Physicians Health Program Policies Introduction:
The TMF takes great care to ensure that, as with any health care related endeavor, the names, addresses, and case information related to its participating physicians remain strictly confidential. This policy of confidentiality protects the public by encouraging physicians who need our help to feel free to contact us with the knowledge that their request for assistance will be professionally addressed with the privacy that any other health care patient would expect who sought medical care from a physician, hospital or nursing home.

Tennessee's Peer Review Law of 1967
In 1967, the Tennessee General Assembly passed a statute to encourage committees of physicians to vigorously review the work and quality of care that their peers were providing across the state. The legislature recognized that the only way to accomplish genuine peer review would be to make sure that the oversight efforts were done in a confidential atmosphere. The statute, T.C.A. §63-6-219, provides that information generated in the peer review process (which is unavailable elsewhere) is privileged from subpoena and strictly confidential.

The legislature made its intent clear with the passage of the Peer Review Law:
"(I)t is the stated policy of Tennessee to encourage committees made up of Tennessee's licensed physicians to candidly, conscientiously, and objectively evaluate and review their peers' professional conduct, competence, and ability to practice medicine." [219(a)]

Intervention Steps to Recovery
How the PHP Works to Make Physicians and Communities Whole

STEP 1--Identification
Identification of an impaired physician can come in a number of ways. The TMF maintains a 24-hour phone line as an outlet for family members, patients, and co-workers to report -confidentially if they wish - their concerns about a physician. The PHP medical director receives referrals directly, often from hospital-based well-being committees.

STEP 2--Verification
The PHP medical director attempts to verify reported behavior. If the impairment is not verified, the process is halted, or the information is held for further inquiry.

STEP 3--Intervention
When the medical director has verified a physician's impairment, a team confronts the candidate for the purpose of intervention. During the intervention, the physician is invited to participate with the Physicians Health Peer Review Committee in which he or she agrees to seek specified treatment at his or her own expense. In return, the Peer Review Committee agrees to assume an advocacy role relative to the physician's right to re-enter practice after successfully completing treatment.

STEP 4--Treatment
All treatment is carried out at approved hospitals and treatment facilities throughout the country. This is usually a two to four month residential placement for chemical dependency in preparation for re-entry to practice. Physicians impaired by other emotional or behavioral conditions are treated with initial residential evaluation and are subsequently prescribed inpatient or intense outpatient therapy. The PHP medical director closely monitors physicians while they are in treatment, often making personal visits to their treatment facilities.

STEP 5--Re-entry
Re-entry to practice usually occurs within one to two weeks following successful treatment. During this period, the Peer Review Committee is often the physician's strongest - and sometimes only - advocate. The PHP medical director and local well-being committee work in concert to establish contractual ground rules for re-entry to practice.

STEP 6--Aftercare
Aftercare is a five-year process. It is guided by an individualized contract and comprises several elements, including those recommended by the treatment facility. In addition to regular attendance at AA, NA or other support group meetings, participation in Caduceus Clubs with oversight by Regional Aftercare Monitoring (RAM) Teams are key to successful aftercare. Caduceus Club meetings are weekly one-hour aftercare self-help/group therapy sessions held throughout the state for health care professionals, and are mandatory for the length of the aftercare contract. RAM Teams serve as the community-level “eyes and ears” of the PHP medical director. Each team of two or three physicians who themselves are in long-term recovery conduct monthly meetings designed to explore and reinforce the development of the individual's daily recovery program.

STEP 7--“Graduation”
The Physicians Health Peer Review Committee reviews the status of every candidate each quarter. Progress reports are obtained from each physician's Regional Aftercare Monitoring Team, the local well-being committee, and from the medical director. If the candidate has developed a self-supporting recovery program at completion of his aftercare, the “impaired” designation is removed, and the physician has completed the program.

On occasion, the medical director is required to perform a second intervention and recommend additional treatment. Unfortunately, some recoveries are very difficult, and failures do occur. In the event treatment is not pursued or is unsuccessful, the Peer Review Committee withdraws its advocacy. These physicians are soon out of the practice of medicine, either through voluntary retirement or suspension of their licenses.

Physician Retraining
A small number of physicians who participate in the Physicians Health Program require supplemental instruction to acquire or refine skills that might have diminished as a result of their impairment. The PHP medical director, in conjunction with medical school faculty, designs a retraining program for each physician, which takes place at one of the several medical schools in Tennessee.