Disrupted Physician 101.4–The “Impaired Physician Movement” takeover of State Physician Health Programs

Forget what you see
Some things they just change invisibly–Elliott Smith

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Physician Impairment

The Sick Physician: Impairment by Psychiatric Disorders, Including Alcoholism and Drug Dependence, published by the American Medical Association’s (AMA) Council on Mental Health in The Journal of the American Medical Association in 1973,1 recommended 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.”

Recognition of physician impairment in the 1970s by both the medical community and the general public led to the development of “impaired physician” programs with the purpose of both helping impaired doctors and protecting the public from them.

IMG_1010The 1975 media coverage of the deaths of Drs. Stewart and Cyril Marcus brought the problem of impaired physicians into the public eye. IMG_0940Leading experts in the field of Infertility Medicine, the twin gynecologists were found dead in their Upper East Side apartment from drug withdrawal that New York Hospital was aware of but did nothing about. Performing surgery with trembling hands and barely able to stand, an investigation revealed that nothing had been done to help the Marcus brothers with their addiction or protect patients. They were 45 –years old.

Top: Twin Gynecologists Stewart and Cyril Marcus Bottom: The Movie

Top: Twin Gynecologists Stewart and Cyril Marcus
Bottom: The Movie “Dead Ringers” starring Jeremy Irons based on the Marcus twins

Although the New York State Medical Society had set up its own voluntary program for impaired physicians three years earlier, the Marcus case prompted the state legislature to pass a law that doctors had to report any colleague suspected of misconduct to the state medical board and those who didn’t would face misconduct charges themselves.


Physician Health Programs

Physician health programs (PHPs)  existed in almost every state by 1980. 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. Preferring rehabilitation to probation or license revocation so long as the public was protected from imminent danger, most medical boards accepted the concept with support and referral.

As an alternative to discipline the introduction of PHPs created a perception of medical boards as “enforcers” whose job was to sanction and discipline whereas PHPs were perceived as “rehabilitators” whose job was to help sick physicians recover. One of many false dichotomies this group uses and it is perhaps this perceived benevolence that created an absence of the need to guard.


Employee Assistance Programs for Doctors

Physician Health Programs (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.

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The American Society of Addiction Medicine can trace its roots to the 1954 founding of theNew York City Medical Society on Alcoholism (NYCMSA) by Ruth Fox, M.D whose husband died from alcoholism.

The society, numbering about 100 members, established itself as a national organization in1967, the American Medical Society on Alcoholism (AMSA).

By 1970 membership was nearly 500.

In 1973 AMSA became a component of the National Council on Alcoholism (NCA) in a medical advisory capacity until 1983.

But by the mid 1980’s ASAM’s membership became so large that they no longer needed to remain under the NCADD umbrella.

In 1985 ASAM’s first certification exam was announced. According to Dr. Bean-Bayog, chair of the Credentialing Committee, “a lot of people in the alcoholism field have long wanted physicians in the field to have a high level of skills and scientific credibility and for this body of knowledge to be accredited.”2 And in 1986 662 physicians took the first ASAM Certification Exam.

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By 1988 membership was over 2,800 with 1,275 of these physicians “certified” as “having demonstrated knowledge and expertise in alcoholism and other drug dependencies commensurate with the standards set forth by the society.”3 “The formation of State Chapters began with California, Florida, Georgia, and Maryland submitting requests.4

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In 1988 the AMA House of Delegates voted to admit ASAM to the House. According to ASAM News this “legitimizes the society within the halls of organized medicine.”2

By 1993 ASAM had a membership of 3,500 with a total of 2,619IMG_8919certifications in Addiction Medicine. The Membership Campaign Task Force sets a goal to double its membership of 3,500 to 7,000 by the year 2000 to assure “the future of treatment for patients with chemicals. It represents a blueprint for establishing addiction medicine as a viable entity.”5

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Many of these physicians joined state PHPs and over time have taken over under the umbrella of the FSPHP.

Others became medical directors of treatment centers such as Hazelden, Marworth and Talbott.


  1. The sick physician. Impairment by psychiatric disorders, including alcoholism and drug dependence. JAMA : the journal of the American Medical Association. Feb 5 1973;223(6):684-687.
  2. Four Decades of ASAM. ASAM News. March-April 1994, 1994.
  3. . American Medical Society on Alcoholism & Other Drug Dependencies Newsletter. Vol III. New York, NY: AMSAODD; 1988:12.
  4. . AMSAODD News. Vol III. New York, NY: American Medical Society on Alcoholism & Other Drug Dependencies; 1988.
  5. Membership Campaign Update. ASAM News. Vol VIII: American Society of Addiction Medicine; 1993:11.

Inquisition_10_Pushing_Off_Bridge

johnnyLawrence

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11 thoughts on “Disrupted Physician 101.4–The “Impaired Physician Movement” takeover of State Physician Health Programs

  1. […] Physician Health Programs (PHP) can be considered an 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. Originally developed as “impaired physician” programs, the PHPs were created to help doctors who developed problems with substance abuse or addiction an alternative to disciplinary action by State Medical Boards. These programs existed in almost every state by 1980. Often staffed by volunteer physicians and funded by the State Medical Society, these programs served the dual purpose of helping sick colleagues and protecting the public. Preferring rehabilitation to probation or license revocation so long as the public was protected from imminent danger, most medical boards accepted the concept with support and referrals. Most EAPs were developed with the collaboration of workers unions or some other group supporting the rights and interests of the workers. As there is no such organization for doctors, PHPs developed in the absence of regulation or oversight. […]

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  2. […] Although originally funded by medical societies and staffed by volunteer doctors in order to help sick colleagues and protect the public, any system can be subverted for profit and power, and these programs have been taken over by groups representing the multi-billion dollar drug and alcohol testing, assessment and treatment industry and become reservoirs of bad medicine and fraud. All manner of abuse can be hidden under a veil of benevolence. Although most are afraid to speak publicly under fear of punishment and retaliation (“swift and certain” consequences, summary suspension) I have herd from many many doctors in multiple states. Their stories are all the same. […]

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  3. I find it, amazing, that most agencies that are created to ‘SERVE people, end up CONTROLLING the people, they are intended to SERVE’… Unjust…

    In the 70’s, my own Dr. attempted suicide several times and finally succeeded… Even though I knew he had issues, it never crossed my mind to find a different Dr. …. He was human with issues/faults like anybody… In spite of his ‘humanity’, he was an awesome Dr.

    Accountability, should be paramount… You are doing a good thing by bringing this to public awareness… Have you thought about asking Erin Brockovich to assist in bringing this issue forward?… Just a thought…

    Liked by 1 person

    • Thanks Deb,

      Aldous Huxley said that the “surest way to work up a crusade in favor of some good cause is to promise people they will have a chance of maltreating someone. To be able to destroy with good conscience, to be able to behave badly and call your bad behavior ‘righteous indignation’—this is the height of psychological luxury, the most delicious of moral treats.” (Chrome Yellow 1921). It is no different here as it is the perfect funnel for sociopaths who have done horrendous things most doctors would never dream of doing ( stealing IV pain killers from dying cancer patients, selling industrial quantities of the date-rape drug to the DEA, pedophiles, etc–there are felons and double felons IN CHARGE of regular doctors. These sociopaths have gotten their licenses back by claiming “I’ve been saved” and the gullible regulatory agencies and board members BOUGHT IT and PUT THEM IN CHARGE!. The old ‘sweetheart” swindle. Well they naturally banded together and took over. That is what sociopaths do! And I will contact Erin Brokovich. We need all the help we can get. The mainstream medical bloggers won’t touch it.

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  4. Reblogged this on Disrupted Physician and commented:

    These ASAM “addiction experts” have become so numerous they have been able to take over almost all the state Physician Health Programs (PHPs). Their national association—the Federation of State Physician Health Programs (FSPHP)–has a stated goal of universal acceptance of the 12-step doctrine: lifelong abstinence, and spiritual recovery as the one and only treatment, as spelled out in the “PHP Blueprint.”

    Very much like Straight, Inc in the 70s and 80s, they have cast a wide net with doctors to ensnare them in an endless loop of drug testing and rehab—whether the tests are fabricated or not. The doctors will enjoy no sympathy from the public, and complaining about it is deemed a sign of your “disease.” Furthermore, ASAM recommends that physicians only be referred to “PHP approved” facilities.

    The medical directors of these facilities can all be found on this list of ”Like-Minded Docs.” Surprisingly, many Like-Minded Docs were former addicts and alcoholics, some even with criminal backgrounds. There are felons and even double-felons on the list.

    It’s a rehab shell game. Heads I win tails you lose.

    And the program is expanding. The organization that oversees the licensing for all medical doctors, the Federation of State Medical Boards, adopted a new policy and approved the concept of “potentially impairing illness” and the Orwellian notion of “relapse without use.”

    Signals for “impairment can be as benign as not having “complete accurate, and up-to-date patient medical records” according to Physician Health Services, the Massachusetts PHP. Despite the overwhelming amount of paperwork now have, incomplete or illegible records could be construed as a red flag, since as Associate Direct of PHS Judith Eaton notes “when something so necessary is not getting done, it is prudent to explore what else might be going on.” The question is, who is next?”

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