Should I refuse FFDE?

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I don't understand how it keeps coming up that since you have been compliant with PHP that the board is still unaware. I cannot imagine that the PHP is not going to forward the results of the FFDE, especially if negative.

Are there some states where PHPs have this sort of "autonomy" of dealing with physicians and it's only on a "need to know" basis they send things to the board?

My guess is that there is communication regardless, and if the PHP sends "non-compliant" that trigger some kind of review or license suspension? Automatically maybe until the board meets for review?

I know this is speculation, but the reality is that these things do in fact vary, and I think having a bird's eye view does help navigate the raft down the river.

For me, I'm not sure I would cooperate with a PHP against attorney advice because they might tattle on me to the board, because I can't imagine anything (especially damaging FFDE) with a PHP is going to be kept from them indefinitely.

Maybe the idea is if the FFDE comes back totally clean, then the board isn't notified?
 
This thing where choosing your own provider is too "biased" but the PHP can self refer for tens of thousands of dollars and that is somehow more "trustworthy" just STINKS and it is literally one of most infuriating things in the whole process to me.

It is beyond hypocritical. Not to mention, as a profession don't we maintain that generally any doc in good standing can be trusted to make medical decisions? Yet somehow a 3rd party physician's word counts for jack **** up against someone that stands to gain a whole lot more.

The option should be you get 2 opinions from doctors you choose, and the board has one they refer you to. That doesn't run one of these inpt programs.

There are plenty of docs in the community that can assess people JFC. I get that those folks may not have enough volume to run one of these centers, but I don't see why they can't refer.

It is crooked and stupid.
 
Crayola227 said:
This thing where choosing your own provider is too "biased" but the PHP can self refer for tens of thousands of dollars and that is somehow more "trustworthy" just STINKS and it is literally one of most infuriating things in the whole process to me.

It is beyond hypocritical. Not to mention, as a profession don't we maintain that generally any doc in good standing can be trusted to make medical decisions? Yet somehow a 3rd party physician's word counts for jack **** up against someone that stands to gain a whole lot more.

The option should be you get 2 opinions from doctors you choose, and the board has one they refer you to. That doesn't run one of these inpt programs.

There are plenty of docs in the community that can assess people JFC. I get that those folks may not have enough volume to run one of these centers, but I don't see why they can't refer.

It is crooked and stupid.
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You are preaching to the choir. Its very sus and if i could keep my $7000, I would instead of paying $7000 to be told I am an addict that will be fit for work post-treatment. I have analyzed all my options and I can delay this with my overzealous atty and end up out of a job for a year and my program expiring my training while i was t minus 3mo from graduating.

Yes PHP “shields” you from the board. As long as you are compliant, they actually will hide this from ever being reported. Yes the board will see the DUI but also see me listed under “compliant with PHP” so never open investigation

I truly trust FFDE process from as many anecdotes i got from graduates. I dont expect best case scenario that I am perfect and fit for work. They likely will call me an addict. To make more money. The most likely scenario is they will send me back to my program saying im only fit for work after treatment and years of urine ETG screens
 
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TulaneUnderdog said:
You are preaching to the choir. Its very sus and if i could keep my $7000, I would instead of paying $7000 to be told I am an addict that will be fit for work post-treatment. I have analyzed all my options and I can delay this with my overzealous atty and end up out of a job for a year and my program expiring my training while i was t minus 3mo from graduating.

Yes PHP “shields” you from the board. As long as you are compliant, they actually will hide this from ever being reported. Yes the board will see the DUI but also see me listed under “compliant with PHP” so never open investigation

I truly trust FFDE process from as many anecdotes i got from graduates. I dont expect best case scenario that I am perfect and fit for work. They likely will call me an addict. To make more money. The most likely scenario is they will send me back to my program saying im only fit for work after treatment and years of urine ETG screens
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This would make sense, but I guess I just wonder what you gain if the PHP says you need a bunch of treatment before you can work? Are you going to be able to work after the FFDE while getting "treated" by the FFDE? Any idea? How long will that take? Will it really take a year and be that hard for your attorney to establish it's a big nothing burger?

I mean finishing residency is number 1. It's just a shame because this is going to follow you around forever for the rest of your career. Not an ender, but it can be a hassle, costly, cost you some jobs if the wheels of licensing and credentialing take too long.

The last thing I will say then, is if you really think you can just work these last 3 months, yeah, it probably is worth it to finish the damn residency. If however the FFDE and PHP leads you to delay, then I will question why not do it the other way.

But I understand that it can be next to impossible to predict what everyone who has your fate in their hands is gonna decide and you do have to take your best guess and see where the chips fall.

Good luck. I know these choices are beyond hard.
 
There is one piece of advice from your attorney I would NOT blow off, and it makes sense to do it where you are now before any "treatment." Getting your own evals. I think this is crucial before you are too deep into this, to establish a "baseline." I think whatever degree of psychological "dysfunction" or substance abuse, you want documentated by a 3rd party not set to character assassinate you.

My thoughts are this. This IS based on experience. You want to establish how you are doing/have done now and before all this **** show and the PHP. Effectively, what are you like, how impaired, how ****ed up, before supervision and treatment were started? Because if you wait until you jump through all these hoops, and it goes to a board or other entity, the question will always be, "we have no idea what you were like and how safe you were or how bad your MH/SUD were before we (PHP or board) got involved, all we know if what you are like with us up your ass, so ergo the safest thing is for us to be up your ass almost forever."

Having the baseline of what you are like BEFORE intervention, creates a sort of "worst case scenario" and if it isn’t that bad and you prove yourself trustworthy going forward, that can make a case for yourself in the future of needing little to any continued monitoring.

But two things. You probably want some of the data for this "baseline" not to purely come from the PHP. Also you have more data points to provide. Also you get to offer what is hopefully a balancing opinion.

Pursuing your own eval and treatment, which can be seen as a form of taking responsibility (boards like to see this) can only really help you unless the parties you involve have something more damaging to say than the PHP which is unlikely.

It is interesting that this doesn't go to the board. Would that be true if they found you were a big danger before now and/or they thought you needed intensive/inpt tx?

It won't matter, because ultimately anything like this is considered part of your medical record. And most other states the license/credentialing process will expect you to narc on yourself about much of this and will be impossible to hide, you will have to honestly check boxes that will almost certainly request all this info which will be part of your medical records.

As said, this is all worth it to finish residency and be board eligible. That said, I see no reason not to add some favorable or objective data points to your record.

Seriously, why are you not interested in pursuing your own evals? I can't see how it can really make this worse. And I explained how it might help. I can see money being an issue, but you already brought up medical insurance.

Which could lead me to another totally intense topic about coverage and PHPs.

Even if it isn’t covered, the costs of your own evals in the sake of the life of your career, is probably worth it.
 
Crayola227 said:
There is one piece of advice from your attorney I would NOT blow off, and it makes sense to do it where you are now before any "treatment." Getting your own evals. I think this is crucial before you are too deep into this, to establish a "baseline." I think whatever degree of psychological "dysfunction" or substance abuse, you want documentated by a 3rd party not set to character assassinate you.

My thoughts are this. This IS based on experience. You want to establish how you are doing/have done now and before all this **** show and the PHP. Effectively, what are you like, how impaired, how ****ed up, before supervision and treatment were started? Because if you wait until you jump through all these hoops, and it goes to a board or other entity, the question will always be, "we have no idea what you were like and how safe you were or how bad your MH/SUD were before we (PHP or board) got involved, all we know if what you are like with us up your ass, so ergo the safest thing is for us to be up your ass almost forever."

Having the baseline of what you are like BEFORE intervention, creates a sort of "worst case scenario" and if it isn’t that bad and you prove yourself trustworthy going forward, that can make a case for yourself in the future of needing little to any continued monitoring.

But two things. You probably want some of the data for this "baseline" not to purely come from the PHP. Also you have more data points to provide. Also you get to offer what is hopefully a balancing opinion.

Pursuing your own eval and treatment, which can be seen as a form of taking responsibility (boards like to see this) can only really help you unless the parties you involve have something more damaging to say than the PHP which is unlikely.

It is interesting that this doesn't go to the board. Would that be true if they found you were a big danger before now and/or they thought you needed intensive/inpt tx?

It won't matter, because ultimately anything like this is considered part of your medical record. And most other states the license/credentialing process will expect you to narc on yourself about much of this and will be impossible to hide, you will have to honestly check boxes that will almost certainly request all this info which will be part of your medical records.

As said, this is all worth it to finish residency and be board eligible. That said, I see no reason not to add some favorable or objective data points to your record.

Seriously, why are you not interested in pursuing your own evals? I can't see how it can really make this worse. And I explained how it might help. I can see money being an issue, but you already brought up medical insurance.

Which could lead me to another totally intense topic about coverage and PHPs.

Even if it isn’t covered, the costs of your own evals in the sake of the life of your career, is probably worth it.
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ya i agree; its just double the costs and kind of redundant to 2nd eval to double dip the first. But to your point, it buffers my 1st eval and can counter it which it can save my life and protect me a lot if i get hit by a crippling FFDE. Im still looking for cheap addictionologists - I won’t dismiss it completely. Obviously if im truly paranoid of UF results, i should do it absolutely. I have surreptitiously taken the tests from previous grads and kind of know what i will get. UF is as neutral as they can be; they are only motivated to find impaired doctors that they can treat and monetize and not motivated to hit them with unfit and destroy their careers, their reviews, and their reputation as the “facility to assimilate impaired professionals back into society”. They will Peth my blood (looking for drinking up to an entire month) and hair follicle me (up to 6mo) and add the DUI (even dismissed) to DSM criteria. They will psychoanalyze me to admit to more drinking (hey you were 0.06 on BAC, you werent just sipping beer) to build more to criteria. They may try to bait tears and anger to build more to other personality traits/depression/clusterB. Ive studied this thoroughly, they will hit me with an ICD code but it benefits them and their wallet to get me fit for duty “as long as he does treatment” (in our programs).

Yes i can end up working while under treatment depending on their Dx. If I am “mild alcohol
use disorder”, I have to do IOP (intense outpatient treatment) so it will be night classes while working (zoom into their virtual classes, therapist, and their assignments). The DUI alone hits more than mild however so I will assume they hit me moderate.
 
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TulaneUnderdog said:
ya i agree; its just double the costs and kind of redundant to 2nd eval to double dip the first. But to your point, it buffers my 1st eval and can counter it which it can save my life and protect me a lot if i get hit by a crippling FFDE. Im still looking for cheap addictionologists - I won’t dismiss it completely. Obviously if im truly paranoid of UF results, i should do it absolutely. I have surreptitiously taken the tests from previous grads and kind of know what i will get. UF is as neutral as they can be; they are only motivated to find impaired doctors that they can treat and monetize and not motivated to hit them with unfit and destroy their careers, their reviews, and their reputation as the “facility to assimilate impaired professionals back into society”. They will Peth my blood (looking for drinking up to an entire month) and hair follicle me (up to 6mo) and add the DUI (even dismissed) to DSM criteria. They will psychoanalyze me to admit to more drinking (hey you were 0.06 on BAC, you werent just sipping beer) to build more to criteria. They may try to bait tears and anger to build more to other personality traits/depression/clusterB. Ive studied this thoroughly, they will hit me with an ICD code but it benefits them and their wallet to get me fit for duty “as long as he does treatment” (in our programs).

Yes i can end up working while under treatment depending on their Dx. If I am “mild alcohol
use disorder”, I have to do IOP (intense outpatient treatment) so it will be night classes while working (zoom into their virtual classes, therapist, and their assignments). The DUI alone hits more than mild however so I will assume they hit me moderate.
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Mmm yeah I can understand not redoing the FFDE, that might be redundant.

I don't know much about addictionologists. If you get a psychiatrist to refer you, would insurance cover it? As you can probably tell I'm all about learning more about these systems.

I also wonder what if any value there is to just having a psychiatrist eval you? That should almost certainly be covered. But if the atty is rec'ing the more specialized eval I would guess that has more utility.

Just an idea though, to get in with a psychiatrist anyway. If it's covered or cheap... hard to say how much it counts for. But might not hurt.
 
TulaneUnderdog said:
Ive listened to my attorney every step of the way to this point. He still can work with me but no gaurantees. No i didnt prepare funds for that. But getting back to work means i now get paid so i can gather it with time. i aint an attending. my insurance should help out a bit here ☠️ .


I technically do not work for my hospital but for my residency. Like a contractor in the hospital. And my program says to follow PHP and they say they only take the eval centers they recommend nowhere else; they believe there is biases favoring me if i do it from my own hospital. Yet they refuse other addiction centers across the state too :/. Very out of control indeed. The residency crap makes this situation more complex
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Just have to say, kudos to you for recognizing your situation for what it is--that your program really has you over the barrel here. Yes what is happening to you is unfair, but I don't think there is any other option available to you that makes it more likely that you get to graduate residency.

Good luck.
 
It's probably too late for you, the following advice which is the best advice I can ever give a physician who has any whiff of mental health issues or SUD.

If you go to another state one day and they do reduce your monitoring burden, maybe take this on yourself.

If you have MH/SUD issues, be sure you are proactively establishing a relationship with a good psychiatrist of your own choosing. There are often a couple who are known for working with physicians. They may have a good relationship with the board.

Should anything go south and the board starts digging into you (even a disgruntled patient report can do this), this data and this relationship can do a lot to help you. It's better than if you don't have it.

Physicians often go without treatment because they don’t want to check certain boxes on apps. That can majorly backfire. There are strategies for getting care mostly under the radar, but then having this relationship help you if **** hits a fan.

Rule of thumb, it's hospitalizations for your issues you don't want. I've seen several state licensing apps where that is specifically asked about, and I've read bylaws of different state boards regarding this. Some states use this as their yardstick if your MH issues rise above a certain level of severity they think requires more of their attention.

If you need to be hospitalized, do it, of course.

Psychiatrists are themselves a non-PHP protection for patients as well. They are mandatory reporters if they think someone is in iminent danger, so that would be true of a physician who as a result of MH is a danger to patients, despite confidentiality laws. This can really freak some doctors out from receiving care.

This is something for you to discuss with your psychiatrist and be upfront about, and be honest with them, because... The key for you and the psychiatrist, would be for you to take a voluntary leave of absence before things get that far, if you two can see it coming. In that case there is nothing to report to the board. This is how a couple psychiatrists explained to me how they handle it. Just make sure they have a similar philosophy. Voluntarily putting yourself into this kind of care is good. This requires trust on your part, and also your psychiatrist's trust. It's only going to work though if you have the presence of mind to heed their call before things get really bad.

And wouldn't you rather the psych you picked and trusted being the one to tell you to stay home and figure your **** out before you're actually in real trouble, than have it be the board and a PHP??

Franky it isn't bad for physicians with MH and SUD disorders to have someone they are held accountable to, and it's best if you do that on your own than have someone make you.

Don't let the change in culture towards MH/SUD make you lax or think you'll wait until there's trouble. Too late by then. These things don't aren't have the same stigma they once did overall, but it only means so much to the board. You have to be accountable.

If you are a doc with MH/SUD the best advice I can give you for keeping anyone off your back, is to be proactive. It can prevent trouble and help you after.
 
Apollyon said:
That's highly unlikely.
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You're right in that I have heard of docs doing all the right things and moving to a new state and having to start all the way over. I don't know how common that is compared to any clemency.

It's a small hope but one worth striving for. People involved in the process have told me it's the best hope to ever get the board out of your ass and to ever reduce monitoring if you go out of state. I was told in some cases it can help and I've heard stories.

Below, many physicians continued going to 12 step programs after "completing." Presumably the population in the paper had real issues they needed addressed, and this is probably reflected in the sheer number continuing 12 step on their own.

Physician Views Regarding Substance Use-Related Participation in a State Physician Health Program - PMC

Physician Health Programs (PHPs) safeguard the public by monitoring impaired physicians, but participation is not always voluntary, and many physicians resist referral. In this study, 80 physicians (85.1% male) who were referred to a state PHP for ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov

This guy also claims being able to get long standing controlled issues dismissed by the board (no PHP) after submission of relevant facts, in Texas. But that would obviously only work if you had such facts to present.

(Shockingly he suggests he gets DWIs thrown out... it would be one thing if it was like OP's situation where the DWI was legally dismissed, but I would be surprised if the charge stuck and he could get the board to just dismiss it. You wonder if the attorney is overstating his successes, vs wtf is going on in TX.)

www.txmedicallicensinglaw.com

Inappropriate Referrals to the Texas Physician Health Program

Since its inception several years ago, the Texas Physician Health Program has provided a valuable option for physicians suffering from chemical
www.txmedicallicensinglaw.com www.txmedicallicensinglaw.com

@TulaneUnderdog check out the above link. Did your attorney have any hope of a quick informal resolution with the board, or is it generally a drawn out ****show if you have to wait for a board meeting? Or the only real way to handle it in FL is PHP and leave the board out of it? I'm just curious what if anything is the "norm" there. I knew a resident who got a DUI in FL as as a senior specifically, and went on to pratice, but I never got the rest of the story or how it worked out going to a new job they had lined up out of state. I know because of residency you're pretty much stuck with your current path.
 
Crayola227 said:
You're right in that I have heard of docs doing all the right things and moving to a new state and having to start all the way over. I don't know how common that is compared to any clemency.

It's a small hope but one worth striving for. People involved in the process have told me it's the best hope to ever get the board out of your ass and to ever reduce monitoring if you go out of state. I was told in some cases it can help and I've heard stories.

Below, many physicians continued going to 12 step programs after "completing." Presumably the population in the paper had real issues they needed addressed, and this is probably reflected in the sheer number continuing 12 step on their own.

Physician Views Regarding Substance Use-Related Participation in a State Physician Health Program - PMC

Physician Health Programs (PHPs) safeguard the public by monitoring impaired physicians, but participation is not always voluntary, and many physicians resist referral. In this study, 80 physicians (85.1% male) who were referred to a state PHP for ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov

This guy also claims being able to get long standing controlled issues dismissed by the board (no PHP) after submission of relevant facts, in Texas. But that would obviously only work if you had such facts to present.

(Shockingly he suggests he gets DWIs thrown out... it would be one thing if it was like OP's situation where the DWI was legally dismissed, but I would be surprised if the charge stuck and he could get the board to just dismiss it. You wonder if the attorney is overstating his successes, vs wtf is going on in TX.)

www.txmedicallicensinglaw.com

Inappropriate Referrals to the Texas Physician Health Program

Since its inception several years ago, the Texas Physician Health Program has provided a valuable option for physicians suffering from chemical
www.txmedicallicensinglaw.com www.txmedicallicensinglaw.com

@TulaneUnderdog check out the above link. Did your attorney have any hope of a quick informal resolution with the board, or is it generally a drawn out ****show if you have to wait for a board meeting? Or the only real way to handle it in FL is PHP and leave the board out of it? I'm just curious what if anything is the "norm" there. I knew a resident who got a DUI in FL as as a senior specifically, and went on to pratice, but I never got the rest of the story or how it worked out going to a new job they had lined up out of state. I know because of residency you're pretty much stuck with your current path.
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Drawn out **** show. Wont graduate prolly in the next year if investigation opens at Board. Not that it is complex or they find me guilty; but that they will be sipping their coffee as it sits on their desk X months with time as their luxury. Time is not so much a luxury for me. These are not criminal matters; its a privilege so it does not be regulated under the due process like a criminal matter would (i.e. my dui)

I like your first link: those outcomes for those evaluees are very uplifting even despite the 5-year drug tests and AA. From as far as what my former graduate told me; they dont UDS weekly for an entire 5 years, it starts initially then spreads out to monthly. Punishment for +UDS he was told would be repeating the same process all over again (FFDE -> treatment with relapse focus) but varies case by case and drugs involved. In that sudy, Im surprised there was little % of anger or negative feedback about it - too low so i bet there is selection bias or participation bias. Regardless of that, it is consistent with the personal stories i collected; and Id say it correlates with our states outcomes. No one truly gets hit with “unfit”. I bet UF Gainesville was an eval option for them as it is for us.
 
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TulaneUnderdog said:
Drawn out **** show. Wont graduate prolly in the next year if investigation opens at Board. Not that it is complex or they find me guilty; but that they will be sipping their coffee as it sits on their desk X months with time as their luxury. Time is not so much a luxury for me. These are not criminal matters; its a privilege so it does not be regulated under the due process like a criminal matter would (i.e. my dui)

I like your first link: those outcomes for those evaluees are very uplifting even despite the 5-year drug tests and AA. From as far as what my former graduate told me; they dont UDS weekly for an entire 5 years, it starts initially then spreads out to monthly. Punishment for +UDS he was told would be repeating the same process all over again (FFDE -> treatment with relapse focus) but varies case by case and drugs involved Im surprised there was little % of anger or negative feedback about it - too low so i bet there is selection bias or participation bias. Regardless of that, it is consistent with the personal stories i collected; and Id say it correlates with our states outcomes. No one truly gets hit with “unfit”. I bet UF Gainesville was an eval option for them as it is for us.
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So with the UDS, it's random and they are expecting zero for alcohol? I'm just wondering if this means no social drinking ever? They want to test you at 6 pm on Saturday your day off, is there going to be an issue?

Or are they just checking you're not >0 at work and nothing nonprescription in your pee?
 
Crayola227 said:
So with the UDS, it's random and they are expecting zero for alcohol? I'm just wondering if this means no social drinking ever? They want to test you at 6 pm on Saturday your day off, is there going to be an issue?

Or are they just checking you're not >0 at work and nothing nonprescription in your pee?
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Yup undetectable. Pretty much sobriety. And UDS includes Urine ETG - which stays longer. It detects drinking back to 72h. So thats why they sneak it after weekend.
 
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TulaneUnderdog said:
Yup undetectable. Pretty much sobriety. And UDS includes Urine ETG - which stays longer. It detects drinking back to 72h. So thats why they sneak it after weekend.
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Dude, you need to change the mindset. "Sneak it"? No, it's whenever they say you need to come in.
 
TulaneUnderdog said:
Sorry sneak in the context that on Monday morning the etg will catch all weekend behavior with 72h coverage.
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You mean sneak it as in, they test on Monday to catch any weekend stuff?

Or you're saying guys you've talked to mentioned this?

I'm giving you benefit of the doubt you don't mean you, you already seemed to understand you're going to have to fly straight for a long time.

Now that you're in the vice the worst thing that could happen to you is a failing a UDS.
 
Just completed my eval; dreading my result. The neurocognitive was the worst part: giving me memory tests to recall a string of words 30min later. Block patterns. Redrawing a complex image after seeing it for just 5 seconds. IQ exam. Talking to a social worker, psychiatrist, therapist, and phd psychologist. They called my PHP and god knows how much they had torn on me in that convo begging them to squeeze a dx out of me. The other evaluees with me was a PA sent by Idaho board for DUI and surgeon sent by Arizona PHP for failing 5-year urine monitoring for ETG on the final 6 months left. They admitted him in-patient.
 
Update 2: My PD just got pre-emptive call today and was told they dont think I meet severe nor moderate etoh use d/o! They also called him to ask if he really was letting me currently work. Also inquired why would he do that against PHP recs and the boss said “absolutely, he hasnt acted up ever on-shift so why wouldn’t I!?!?”. What a F**** bro! The final recs are still pending the labs, likely my hair and nails.
 
TulaneUnderdog said:
Update 2: My PD just got pre-emptive call today and was told they dont think I meet severe nor moderate etoh use d/o! They also called him to ask if he really was letting me currently work. Also inquired why would he do that against PHP recs and the boss said “absolutely, he hasnt acted up ever on-shift so why wouldn’t I!?!?”. What a F**** bro! The final recs are still pending the labs, likely my hair and nails.
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Plot twist: your PD now gets a fitness for duty eval for not doing what the PHP wants 😉
 
HemeOncHopeful19 said:
Plot twist: your PD now gets a fitness for duty eval for not doing what the PHP wants 😉
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Final recs by my evaluators:

Dx: provisional ETOH use d/o

1) Fit for duty for work w/o inpatient treatment immediately upon signing contract
2) Complete IOP : its Outpatient classes (3x a week nightly after work) for 6 weeks
3) 2-year drug monitoring

Able to report no disciplinary action or substance use publicly while under php protection. Can call my initial leave of absence as “medical”
 
TulaneUnderdog said:
Final recs by my evaluators:

Dx: provisional ETOH use d/o

1) Fit for duty for work w/o inpatient treatment immediately upon signing contract
2) Complete IOP : its Outpatient classes (3x a week nightly after work) for 6 weeks
3) 2-year drug monitoring

Able to report no disciplinary action or substance use publicly while under php protection. Can call my initial leave of absence as “medical”
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This sounds like a very positive outcome. Not complete exoneration, but probably the best you could expect from this process I would think. IMO. Good luck to you OP and it pretty much goes without saying but your record needs to be squeaky clean from here.
 
mistafab said:
This was best possible outcome for you. Glad to hear you can make it through without exploitation or excessive monitoring.

From a population protection perspective, this was a safe a reasonable move for the FFDE with a concern of impaired physician.

Please keep us posted!
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Yes bittersweet. It was one tier away from what I wanted but its many tiers away from much worse outcomes. I am just glad to work so Ill take whatever I can get, and learn to not f**k with the board nor with my life/professional career. The evaluees in those 3 dreaded days were taunting me and saying to keep my belongings here because Ill be admitted to stay. So I shouldnt complain - ill take the alcoholic title and work the 2 years to get that brand off
 
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TulaneUnderdog said:
Final recs by my evaluators:

Dx: provisional ETOH use d/o

1) Fit for duty for work w/o inpatient treatment immediately upon signing contract
2) Complete IOP : its Outpatient classes (3x a week nightly after work) for 6 weeks
3) 2-year drug monitoring

Able to report no disciplinary action or substance use publicly while under php protection. Can call my initial leave of absence as “medical”
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Is this from the POV of the Florida medical board? Just curious. I would think regardless you would need to report all this if you apply elsewhere.

Just really glad for you that you didn't get a legal DUI, and you get to graduate your program. 2 years is getting let off pretty easy for these sorts of tales. I've heard Florida is more reasonable than a lot of states.

Good luck man. Thanks for bringing your story here and updating, it's really helpful.
 
Crayola227 said:
Is this from the POV of the Florida medical board? Just curious. I would think regardless you would need to report all this if you apply elsewhere.

Just really glad for you that you didn't get a legal DUI, and you get to graduate your program. 2 years is getting let off pretty easy for these sorts of tales. I've heard Florida is more reasonable than a lot of states.

Good luck man. Thanks for bringing your story here and updating, it's really helpful.
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I have no doubt they called my PHP and discussed together what is the most appropriate recommendations at the end. Im glad i paid more for a more objective eval; I dont believe im an alcoholic but thats what an alcoholic would say; in the end they were great listeners and agreed with all my truthful statements without Polygraphing me (never a lone drinker, never take “eye-opening” shots, never on work days, drink 2-3 monthly and in social occasions and never a binge). They had the power to bend me over and fling me inpatient but were judicious and understanding enough to lighten the sentence and give me 0 inpatient. Also they right - “you drank and drove, knowing the consequence”. I will serve my 2 years time to dispel it; just more red bull on the rocks to order at the bar and now I will be perfect DD for my SO for next 2 years.
 
TulaneUnderdog said:
Final recs by my evaluators:

Dx: provisional ETOH use d/o

1) Fit for duty for work w/o inpatient treatment immediately upon signing contract
2) Complete IOP : its Outpatient classes (3x a week nightly after work) for 6 weeks
3) 2-year drug monitoring

Able to report no disciplinary action or substance use publicly while under php protection. Can call my initial leave of absence as “medical”
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Surprisingly reasonable. Probably one of the most reasonable outcomes I’ve heard of coming out of a PHP FFDE.

A lot of docs who go through this process end up with something way worse than this.
 
I had limited options for evals. Only 5 programs given to me across 4 states but if I could rewind, id still choose the FL one. Dr. T was a former addict and can sniff bull**** with low threshold to polygraph me if I was lying. Its scary that they have the ability to polygraph. They can get anyone to admit out of nervousness to drinking more than they should, not stopping after a limit, and having poor judgment harkening back to their college days and that alone hits 3-4 DSM criteria to be moderate AUD. They were Merciful for sure. I think the dude liked me because I wasnt in complete denial that I was foolhardy that night, had some humility and admitted I made a huge mistake that no doc should do. That alone shows how biased and arbitrary their recommendations can be with the ability to hit you with $50,000 worth of treatment in just a snap.
 
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TulaneUnderdog said:
I had limited options for evals. Only 5 programs given to me across 4 states but if I could rewind, id still choose the FL one. Dr. T was a former addict and can sniff bull**** with low threshold to polygraph me if I was lying. Its scary that they have the ability to polygraph. They can get anyone to admit out of nervousness to drinking more than they should, not stopping after a limit, and having poor judgment harkening back to their college days and that alone hits 3-4 DSM criteria to be moderate AUD. They were Merciful for sure. I think the dude liked me because I wasnt in complete denial that I was foolhardy that night, had some humility and admitted I made a huge mistake that no doc should do. That alone shows how biased and arbitrary their recommendations can be with the ability to hit you with $50,000 worth of treatment in just a snap.
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Study after study has demonstrated that polygraph results are garbage. Not accurate, not consistent, and it’s fairly easy to “beat” a polygraph test in different ways. It’s astonishing to me that they’re even allowed to use unscientific nonsense like polygraphs, Rorschach testing, etc in these evaluations.
 
TulaneUnderdog said:
I dont believe im an alcoholic but thats what an alcoholic would say
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I have two physician patients who both underwent comprehensive FFDE's like you did recently. And what stands out in their reports--and the reason they had more extensive monitoring/treatment recommended--was a lack of insight. Which you also displayed by your insistent legalistic rationalization that you weren't driving drunk because your blood BAC, likely collected after hours of delay (metabolism), was just under the legal limit. At the time you were stopped, you were most likely legally impaired and actually impaired.
 
3-mo update. Now graduated and just doing prn nocturnist shifts. Great and all but having random days to select for drug screens makes it tricky as nocturnist but i shut my mouth. I know not to complain as Ive learned to not f*** with the board so I just leave with scrubs on in the am straight to
the Labcorps and get draw them on my way home. Last 4 weeks was most frequent of random screens: urine (ETG x2, monday and wednesday) and blood test (Peth level on a monday) and whats cheeky is they did the ETG wednesday on same week as Peth I guess to see if I would celebrate. Anyways, a small price to pay to keep career; so far so good.
 
FlowRate said:
I have two physician patients who both underwent comprehensive FFDE's like you did recently. And what stands out in their reports--and the reason they had more extensive monitoring/treatment recommended--was a lack of insight. Which you also displayed by your insistent legalistic rationalization that you weren't driving drunk because your blood BAC, likely collected after hours of delay (metabolism), was just under the legal limit. At the time you were stopped, you were most likely legally impaired and actually impaired.
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I will say this now nearly 6mo out from FFDE, clean drug screens (so far), and s/p 6 months of therapy to suspend my denial: I did not drive impaired, not legally (as determined by the US District Court) and not actually. The DA are not idiots; they reverse extrapolate BAC for those who play delay tactics. The adjust from time of serum back to time of arrest. +0.01 per hour delayed. We doctors are not the only professionals who smell Bullspunk from clients. Esp in this wet state of countless lives lost yearly to drunks; attorneys will exact justice towards true DUI convicts and get the truth. I was below the legal limit based on both actual value and extrapolated value. Now for Field test; no sign of failure on video. Hence my dismissed charges, I was completely acquitted without even a court date; charges were No-Billed; no PTI or plea bargain required.

Am I completely exonerated? No. But let me ask you this: does everyone who commit a DUI have an ETOH use d/o? Yes or no. There is a significant portion surely. How about those completely acquitted of DUI? How about those who drank then drove but blew 0.01? Or 0.02? So, does everyone who commit a DUI need a substance use eval? I will go with “Yes” esp those in fields where the lives of others are in jeopardy (pilots, military, docs, lawyers). Ive entered FFDE for that against all my legal counsel because Ive held that conviction - and Ill divulge to you the truth whether you believe it or not esp now that this matter has now been settled months ago, and legal and academic proceedings have all been concluded and written in stone. I like to drink, I drink 2-3 equivalents, it happens usually on my social events, I dont like to on my workdays, not even nights off before work because I cant stand the hangover, I dont take an eye opener, and I dont ever drink alone, I cant recall the last time i ever was sloshed or blackout drunk, prolly some moment in med school after an anatomy test or something years ago. So I drink about 2x a month on the night before a day off or a resident social. So take that however way you want and reference your DSM manual if you want to determine my dx.
 
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TulaneUnderdog said:
But let me ask you this: does everyone who commit a DUI have an ETOH use d/o? Yes or no. There is a significant portion surely. How about those completely acquitted of DUI? How about those who drank then drove but blew 0.01? Or 0.02? So, does everyone who commit a DUI need a substance use eval? I will go with “Yes” esp those in fields where the lives of others are in jeopardy (pilots, military, docs, lawyers).
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If you are acquitted then by definition you are literally innocent of DUI.

I do not think people who are arrested for alleged crimes they did not actually commit should be forced to undergo further scrutiny than what the court system already puts them through.

I think society would be better served by enacting and enforcing actual punishments for those that are convicted of DUI rather than forcing physicians who are arrested of DUI but found innocent to pay a doctor tax to some PHP system for additional evaluation. Everybody who gets behind the wheel of a car is in a situation where the lives of others could be in jeopardy.
 
The legal system has a relatively high bar for conviction. It's not unreasonable to use a lower bar to get people help / assessment before something bad happens. That said, I agree that the PHP system in some jurisdictions seems completely out of control and without any checks and balances, which is wrong. So the process needs to be fixed, not removed completely.

A separate issue is the normalization of "drinking some but staying under the limit" and driving home. The difference between a BAC of 0.07 and 0.08 on driving impairment is probably small, yet one is legal and one is not. That's the nature of a legal system, where someone needs to define cutoff level of normal/abnormal.
 
Here is one case I would really have liked to read the resolution of. I hope TU is still alive, sadder but wiser. And that he comes back to finish the story. A lot of truths have been shared here, so am glad I found this thread. For anyone who likes reading horror stories (it IS nearly Oct 31), see a book just released entitled "Disrupted Physician" by Dr. Anne L Phelan. As helpful as PHPs MIGHT be for those who actually have SUD, they are notorious for finding that diagnosis in almost anyone who ends up in their clutches. And (although they would never admit this), they suggest preferred "Evaluation and Treatment Centers" on the basis of their willingness to find a diagnosis the PHP is looking for. FRC is one of the worst for this. NONE of them has any interest in helping with other issues, in fact physicians have suicided because their actual problems are dismissed and legitimately prescribed, longstanding and sometimes life preserving treatment even suspended so as not to interfere with longerm invasive monitoring. Best of luck to the Underdog, wherever he ended up (possibly under a bus).
 
NotAProgDirector said:
It's a slightly positive sign that they let you pick your FFDE site. The worst states have a single provider, you get no choice at all, and ultimately everyone ends up being referred for a 90 day stay. It's a huge financial COI.

It sounds like your atty was successful with that other person. But, they lost their cards fellowship. Not great, but their career continues. if you lose your residency spot, it's completely unknown whether you'll be able to get another one / complete training. So the risk in your situation is much higher.

But as others have mentioned, this could easily turn into a 90 day stay. And if that happens, your residency may drop you anyway since that would extend your training into the next academic year.

So get input from your atty and PD, and try to make the best decision you can. Understanding that it could end badly no matter what you choose.
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Most PHPs have now realized that the appearance of COI is even greater when they mandate one particular "preferred Evaluation and Treatment" Center, so they are typically offering several. But ALL "preferred centers" have COIs. They will not receive further referrals from this rather exclusive (typically deep pocketed) cash-pay-only patient stream unless they issue diagnoses that are to the PHPs' liking (those that require followup with local providers and preferably extensive drug monitoring). Some referees have even been told by such centers (when it was ultimately impossible to justify a diagnosis of SUD): "Well, we have to give you a diagnosis, so we'll call it a Personality Disorder." This is precisely what happened to Dr. Usman in the Doctors' Crossing Episode mentioned previously https://doctorscrossing.com/wp-content/uploads/2022/07/Episode-089-Transcript.pdf

What legitimate provider ever "HAS to give a diagnosis", to the extent that they will make one up? This is diagnosis rigging, "Diagnosing for Dollars", and pandering for future referrals. And it's malpractice if any injury results, and false claims/fraud if any insurer is asked to pay any part of it.
 
TulaneUnderdog said:
Final recs by my evaluators:

Dx: provisional ETOH use d/o

1) Fit for duty for work w/o inpatient treatment immediately upon signing contract
2) Complete IOP : its Outpatient classes (3x a week nightly after work) for 6 weeks
3) 2-year drug monitoring

Able to report no disciplinary action or substance use publicly while under php protection. Can call my initial leave of absence as “medical”
Click to expand...
Very happy to hear you had a good outcome! Would you be able to give me some advice? I am facing a similar situation.
 
12-mo update. Still in compliance with the PHP; have had so many labs and charges done that when doing taxes, there is >$15,000 spent in “medical expense” that is out-of-pocket in addition to my insurance for the 2024 year ($3,000 in eval, $7,000 in outpatient, $4,000 in labs). Speaking labs, I had 2 blood draws just two weeks apart for the same test (peth) both negative but its quite absurd and redundant for a test that is supposed to be a 3mo marker and over a time span that weekly urine etgs could have achieved but less invasive and cheaper. It costs $150 per analysis of peth + $100 collection fee so its half my mortgage right there in 2 weeks.
 
TulaneUnderdog said:
12-mo update. Still in compliance with the PHP; have had so many labs and charges done that when doing taxes, there is >$15,000 spent in “medical expense” that is out-of-pocket in addition to my insurance for the 2024 year ($3,000 in eval, $7,000 in outpatient, $4,000 in labs). Speaking labs, I had 2 blood draws just two weeks apart for the same test (peth) both negative but its quite absurd and redundant for a test that is supposed to be a 3mo marker and over a time span that weekly urine etgs could have achieved but less invasive and cheaper. It costs $150 per analysis of peth + $100 collection fee so its half my mortgage right there in 2 weeks.
Click to expand...

Yeah this a notorious problem with PHPs.
 
Seeing this thread pop up again, if anyone is ever in the position of needing to pick a facility/evaluator and has Acumen Institute as an option, that's the one that my physician patients attended. They write very thoughtful, reasonable assessments and both physicians came to actually appreciate/find value in their process.

PHP's that shop for overdiagnosing institutes sound awful. And the cash outlay is also really unfortunate.
 
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