How do we care for the people who care for us? As doctors, we’re immersed in pain and suffering—as a career. We cry when our patients die. We feel grief anxiety, depression—even suicidal—all occupational hazards of our profession.
A recent Medscape article on Physician Health Programs suggests that the people who are here to help us may actually be doing more harm than good. And they may even be increasing physician suicides.
Both doctors I dated during medical school died by suicide. Eight physicians killed themselves in my town alone. I’ve become a specialist in physician suicide. My cell phone has turned into a physician suicide hotline. And I have a stack of physician suicide notes that I keep at home. Here’s one of them:
Dear Some, My family, I love you. To others who have been good friends, I love you too. This is just the end of the line for my particular train. Earth wasn’t a great place for me. We’ll see what else is out there. Will miss you all. I’m sorry for what it’s worth. Love Greg.”
On June 22, 2012. Dr. Greg Miday killed himself—12 hours after being told not to follow his psychiatrist’s safety plan by the Physician Health Program that controlled his medical license. Sober for years, he relapsed just before his death. A brilliant clinician, never impaired at work, Greg drank to cope with anxiety.
Afterwards, 2 interns jumped to their deaths from New York hospitals (the same week within 3 days of each other, I believe). Greg’s mother, a psychiatrist, sent this letter to the editor of The New York Times:
An unacknowledged predicament for physicians who identify their struggle with substance abuse and/or depression is that they are often placed under the supervision of their State Medical Board’s Physicians Health Program. My son, Greg, was being monitored by such a program. He took his own life at age 29, one week before he was to enter an esteemed oncology fellowship. His final phone calls were to the Physicians Health Program notifying them of his use of alcohol while on vacation, a disclosure he had previously described as a ‘career killer.’ These programs, which often offer no psychiatric oversight, serve as both treating and policing agencies, a serious conflict of interest. Threatened loss of licensure deters vulnerable physicians from seeking help and may even trigger a suicidal crisis. Medical Boards have the duty to safeguard the public, but the assumption that mental illness equals medical incompetence is an archaic notion. Medical Boards must stop participating in the stigmatization of mental illness. We cannot afford to lose another physician to shame.
Greg Miday, M.D., and his mother, Karen Miday, M.D.
Our medical schools, hospitals, and clinics actually cause or exacerbate mental health conditions in physicians, and then they blame us and force us to release our confidential medical records. And in the end, they take our license. . .
Maybe that’s why my friend, an excellent psychiatrist, drives 200 miles out of town, pays cash, and uses a fake name to get mental health care.
And another physician friend who was deemed “too slow” [seeing patients] by her residency director, was sent to a psychiatrist who diagnosed her with mild OCD (don’t we all have mild OCD if we are thorough physicians?). Well she was actually then sent to the medical board who referred her to a Physician Health Program that mandated an AA-style substance abuse program—which makes no sense at all since she does not do substances. She doesn’t drink or smoke.
So who the hell is protecting us from being misdiagnosed, mistreated, and abused?
There are many who prey upon physicians. So who cares for doctors?
And how in the world can we give patients the care we’ve never received?
Pamela Wible, M.D., is a pioneer in the Ideal Medical Care Movement. When not treating patients, she dedicates her time to medical student and physician suicide prevention. Dr. Wible is the recipient of the 2015 Women Leader in Medicine Award. Video by GeVe. Photos courtesy of Miday family.
i reached the end of my rope almost 8 years ago. Wracked with anxiety, guilt and depression I overdosed and arrived at the hospital in cardiac arrest. Fortunately I was revived. My PHP was the anchor of my recovery. I chose to go to a 90 day program where I got help for a chronic addiction and for my depression. I saw a psychiatrist regularly throughout my stay. When I returned I signed up for the PHP and cannot praise them enough. I get concerned when all PHP’s get lumped together. Are there bad ones out there. Certainly but there are also good ones.
Yes. No need to demonize all. I’m just asking the question that others have posed to me. Certainly many need oversight. Many unanswered questions. And many physician suicides that have not had proper investigation.
Hi Pam, This touched my heart and I had to share it on my blog site. Thank you for never letting up on getting the word out!
Dear Pamela,
As a psychiatrist, I have seen Physicians’ Health Programs either be wonderful at supporting fellow docs, or absolutely awful. In some cases, they fail to individualize their programming to accommodate what the physician specifically needs — or their mandate to protect the public makes them overly restrictive. It has been extremely painful to me to treat physicians at the same time I’m having to provide periodic letters to medical boards about them. I cannot say my results have been spectacular in those cases.
Where physicians are willing — and can receive — truly private treatment or coaching with me, is another story altogether. Much more likely to result in healthy outcomes. Unfortunately, medical boards and PHP’s encounter physicians who are in need of, yet are resistant to, treatment. It’s a challenging situation for all: the doctor, the board, the PHP, AND the public. Yikes.
God bless the psychiatrist friend of yours to goes incognito for her treatment. I would say that’s guerrilla self-care of the highest order. I’m sorry that she has to go to such lengths, but I applaud her willingness to do it.
Best wishes,
Pam
Thanks Pam. Sad state of affairs when we have to go incognito to seek out own health care. How do you think we can change this?
I have had many of the same problems and the medical problems I developed from the never ending stress plus the many thousands of dollars has driven me to the point of suicide several times luckily I was able to diffuse the pain and not follow thru. The unrealistic demands just continue and they expect me to spend very large sums of money I don’t have with no end in site yet it’s been 12+ years. Now I am at risk of losing it all because of paperwork even though I have remained sober. I can never get away and the demands never quit but if I fight then I still lose! Please help me as I am near my limit!
Hi Bob, I am always available to talk and have lots of resources and creative strategies to share so you don’t feel so desperate and can salvage your career. Never give up your precious life. reach out here: https://www.idealmedicalcare.org/contact/
Pamela,
Thank you for taking such a powerful stance. This issue has finally reached visibility thanks to persistent efforts such as yours and Karen Miday’s and Michael Langan’s.
It is so mind-boggling that physicians have to obtain our mental healthcare secretively, not for concern about stigma. No, for fear that one’s gestapo medical board and PHP might find out and find a way to use this to destroy you.
When medical boards and PHPs and even medical staffs have become this ruthlessly tyrannical, we’ve reached a point where confrontation must take place. They must be held to account for the unconscionable harm they have caused. And there must be dramatic reform with ongoing intensive monitoring and accountability.
Wishing you renewed vigor as you continue your hope-giving work.
Kernan
Thanks Kernan. We absolutely must help our most vulnerable from being victimized when they need our help. Thank you for revealing your own story so authentically.
Someone in my my life had said, ” The idiots are the happiest people in the world ! ” And I agreed completely.
I was ignored and blacklisted by previously wonderful faculty after leaving an abusive relationship “the wrong way.” I was put on leave for two weeks and forced to go to a psychiatrist picked by the program’s social worker to determine my “fitness to practice.” I was never treated the same way afterwards and was forced to make up that time tacked onto the end of the residency. I quickly learned that those above a clinician are not interested in the clinician’s health but only productivity. I learned to tackle my own problems and only discuss weakness with true friends. If I was to ever seek professional advisement, I would do very much like your friend and travel far out of my area and use an alias.
On the phone now with a physician who is being monitored by a PHP for 8 years. She fears for her career to write this herself and is permitting me to write this on her behalf.
She is in a small town in which 3 doctors died by suicide in 18 months (2 were in the PHP). She has been charged monthly fees that she can’t afford to pay. She got behind in payment of fees so she was deemed non-compliant with the program (and they make no differentiation between whether it is financial non-compliance or whether she had relapsed on alcohol) and because she was non-compliant they extended her monitoring by another 5 years. “It is extremely frustrating,” she says. “Nothing that they have me do is covered by insurance and they have not been helpful to me (never remember what I said last time during therapy sessions). I believe the reason why I have been as successful as I have is because I sought counseling outside of the PHP. I feel so abused by them.”
“I read about the man who died after drinking on vacation (Greg Miday) and I saw the face of a physician who I know and I didn’t realize what he was going through, but he had some problems with alcohol and he finished up his charts one day and shot himself in the parking lot of his clinic. Absolutely horrific. When I heard what had happened and what his background was I thought his recovery must have not been going well. Now after being in the PHP as long as I have, I realize they are not here to advocate for you or help you.”
“I have a friend who is a psychiatrist and every time I tell him about this he is shocked. He does not understand what they are doing. The man who runs the programs is not a psychiatrist. He is in primary care and went to some kind of residency I never heard of that allows him to run a program like this.”
“The purpose of the PHP is not my treatment or to get me well. Their focus is to make sure I’m not a danger. I thought at the beginning that they wanted to help me get well. That is not their purpose. When I figured this out and came to peace with this it made it somewhat more tolerable. Their job is to organize my paperwork and take it in front of the Board so that the Board members can make sure that the public can ‘feel like’ they are protected. And their job is to collect fees.”
Pamela, I deeply appreciate your stance compelling us to examine the role that PHPs seem to be playing in intensifying physicians’ despair and driving them to suicide.
The issue here is not whether a physician may have developed a drinking or drug problem or may be experiencing what is conventionally termed a “mental illness.” Rather, it’s about how that physician, grappling with this alleged illness, is assessed and treated and what role a PHP – and therefore indirectly a medical board – play in the appropriate treatment of that physician and what is appropriate and discrete oversight of that physician’s recovery.
Let’s be clear about organizational missions here: a medical board exists to regulate the practice of medicine for the safety of the citizens of that state. A PHP exists to reach out to and assist physicians who may be experiencing a mental illness or substance abuse and facilitate their recovery. A PHP’s mission is NOT to protect the public.
However, it would appear that PHPs themselves, in their very close relationship with Medical Boards, have lost sight of this distinction and have felt compelled to be the primary diagnosers and exclusive treaters / treatment arrangers of physicians who may have such problems. And in doing so, and because of their cozy relationship with boards, and because of their own confusion of their mission, they have taken – and been given – a heavy hand in their interventional authority.
And now, if one resists the PHP’s efforts, one is labeled as “avoidant” or “in denial” or “non-compliant.”
But that’s not necessarily the case. Their resistance is entirely understandable.
In fact, many physicians who have learned (see comments in Medscape “Physician Health Programs: More Harm Than Good?”) of PHPs’ extreme treatment recommendations (and even mis-diagnosis) which must be complied with or face medical sanction are terrified of being evaluated by or having one’s treatment “monitored by” a PHP. Physicians are seeing PHPs as invasive tyrants whose edicts are extreme and uncompromising and non-compliance with such can mean the end of one’s career. And they are operating with neither oversight by nor accountability to anyone.
Further, as has been documented in numerous case reports (see comments in above Medscape article) as well as by one state auditor and one class action lawsuit in Michigan against both the medical board and the state’s PHP these programs routinely deny the subject physician their due process rights. In other words, one can’t learn of their now-infallible PHP diagnosis, can’t see or correct their diagnostic report, can’t get a second opinion consultation, and can’t challenge the PHP’s diagnosis or harsh recommendations. Kafkaesque?
Worse, the pattern of recommendations is extremely disturbing: referral to an extremely costly 4 day evaluation at a “preferred” out-of-state facility (often staffed by a polygraph expert) followed by that program’s nearly invariable recommendation of referral to extended in-patient treatment (also at one of PHP’s “preferred programs”). And the in-patient treatment is likewise cash only and based on an antiquated and invalidated model of bullying confrontation and “surrender to a higher power.”
But even worse, some states’ license applications ask questions about whether you’ve ever had a “mental illness or substance abuse problem” and, if you’ve been treated for such, they demand to know – even if it was in college! And if you are not forthcoming, they have a right to immediately void your license at any time. And it you tell the truth, apparently no matter how remote the occurrence, you’re mandated to go through a PHP evaluation, where you being subjected to the entire costly evaluation and treatment cascade and being put on what amounts to house arrest for 5 years.
So invasive and destructive is this intrusion that a number of physicians are too frightened to get any help for fear that the board will find out and even subpoena their therapist’s records. Imagine!
Now, truth be told, it’s not surprising that a number of docs wouldn’t want to go to a psychiatrist or other mental health clinician (particularly that a PHP has recommended) as many – not even considering their less-than-approachable demeanor – have fallen into the medicalization of life problems / over-diagnosis habit, believing that every person who comes to see them must have a psychiatric diagnosis. And, of course, that’s potentially discoverable, and share with the referring PHP, and reportable on one’s next license renewal.
So, imagine this:
If I as a physician develop a mental illness or substance abuse problem, no matter how minor, and go to PHP, I’m screwed.
If I balk at being referred, I’m really screwed.
If I accept their recommendations, I’m screwed.
If I accept their community referral, I’m screwed.
If I see my own private mental health professional for help and let PHP know I’m seeing my own clinician, I’m screwed.
And if I see any mental health clinician in the community at all, I could be screwed.
Talk about nowhere to turn!
So, is it fair to say that PHPs are contributing to physician suicide? It would certainly seem apparent. But that’s only a part of the problem. They, along with invasive medical boards who demand to know one’s mental health and substance use history. Along with shrinks who erroneously believe that everyone who comes for treatment must have a lurking diagnosis and that diagnosis must be boldly documented and that record must be produced for the PHP and medical board on their request.
Physicians today are under extraordinary stress – 30-50% are grappling with burnout. And they need support. They too occasionally need solidly grounded mental health treatment. The very last thing they need is to be tortured by their PHP and medical board.
But the way the forces are aligned currently constitutes what might best be termed the perfect storm of physician suicide.
We must remedy this immediately.
Your comment, that “don’t we all have mild OCD if we are thorough physicians?” reminds me of a plenary lecture by the late David T. Dodd, at an ACP Annual Session, that impressed and moved me. He pointed out that the personality/character traits that make someone a great physician for his or her patients, make life very difficult for them. Obsessiveness was very high on the list of what you want in your doctor, but not necessarily in yourself!
I meant to say, “the personality/character traits that make someone a great physician for his or her patients, make life very difficult for those physicians themselves.”
Yes excruciating attention to detail can really slow one down outside of the office.
This is why I also, like the woman you mention, pay out of pocket for care and meds that are nearly financially crippling for my genetically inherited depression. I, and my doc, know I am/have never (been) impaired at work, even before my current stabilization, but I can’t trust anyone else would believe it or trust me, so I keep it all secret. And I’m a psychiatrist myself. I wish I could be “out,” but it’s too terrifying to risk it. Something needs to change. We preach about ending stigma, we need to start with each other.
EXACTLY. I plan to end the stigma right around November 18, 2015 with my TEDMED talk on this VERY TOPIC! –> https://www.idealmedicalcare.org/blog/physician-suicide-npr-interview-with-tedmed-speaker-dr-wible/
Watched your Ted talk, your post-interview with the AMA, and a couple of others. I’m not a physician (actually, an engineer, but am in the process of applying to medical school as a late career change). I also know several physicians, and they are under **huge** strain due to their profession.
I was absolutely astounded to hear about this issue. Flabbergasted. Stunned.
I am so glad you are out there with a bullhorn bringing this issue up. Encouraging physicians to screen for mental health issues and bring the issue out of the dark ages, while simultaneously stigmatizing them for suffering the same is completely and utterly unacceptable.
Oh then you’d love the book Physician Suicide Letters—Answered:
1) https://www.idealmedicalcare.org/blog/physician-suicide-letters-answered-a-sneak-peek-inside-my-new-book/
2) https://www.idealmedicalcare.org/blog/physician-suicide-letters-answered-by-pamela-wible-m-d/
Regarding the doctor diagnosed with “mild OCD”– every person I know who has an advanced degree, which requires years of study, attention to details, and dogged persistence to hang in there until they achieve it, has this trait. This makes her better at her work, not sick. It won’t make her a corporate cash cow, however. There’s a better place for her to shine. Heads up, buttercup! Don’t let them steal your joy!!
i have been in a program voluntarily for over 6 yrs. one slip up recently (zero in over 6 yrs) and i am contemplating leaving it all. including the earth today.
im tired of my life being run by and dictated by others and i have had a life on hold and they talk now about extending my contract. if i didn’t have school loans i wouldn’t be practicing anyway. i hate this life but trapped
tonight id rather die than live this way any longer. took away my late 30s and early 40s still single I’m worthless
I just got your message. My computer crashed. I will email you now. Please don’t let go of your life over the PHP. You are not worthless. You have just been in a system that was not able to help you and may have injured you. I am so sorry. Emailing now . . . Call me! 541-345-2437 and I’ll call you back.
I stumbled across this website and feel compelled to share my story, as I feel the hopelessness and despair over being so “wronged” by the people that should be protecting me. I am a physician assistant. I have specialized in pain management for the last 11 years. I had a new patient, a classic “drug seeker”, jump on the internet to file a complaint, when I would not provide the highly abusive form of a narcotic she was currently on. The board reviewed the office visit notes which reveal the patient provided an inappropriate drug screen, she is non-compliant, and lied to a pharmacist. During the investigation, the Board found I was prescribed opiates for a recent hip replacement, and sent me for a PHP evaluation. It was a grueling assessment from day one. At the end, I was glad to be done with it and return to work. Thirty days later, my attorney received a demand that I sign an interim consent agreement, or have my license suspended. The PHP provided a scathing 40 page assessment that included the results of my hair,urine, and blood (PEth) test. All were appropriately positive for prescribed medication only and negative for alcohol. The report also contained an electronic prescription report that supported my stable use of pain medication (no early refills, no doctor shopping etc.). The report also included a multitude of psychiatric tests that were also negative for psych. problems or abuse of opiates. The only negative and derogatory portion of the report is the PHP clinicians verbal assault on me, with no objective data to support it. I was ordered to immediately enter a 90 in-patient rehab at $800 per day, followed by 5 years of monitoring by PHP at $1200 a month. My attorney advised me that I had to sign within 72 hours or have my license suspended. All he could do is tell me “both options are horrible”. The consent was signed April 8th and I could not return to work until I complied with the in-patient demand. I refused to enter rehab. Five months later and more than $31,000 in legal fees, I am still out of work and now I am out of money. This is what prompts suicidal ideation. When you are forced out of your job, and you lose your home. Your only option is to attend the 90 day in-patient treatment – “financing available” and put yourself in an even more vulnerable situation’ or walk away from your career. In the end, you have been violated, but there is no recourse. It is devastating.
Absolutely INFURIATING!!!!! These PHPs are predatory organizations that entrap docs & other health professionals for their own economic enrichment. Total conflict of interest.
This is so disheartening to hear. As a PA, who had a similar experience, I can relate. I am curious to know which PHP approved “contracted” organization performed the ” assessment”. I previously have worked at Promises which often takes those from Arizona for these assessments. In response to the obvious concerns of corruption, I was interested to learn that the parent company of Promises, Elements Behavioral Health, was sued for several million when it was learned that they the company owned large shares in a toxicology lab, Sky Toxicology, who paid large kickbacks to Elements Of note, Greg Skipper, who runs Promises PHP, an Elements company and is also a former PHP president ( Oregon), and maker of one of a controversial tox screen used by PHPs. These sorts of incestuous relationships really highlight the level of corruption which are at the heart of these programs. Unwitting professionals fall victim to greed every day. It is truly disgusting and demands public outrage.
You definitely need to connect with Dr. Michaal Langan who has done much investigation of the PHP corruption.
Reading this last story about the PA, brought back terrible memories of the nightmare which caused me to leave my career after 15 years, after being forced into a PHP. It is a horrendous cycle that you cannot escape. It defies logic and that is what makes the experience even more loathsome.