Mission, History, and Operation of the Physician Recovery Network
This year, the Physician Recovery Network (PRN) changed its name to the Idaho Health Professionals Recovery Program (HPRP), as the DOPL awarded a contract directly instead of through the Idaho Medical Association. But while the name and contracting route have changed, its mission has not. HPRP works to prevent, identify, intervene with, and rehabilitate Idaho physicians/physician assistants who have or are at risk for developing disorders that are associated with functional impairment. This is done consistently with the laws and medical practice acts of the state of Idaho and with best practices for treating addiction disorders.
HPRP was formed in 1986 with the support of the Idaho Medical Association (IMA) House of Delegates as the PRN. It advocates for and helps Idaho physicians or physician assistants who are impaired by substance use disorder, or mental illness. This protects the public from unsafe medical practice by impaired professionals. Individuals can recover from impairment confidentially through the HPRP without necessarily jeopardizing their medical license.
HPRP also operates outside the confines of a physician’s employment, so the physician can feel comfortable seeking assistance outside their employer.
HPRP functions by providing a network of trained physicians and other healthcare professionals to aid in confidential investigations of alleged impairment. When appropriate it conducts interventions, coordinates placement in a treatment program, and develops and coordinates an individualized long-term monitoring recovery program.
HPRP also seeks to educate Idaho physicians and other involved parties about the problems of impaired physicians and how the program operates. It also establishes liaisons with other professional organizations concerned with these issues.
Currently, HPRP is partially funded through a contract with the Idaho Board of Medicine (BOM), which is the official diversion program for impaired physicians in the state. The Division of Occupational and Professional Licenses contracts with Southworth Associates (SA) and Benjamin Seymour (co-owner of SA) to provide impaired physician services. Katie Stuart, Administrative Bureau Chief with the Division of Occupational and Professional Licenses, oversees this program and presents to the Medical Board as needed.
The HPRP Process
Outreach and Enrollment
Most individuals join the program through some form of “benevolent coercion,” seeking assistance because of external pressure that comes primarily from professional colleagues, but also spouses, administrators, and lawyers too. Many voluntarily enroll in the program. When a call is made to SA or the HPRP committee, SA program staff initiates a discreet inquiry. If substantial evidence of impairment is discovered after a complete and confidential investigation, an intervention takes place. The program coordinator sets up an appointment with the individual and facilitates a caring confrontation.
If the person agrees, he or she is sent to a selected facility for a complete evaluation. If the evaluation indicates impairment and needs treatment, the licensee is asked to sign a contract with HPRP. Generally, it requires the person to abide by the contract for a period of five years. This typically includes completing an inpatient program with a complete medical and psychiatric work-up as well as counseling.
After the successful completion of primary treatment, the participant signs a monitoring contract and recovery plan. Assuming the impairment is chemical dependency, they would be asked to commit to total abstinence from addictive chemicals, continuing treatment, behavioral monitoring, random toxicology testing, worksite monitoring, and attendance at 12-Step meetings.
This contract serves as a powerful tool in documenting the recovery process and helping participants return to the practice of medicine. Success depends on the positive outcome of the participant’s recovery and a supportive peer network that ensures that appropriate monitoring is followed. When participants follow their recovery program, the HPRP can be a strong advocate. In the past, the HPRP has advocated on behalf of physicians/physician assistants to the BOM, federal agencies, judges, malpractice insurance carriers, and hospitals.
HPRP offers continued monitoring to graduates of the program through Phase III monitoring which includes participation in random drug screenings approximately three times per year. Through extended monitoring, the HPRP will continue advocating for the recovering participant even after the initial five-year monitoring contract has been completed.
Interaction with BOM
HPRP maintains an arms-length relationship with the Board of Medicine but still interacts with it in a way that develops trust and satisfies legal requirements. Inquiries to HPRP are confidential and are not automatically reported to the Board of Medicine. If a participant complies with HPRP program requirements, he/she will not be reported to the Board. However, HPRP will contact the Board if a licensee refuses to comply with its recommendations.
HPRP Committee Structure
A recovery committee of at least ten (10) members will be created to provide guidance to the program vendor and the Idaho Board of Medicine on matters relating to physicians who may be impaired due to substance use disorder (SUD)/alcohol use disorder (AUD) and/or mental illness. Members of the committee shall include persons who are knowledgeable about SUD/AUD and mental illness.
The Division Administrator shall appoint people to the committee who are appropriate to accomplish the committee’s charge. Nominations for consideration for appointment shall be solicited from the Idaho Board of Medicine, current committee members, as well as members of the public.
Members of the committee shall be licensed Physicians in Idaho, graduates of the recovery program, and at least one (1) member shall not be a licensed healthcare professional. In making appointments the Division Administrator will consider the geographical representation of the state, and the makeup of different specialties to ensure a variety of practice settings.
Appointments shall be for three-year terms. Members may be appointed to serve for three (3) consecutive terms. The first appointment terms will be staggered for two (2) to three (3) years.
The Committee meets quarterly.
1) Review of client requests for change in monitoring schedule. These are carefully considered with input solicited from workplace monitors and counselors. Reduction in monitoring frequency is approved only in accordance with a set schedule that is established in advance of requests.
2) New client interviews. Individuals who self-refer or who are referred by the Board of Medicine are invited to meet with the Committee in person. Events leading up to referral are reviewed and the monitoring process is outlined. The client is reassured that the HPRP will be a supportive advocate so long as the monitoring program is followed.
3) Review of potential clients. A list of those for whom concern has been raised is maintained and updated as needed.
A Rapid Response Subcommittee exists to deal with more urgent issues which arise between meetings. Issues include relapse, worrisome behavior changes, concerns raised by peers, etc.
One of the most important activities of the HPRP is the education of physicians,
healthcare administrators, hospitals, and the public regarding the prevention, early identification, intervention, and treatment of substance use disorders and other illnesses affecting physicians and physician assistants. As more people are educated about substance use disorders and their effect on health professionals, we see earlier identification and intervention taking place, alleviating some of the problems that arise as the disease progresses. We desire to reach out to more hospitals and organizations to help educate them on identifying the signs and symptoms of the “troubled colleague” and inform them of the purpose of the HPRP program.
HPRP Outputs and Outcomes
Success is generally defined as a participant achieving a chemically free and professionally productive lifestyle. Nationally, professional health programs have high success rates ranging from the mid-60 % to the low 80% range. While physicians are typically closer to the 80% range. Idaho’s program’s recent experience is consistent with those results.