- Joined
- Oct 21, 2008
- Messages
- 2,869
- Reaction score
- 3,450
- Points
- 5,571
- Attending Physician
I’ve heard bad things about Acumen also. I think anyone involved in the PHP business is dirty, almost without exception.
Should I refuse FFDE?
- Thread starter TulaneUnderdog
- Start date
I’ve heard bad things about Acumen also. I think anyone involved in the PHP business is dirty, almost without exception.
- Joined
- Jun 24, 2014
- Messages
- 215
- Reaction score
- 250
- Points
- 4,816
- Resident [Any Field]
I want to tack on to that and say any 3rd party evaluator not designated as PHP-approved will likely have their final assessment of you disregarded by the PHP. I dont know if they specifically are approved or not but if they are what you say; they likely are PHP-affiliated. My PHP only recommended 4 or 5 evaluators they approve of across a 1000 mile span (ridiculous) and warned against going to anyone else.
Not that you shouldn’t - as I noted earlier in the thread before I waved the White flag, my lawyer encouraged to have my own private evaluation done. People just need to weigh risk:benefit of that and follow what their attorney suggests. At worst; it may put you up to a year out of work and you end up paying for 2 evaluations ($3000-$5000 times 2).
- Joined
- Oct 13, 2008
- Messages
- 7,443
- Reaction score
- 5,808
- Points
- 7,391
- Attending Physician
What have you heard that's "bad," exactly? There's a spectrum of things that could be "bad" about that sort of company and those factors matter to varying degrees.
Notwithstanding your aggro (which sounds appropriate), you sound like the ER patients that said "they didn't do anything" after labs, X-ray, and CT were all negative.
Do you ask for your money back after you don't win the lottery?
Or would you rather your labs were positive, so that your money wasn't "wasted"?
- Joined
- Jun 24, 2014
- Messages
- 215
- Reaction score
- 250
- Points
- 4,816
- Resident [Any Field]
Well; for one, those patients likely are covered for the $10,000 worth of labs, etc with many not paying a single dollar; meanwhile, I had to pay my $10,000 entirely out the pocket since Blue Cross Blue Shield wouldnt ever cover it. I guess they see the lack of evidence in it too. And its not the urine draws; I can live with that - its the follicle pulling and the blood phlebotomy that they dont even spread out monthly-quarterly; but do weekly biweekly which there’s no evidence for. And seem frivolous as these detect substances back 3-6mo so why make me overpay for that. There is no evidence, the insurance is right. Their pattern of draw isnt “random” but “pseudorandom” where I get a bolus of $1000 lab tests 4 times in one month of football season, then 2 months of none. A problem drinker can game this and they could punish this by actually randomizing Peths/UDS but they truly dont care.
I admit that Im that guy that orders all those blood counts and blood chems on patients on the daily and hearing from them every time that its wasteful. The difference is: I’m ordering a diabetic’s quarterly A1C (poor control), a vasculopath’s yearly lipids, an ESRDs weekly bicarb phos and K. weekly INRs on warfarin pts. Even alcoholic’s LFTs Mag and B12. See the difference now?
Last edited:
- Joined
- Jun 24, 2014
- Messages
- 215
- Reaction score
- 250
- Points
- 4,816
- Resident [Any Field]
Perhaps you'll get it if I put it this way; repeating someone's Peth a week later is like repeating a diabetic's A1C a week later.
I'm not sure about that, friend. And, at the same time, no matter how crazy or unsound it seems, it's part of playing the "game", even though it's no game to you. Truly, it sucks.
- Joined
- Jun 24, 2014
- Messages
- 215
- Reaction score
- 250
- Points
- 4,816
- Resident [Any Field]
So I've been getting a lot of DM's from people who are also in a similar situation where they are trapped under the yoke of their own state's PHP (which is sad to hear because I was hoping this kind of extortion is a rare event and wouldn't wish this to happen on even my worst enemy).
To protect their privacy especially since a lot of them are also pursuing to take their PHP to the legal arena and contest their evaluations; I will try to limit the specifics of their situation but also am getting the same DMs over and over so iIl post a FAQ. To the lurkers dealing with PHPs; sorry if I didnt dm back but you can easily reference this as it answers the 10 repeated questions I keep getting; apparently there are way more physicians (and residents) than I thought being victimized by the physician health scheme.
Most Common DMs/scenarios I hear from
folks trying to handle PHP/evals
1) Reacting a little too late.
Been getting DMs of "should I get an attorney now" after papers been signed, meetings with PHP been conducted accepting evaluations, and they already completed a full eval at PHP-affiliated facility . Lots of DMs come after the evaluation has been conducted and, of course, concluded with diagnosing them with a dx way worse than what they expected. Sure, get an attorney as its never a wrong answer but just know that on paper and on court, a DX given by a multi-disciplinary team of therapists, doctors, neurocognitive scientists, etc has a lot of weight. My situation was I hired an atty before I even approved of an evaluation; but even that felt a bit late to me - I shouldve done it right in the beginning; before I naively went to my PD whom I felt was such a good cop that I divulged my entire story to him. In hindsight, if I let the legal proceedings conclude first; then my case likely wouldve been dismissed and credits would have rolled right there
2) "I still know my rights ... I'm going to fight this to the end... take this to war"
You certainly have rights; first step is get an atty - not suggesting not to but ideally before you even sign papers, before you do an eval, and even before you meet with your employer or whoever initiated the Referral. But you need to do a full introspection on your situation and eliminate all of your own bias and emotion - an attorney can help do it for you. How egregious was the act that you are being accused of? And how much evidence is being used against you - is it all just hearsay and by mutliple witnesses? Who wrote the initial referral - your PD, your employer, the law, the Board? You need to realize that they will Err on public safety and general patient health no matter how innocent you are; and pull you out of work pending an evaluation/investigation/etc of whatever was alleged you did. Don't take it personal - this is the best window to get an attorney actually - don't meet with your boss or PHP yet to share your story. If you messaged me after the fact and signed paper with the PHP or whoever referred you; then the next best thing is to find your own evaluator - avoid a PHP-affiiliated one but find private ones; they can be as objective as possible to evaluate you. Your PHP will hate that but it still will give you evidence that favors you esp when it feels the world is against you. Sometimes your psych colleague can pitch a good addictionologist/evaluator who is private and done this before to evaluate you without any bias or conflict of interest.
3) "How rigged is the eval? I even see a psychiatrist who agrees; I have no substance use, psychosis, nor history of it at all!"
You will get a DX period. It's not a question of will you get dxed or not. It's a question of what kind of dx they will give you. You're the cleanest person in the world and in the evaluation all your tests checked negative; but drink socially - then you will get AUD, mild . You had done nothing wrong but you were prescribed adderall that you are taking appropriately and a nurse saw you appear intoxicated - then you will get dxed amphetamine use disorder and go inpatient where they will strip the ADHD dx off you even though you were given that as a child. You have the most perfect screenings at the evaluation and most perfect interview with nothing incriminating; then they will call people without your consent including the witnesses who reported you and if they said they saw you appearing paranoid at work and had tremors; then they will give you a Personality disorder that requires 6 weeks inpatient to resolve. Why would they do that? Because $$$$; you will be the easiest person to charge and they will use the "it's for the benefit of the patient population" excuse to err on overdiagnosing you and putting you inpatient. It's because all these PHP-approved evaluators have inpatient facilities conveniently attached to them that they can then shove you into afterwards and make an extra $50,000 off of you for.
4) “i am not doing what my PHP is asking of me… now they are threatening to report me to the Board… Let em!”
Ok… there are a few rare scenarios where taking this to the Board is ideal and your atty can comfirm if yours is one of them. Based on the scenarios Ive heard in my DMs; none of them would be ideal to take to the Board - the Board would publicly open an investigation and issue you a reprimand that will be open for the whole world to see. But there are times when a PHP is being unreasonable and escalating to the Board is the right way; you hopefully have already built yourself a strong enough defense before you make such a motion… which Ive already mentioned earlier.
5) “I ain't an addict, psycho, or alcoholic ... This is all gaslighting".
Yes I have been gaslighted. It hurts; being told that you have something that you know in your heart that you do not have. But unfortunately, in this world there are many healthcare professionals who say this too but actually have substance use disorders and are in denial… the two usually go together. I believe you ... but they won't. They will just pile you with them. Instead of just denying you have an addiction; channel that energy to build evidence to prove you dont. Show all your previous visits with Psychiatrists if you have gone to them; show all your residency evals or work records showing no reports of intoxications; and finally; go get an actual evaluation done. Preferably a facility that isnt tied to the PHP but still has neurocognitive and forensic-style testing including UDS , peth screening, personality testing, attention/memory tests, and psychiatrist interviews. That will be a lot of evidence to support you and would mimic that of a PHP approved one.
6) I’m now labelled non-compliant by my PHP, but idc, I am not a p*ssy b**ch, gonna appeal to board, skip deadlines, and im also gonna work anyway.
Don’t burn bridges with anyone … delay as much as you can but don’t get hit with “non-compliant” label if you can avoid it. The PHP is an extension of the board; don’t antagonize them. Limit communication with them - your atty will say to close all contact and let him speak for you. Being spiteful with them and missing deadlines will only be giving more fodder and evidence to PHP to claim you have some disorder they accusing you of. Also dont go to PHP-affiliated Evals but at least be somewhat compliant - its a general rule to not work while pending an evaluation, Please Do That! Comply halfway with PHP and dont give them any ammunition. I have to be honest - all the >15 or so DMs i get is everyone denying they have a personality or substance disorder but by statistics alone, at the very least one actually has one and in true Denial. I highly implore yall to put doctor ego aside and do a full self introspection with help of a neutral party like a therapist or psychiatrist. I have had one guy DMing who has disliked the dx an evaluator had given him so he went to a 3rd party unrelated evaluator but they too also ended up giving him the same dx. He wants to refute that as well and appeal again the 2nd time which leads to my final point
7) “I will never bend!! Even though my vacation weeks and PTOs have been exhausted a month ago; ive been unemployed and living off my last paycheck and my atty promises there will be a response from the board, eventually.”
My final advice is this: set a point in your head where you will wave the White Flag: do it before you even begin to do your eval, hire atty, etc - write it down if you have to because things can escalate fast and if you begin to be overzealous you need a reminder of the past to temper yourself. Its impossible to say how far you must contest the PHP because every case is different. And other big factors is how far along are you with PHP process, how close are you to graduating, and last but not least how secure is your financial state. Are you resident or attending, the latter means you can be more litigatious while the former is a lot more complex, because you now deal with not just PHP but Academic Affairs, If you are referred to PHP by your own residency’s PD then its best to be very compliant with PHP as to not jeopardize your graduation and PGY spot. A certain number of rotations will mean you may get held back a year; or worse. If you’re an attending; do you have disability insurance and does your program offer good PTO? These matter - if you want to take the heroic route and have your attorney escalate this, just know that this will become a very bureaucratic process with slow response times; upwards to a year. In my specific situation the moment I decided to comply with my PHP was when my attorney warned me he wants to take this to the board and it may sit on the boards desk for a loooooong time. So i refused, I wanted to graduate residency while only having 3mo left of training; be an attending; and finally put this behind me instead of staying a resident for 12 more month while my atty delays and delays and take this to war. If you're an attending you probably have more leeway; perhaps can delay and still work on side with a sly skillful enough attorney and hired him before you even signed papers. Finally when to wave a white flag is also dependent on how much evidence do they have on you. I would say after 1 or 2 incriminating evals confirming a dx of problem drinking, substance use disorder, etc; just take the knee as the odds are not in your favor any more. The Worst case scenario of isn't terrible - you gotta go inpatient… just go. I never went per my recs but during my 3day eval, I was alongside surgeons, NPs, and nurses who were locked in there for 6-12 weeks and they told me about it; some were appreciative - if you have good insurance, it should be a smaller copay; go to a place that allows phone privileges, pc priviliges, offers "day-off" passes, and has a more modern approach of teaching rather than an archaic religious one. For example UF offers bad evaluations I've heard but does have good inpatient.
To protect their privacy especially since a lot of them are also pursuing to take their PHP to the legal arena and contest their evaluations; I will try to limit the specifics of their situation but also am getting the same DMs over and over so iIl post a FAQ. To the lurkers dealing with PHPs; sorry if I didnt dm back but you can easily reference this as it answers the 10 repeated questions I keep getting; apparently there are way more physicians (and residents) than I thought being victimized by the physician health scheme.
Most Common DMs/scenarios I hear from
folks trying to handle PHP/evals
1) Reacting a little too late.
Been getting DMs of "should I get an attorney now" after papers been signed, meetings with PHP been conducted accepting evaluations, and they already completed a full eval at PHP-affiliated facility . Lots of DMs come after the evaluation has been conducted and, of course, concluded with diagnosing them with a dx way worse than what they expected. Sure, get an attorney as its never a wrong answer but just know that on paper and on court, a DX given by a multi-disciplinary team of therapists, doctors, neurocognitive scientists, etc has a lot of weight. My situation was I hired an atty before I even approved of an evaluation; but even that felt a bit late to me - I shouldve done it right in the beginning; before I naively went to my PD whom I felt was such a good cop that I divulged my entire story to him. In hindsight, if I let the legal proceedings conclude first; then my case likely wouldve been dismissed and credits would have rolled right there
2) "I still know my rights ... I'm going to fight this to the end... take this to war"
You certainly have rights; first step is get an atty - not suggesting not to but ideally before you even sign papers, before you do an eval, and even before you meet with your employer or whoever initiated the Referral. But you need to do a full introspection on your situation and eliminate all of your own bias and emotion - an attorney can help do it for you. How egregious was the act that you are being accused of? And how much evidence is being used against you - is it all just hearsay and by mutliple witnesses? Who wrote the initial referral - your PD, your employer, the law, the Board? You need to realize that they will Err on public safety and general patient health no matter how innocent you are; and pull you out of work pending an evaluation/investigation/etc of whatever was alleged you did. Don't take it personal - this is the best window to get an attorney actually - don't meet with your boss or PHP yet to share your story. If you messaged me after the fact and signed paper with the PHP or whoever referred you; then the next best thing is to find your own evaluator - avoid a PHP-affiiliated one but find private ones; they can be as objective as possible to evaluate you. Your PHP will hate that but it still will give you evidence that favors you esp when it feels the world is against you. Sometimes your psych colleague can pitch a good addictionologist/evaluator who is private and done this before to evaluate you without any bias or conflict of interest.
3) "How rigged is the eval? I even see a psychiatrist who agrees; I have no substance use, psychosis, nor history of it at all!"
You will get a DX period. It's not a question of will you get dxed or not. It's a question of what kind of dx they will give you. You're the cleanest person in the world and in the evaluation all your tests checked negative; but drink socially - then you will get AUD, mild . You had done nothing wrong but you were prescribed adderall that you are taking appropriately and a nurse saw you appear intoxicated - then you will get dxed amphetamine use disorder and go inpatient where they will strip the ADHD dx off you even though you were given that as a child. You have the most perfect screenings at the evaluation and most perfect interview with nothing incriminating; then they will call people without your consent including the witnesses who reported you and if they said they saw you appearing paranoid at work and had tremors; then they will give you a Personality disorder that requires 6 weeks inpatient to resolve. Why would they do that? Because $$$$; you will be the easiest person to charge and they will use the "it's for the benefit of the patient population" excuse to err on overdiagnosing you and putting you inpatient. It's because all these PHP-approved evaluators have inpatient facilities conveniently attached to them that they can then shove you into afterwards and make an extra $50,000 off of you for.
4) “i am not doing what my PHP is asking of me… now they are threatening to report me to the Board… Let em!”
Ok… there are a few rare scenarios where taking this to the Board is ideal and your atty can comfirm if yours is one of them. Based on the scenarios Ive heard in my DMs; none of them would be ideal to take to the Board - the Board would publicly open an investigation and issue you a reprimand that will be open for the whole world to see. But there are times when a PHP is being unreasonable and escalating to the Board is the right way; you hopefully have already built yourself a strong enough defense before you make such a motion… which Ive already mentioned earlier.
5) “I ain't an addict, psycho, or alcoholic ... This is all gaslighting".
Yes I have been gaslighted. It hurts; being told that you have something that you know in your heart that you do not have. But unfortunately, in this world there are many healthcare professionals who say this too but actually have substance use disorders and are in denial… the two usually go together. I believe you ... but they won't. They will just pile you with them. Instead of just denying you have an addiction; channel that energy to build evidence to prove you dont. Show all your previous visits with Psychiatrists if you have gone to them; show all your residency evals or work records showing no reports of intoxications; and finally; go get an actual evaluation done. Preferably a facility that isnt tied to the PHP but still has neurocognitive and forensic-style testing including UDS , peth screening, personality testing, attention/memory tests, and psychiatrist interviews. That will be a lot of evidence to support you and would mimic that of a PHP approved one.
6) I’m now labelled non-compliant by my PHP, but idc, I am not a p*ssy b**ch, gonna appeal to board, skip deadlines, and im also gonna work anyway.
Don’t burn bridges with anyone … delay as much as you can but don’t get hit with “non-compliant” label if you can avoid it. The PHP is an extension of the board; don’t antagonize them. Limit communication with them - your atty will say to close all contact and let him speak for you. Being spiteful with them and missing deadlines will only be giving more fodder and evidence to PHP to claim you have some disorder they accusing you of. Also dont go to PHP-affiliated Evals but at least be somewhat compliant - its a general rule to not work while pending an evaluation, Please Do That! Comply halfway with PHP and dont give them any ammunition. I have to be honest - all the >15 or so DMs i get is everyone denying they have a personality or substance disorder but by statistics alone, at the very least one actually has one and in true Denial. I highly implore yall to put doctor ego aside and do a full self introspection with help of a neutral party like a therapist or psychiatrist. I have had one guy DMing who has disliked the dx an evaluator had given him so he went to a 3rd party unrelated evaluator but they too also ended up giving him the same dx. He wants to refute that as well and appeal again the 2nd time which leads to my final point
7) “I will never bend!! Even though my vacation weeks and PTOs have been exhausted a month ago; ive been unemployed and living off my last paycheck and my atty promises there will be a response from the board, eventually.”
My final advice is this: set a point in your head where you will wave the White Flag: do it before you even begin to do your eval, hire atty, etc - write it down if you have to because things can escalate fast and if you begin to be overzealous you need a reminder of the past to temper yourself. Its impossible to say how far you must contest the PHP because every case is different. And other big factors is how far along are you with PHP process, how close are you to graduating, and last but not least how secure is your financial state. Are you resident or attending, the latter means you can be more litigatious while the former is a lot more complex, because you now deal with not just PHP but Academic Affairs, If you are referred to PHP by your own residency’s PD then its best to be very compliant with PHP as to not jeopardize your graduation and PGY spot. A certain number of rotations will mean you may get held back a year; or worse. If you’re an attending; do you have disability insurance and does your program offer good PTO? These matter - if you want to take the heroic route and have your attorney escalate this, just know that this will become a very bureaucratic process with slow response times; upwards to a year. In my specific situation the moment I decided to comply with my PHP was when my attorney warned me he wants to take this to the board and it may sit on the boards desk for a loooooong time. So i refused, I wanted to graduate residency while only having 3mo left of training; be an attending; and finally put this behind me instead of staying a resident for 12 more month while my atty delays and delays and take this to war. If you're an attending you probably have more leeway; perhaps can delay and still work on side with a sly skillful enough attorney and hired him before you even signed papers. Finally when to wave a white flag is also dependent on how much evidence do they have on you. I would say after 1 or 2 incriminating evals confirming a dx of problem drinking, substance use disorder, etc; just take the knee as the odds are not in your favor any more. The Worst case scenario of isn't terrible - you gotta go inpatient… just go. I never went per my recs but during my 3day eval, I was alongside surgeons, NPs, and nurses who were locked in there for 6-12 weeks and they told me about it; some were appreciative - if you have good insurance, it should be a smaller copay; go to a place that allows phone privileges, pc priviliges, offers "day-off" passes, and has a more modern approach of teaching rather than an archaic religious one. For example UF offers bad evaluations I've heard but does have good inpatient.
Last edited:
- Joined
- Oct 13, 2008
- Messages
- 7,443
- Reaction score
- 5,808
- Points
- 7,391
- Attending Physician
Just adding to this with the context of Tulane's update.
I was going to write more detail relating to the cases I saw that went to Acumen but then decided even obfuscating was still probably too detailed. The point I want to make, though, is that my experience was that Acumen focused more on behavioral patterns/personality vulnerability and development of insight and new ways of behavior in situations that push on those vulnerabilities. I don't recall new DSM diagnoses, although both did have DSM conditions that were largely unrelated to the behaviors that led to PHP involvement. (Neither was for substance use.)
