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White coat notes

Aid for addicted doctors is faulted

Physician health programs in most states are designed to help doctors with substance-abuse problems get the care they need and, when appropriate, return to work while protecting patient safety. But two doctors who have been involved with the Massachusetts program say there is too little oversight of programs across the country and no clear standards.

Doctors referred to such programs have no choice but to participate in the treatment in order to preserve their careers, so the programs are coercive, J. Wesley Boyd and John R. Knight, both of Harvard Medical School and Boston Children’s Hospital, said in a review published this month in the Journal of Addiction Medicine.

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While the programs are highly successful, helping a large majority of doctors they serve to become abstinent and return to work, they have the potential for abuse, they wrote.

“The physicians who are referred to these programs are often so compromised professionally by the time they get to them that, even if they feel that their treatment is not ethically sound, they’re often not in a position to voice them,” Boyd said in an interview.

The programs often refer patients to specialty centers that fund regional and national conferences for the field, the authors wrote. The centers rely on state referrals for their financial viability and may be inclined to recommend treatment, which typically lasts 90 days — far longer than inpatient programs for the general population — and can be expensive.

The review also raised questions about the data collected from such patients and whether physicians truly have the ability to opt out of research projects, when their participation in treatment is obligatory. And it questioned the relationship between physician health programs and state medical boards. Some programs are authorized by boards or receive funding from them, Boyd and Knight said.

Most programs “are beholden to the licensing board and might act in ways to keep the board satisfied, rather than risk loss of financial support or even closure,” the authors wrote. While both have experience working as associate directors of the Massachusetts program, the paper took a national view.

The Massachusetts Physician Health Services is a nonprofit subsidiary of the Massachusetts Medical Society. About 80 percent of its funding comes from the society and two major malpractice insurers. In the 12 months ended in May, 130 Massachusetts providers sought help from or were referred .

Dr. Luis Sanchez, the director, said he does not see much potential for financial conflicts. Patients get several choices of treatment centers and there are programs available for some who cannot afford treatment. He said the organization is sensitive to conflicts.

Sanchez said he does not think it is possible to set US standards because each state medical board and health program is run under different laws.

For the full blog, visit
boston.com/whitecoatnotes. Chelsea Conaboy
can be reached at
cconaboy@boston.com
.
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