPHP. The NCMB contributed $720,000 to NCPHP’s annual operating budget in 2010.

Why?
The NCMB is committed to helping licensees function at their highest level. The Board’s direct financial support of NCPHP ensures that this important resource remains available to physicians, physician assistants and other health care practitioners.

Supporting treatment scholarships
Many licensees choose to provide voluntary contributions to NCPHP’s scholarship fund, which makes awards to help participants and their families defray the cost of treatment or other expenses.

Licensees are given the option to make a donation to this fund at the end of the NCMB’s online license renewal process. In 2010, licensees donated more than $114,000 to this program. Due to their generosity, many NCPHP participants have been able to attend treatment.

Gifts to the PHP Scholarship Fund may be sent directly to the address below. Make checks to NCPHP and be sure to identify your contribution as a gift to the fund.

NCPHP
220 Horizon Drive, Ste. 201
Raleigh, NC 27615