There is a lot to unpack in this anonymous author's posting. The first thing I have to say is that I extend my sympathies and I hope that the author gets in touch with the Center for Physician Rights run by Kernan Manion MD. His resources can be found online quite easily with a simple search.
I don't want to be hard on the author but there are some imprecise statements in the posting that provide opportunities to inform people who may find themselves in this situation. Another writer has mentioned the J Wesley Boyd MD article in Psychology Today that is directly relevant to the author's circumstances and is well worth reviewing.
The number of state PHP's is about correct. My count is 47 PHP's in 46 states (MO has one for MD's and one for DO's.) California does not have a state PHP. In fact, most PHP's are NOT state agencies at all. About half of them are state contracting private organizations. About a quarter are components of state government. And the remainder are typically operated by medical societies. Essentially all PHP's are members of the Federation of State Physician Health Programs (FSPHP) which is a private trade organization linked to the American Society for Addiction Medicine (ASAM).
It is a generally-incorrect statement to say that PHP's advocate for physicians. Many, perhaps most, PHP's give educational presentations in which this claim is made but that claim of advocacy on behalf of a physician is basically untrue. PHP's frequently issue quarterly or annual reports that describe the proportion of their clients that come from various sources. Actually by applying the term "voluntary" to much of their clientele, the reality of coerced agreements is not really disclosed in these public reports. The data obtained when these contractors go through periodic state contract procurement actually gives much more accurate information about the sources of referrals. In one state, the data obtained during the contract procurement process show that for FY 17/18 262 cases were referred to a PHP and of these, 57 were referred by the medical board, 83 were self-referred, and 122 were third-party referrals. In FY 18/19, 241 cases were referred and of these 58 were referred by the medical board, 75 were self-referred, and 108 were referred by third parties. Ancillary information indicates that almost all third party referrals were made by employers and hospitals.
Semi-formal or formal physician health programs arose in the 1980's and were, for the most part, medical society activities that offered assistance to physicians with alcohol and substance use disorders. The Reagan Era Executive Order on Federal Drug-Free Workplaces roughly marked the start of the rapid acceleration in formality, funding, and missions of these organizations. Shortly thereafter, medical boards used them as diversion from discipline programs and many formalized these programs in state legislation or state agency administrative rules. When ASAM took an interest and created FSPHP, the programs took on official policies of "abstinence-only", 12 step treatments, and remarkably long residential stays requiring enormous cash payments. Since its inception, the FSPHP has expanded its mission to concern itself with other aspects of "physician health" that it claims must be addressed in the interest of public safety. Financially and personally ruinous PHP policies with an uncertain and unregulated relationship to the powers of state agencies have now become the norm from coast-to-coast.
Most persons who comment on PHP's advise that they are in no sense any sort of advocate or safe haven and any involvement with them ABSOLUTELY REQUIRES that a physician avail himself of a lawyer who is retained independently (without PHP "help") and who has skill and experience sets in litigation, employment law, and disability law. The particular details of the operation of a PHP can be found in the state contract with the PHP and in the last public bid solicitation for PHP services. These are straightforward to get in states with sound public transparency laws. In the absence of such laws, the 2019 FSPHP Guidelines operate as a useful starting point to understanding the policies and procedures of a given PHP. Importantly, PHP brochures or annual reports or even consent/agreement/disclosure forms drafted by the PHP are often misleading and the only reliable information is found in the state contract and the procurement RFP. PHP's are not usually public entities and owe you no due process. They are rarely susceptible to public transparency or "Sunshine" laws.
State PHP's are monopolies in almost every state where they exist. The FSPHP actually had a published requirement that full FSPHP members could only be those who worked as a monopoly in the states where they operate. The origins and bases of these monopolies are just beginning to receive legal scrutiny.
PHP's have no monopoly on expertise in the diagnosis or treatment of physicians with a host of physical and psychiatric disorders or diagnoses. For that reason, I am skeptical of the proportion of physicians who are "self-referred" to these programs. I believe that much of this self-referred group was coerced and/or deceived. Basically, there is NO diagnosis or treatment service available for physicians that is not better available outside of a PHP. And the advantage of obtaining services privately is a much better chance of not sustaining personal and financial devastation while receiving diagnosis and treatment.
The bulk of physician referrals to PHP's comes from employers and medical boards. In 2019, a plurality of US physicians are explicitly-employed and receive a W-2 form. Employers who "send a physician to the PHP" have to do this in compliance with ADA Title I and, in states with superseding legislation, in compliance with those frequently more-powerful state laws. A medical board that refers a patient must do so in compliance with ADA Title II and the Rehabilitation Act. Private organizations that serve as PHP's must comply with ADA Title III as public accommodations. Other federal statutes are also applicable including GINA, 42 CFR Part 2, HIPAA and a few others. Mostly they are ignored.
