On PHP Programs & A Follow-Up On SB 382…

NC Senate Bill 382 (SB 382) had several provisions but perhaps the one which drew the most attention was that which might empower the NC State Board of Dental Examiners (NCBDE) to compel licensees to undergo physical examination and/or testing without a court order. Ostensibly this bill might relate to mental health and substance abuse concerns – and the interface between the licensee, the Board, and NC’s dental version of the NC Physician Health Plan – the NC Caring Dentists Program (NCCDP). This was the subject of a previous town hall hosted here on CE Dojo in 2023.

SB 382 was passed by the NC Senate but has apparently stalled in the NC House of Representatives. To date, there has been no further legislative activity since last June, 2023. As such, it would appear this bill has died in committee.

This is good news for NC dental licensees. While the proponents of NC organized dentistry state the benefit of such bill would be to protect the privacy of licensees, it neglects the fact that all NCBDE proceedings are a matter of public record. So, while a licensee may benefit from the initial lack of publicity, ultimately their engagement with the NCCDP would not remain confidential. But NC dental practitioners should ask themselves why would organized dentistry be in favor of such legislation? Like all things unseen, if one asks the question “who is to benefit” the answer becomes more obvious. Read further, dig deeper to find out more.

In general, while practitioner health programs (PHPs) provide regulatory agencies a means to address mental health and substance abuse issues among licensees, they have not been without controversy. As can readily be observed, PHP programs share many common facets and a majority of dental programs are modeled likewise. However, the one major difference between physician and dental programs is that while physician programs are operated by licensed physicians – who are qualified to make treatment referrals – dental programs are mostly not. And since the majority of “preferred treatment programs” – if not all – pay a referral fee to the PHP, it is unlikely a referral will be denied. Obviously then the issue of unnecessary care can become a problematic concern.

While PHP programs may portray themselves as being independent and confidential, in some instances unwitting licensees who have contacted a program for advise or help – perhaps on an exploratory basis – find themselves embroiled into treatment leveraged through the revolving door between the PHP and the regulatory agency. Licensees must then undergo evaluation by PHP appointed clinicians and if recommended must likewise undergo therapy in “preferred” treatment facilities. They may face compulsory polygraph testing despite the fact such practice has been abandoned in civil or criminal matters. If the licensee fails to comply, by contract they may face an action against their license. There is no choice.

But NC dental practitioners should ask themselves why would organized dentistry be in favor of such legislation? Like all things unseen, if one asks the question “who is to benefit” the answer becomes more obvious. Read further, dig deeper to find out more.

While we tend to think of PHP programs only in matters of substance abuse such is not the case. In the case of the physician model, licensees have been referred by employers, partners, peer review boards, etc for behavioral issues, questionable treatment or bad outcomes, and even for whistle-blowing. Such was the case for Dr Jacob Neufeld, MD, MPH who agreed to a program referral by his then employer and could not escape it’s grasp. He ultimately committed suicide.

Dentists still enjoy some cottage-industry practice unlike their physician counterparts. However, dentists are increasingly entering practice as employees and may encounter similar situations. So what does one do if a dentist feels they may need professional assistance or advise – or if they believe or know they are facing referral to a PHP program? Or maybe you have a pre-employment question – should I agree to mandatory random drug testing?

One cannot be too careful. Certainly, you could risk a regulatory board inquiry or PHP program referral if you contact a program – or even a clinician in the community without due diligence. Furthermore, no less than your attorney would advise you to talk freely to a state’s attorney, limiting your exposure with PHP principals publicly or privately (CE programs, group meetings, etc) would seem rational and prudent.

Here is a link to a resource that offers 13 tips on obtaining mental health assistance through Ideal Medical Care – a physician support resource.  Though it is hosted by a licensed physician, all healthcare practitioners are welcome to request confidential assistance.

Doctors are facing ever mounting pressures from all fronts. Certainly, mental health and substance abuse awareness – and just good plain common sense – is key. But even then health care professionals can find themselves faced with difficulties. The stresses are multiplied as licensed clinician employees increasingly loose autonomy and control while still being faced with conflict that occurs between the objectives of business on the one hand and patient care on the other. Licensees are urged to identify, establish, and maintain firm boundaries – always know that your obligation as a professional is advocating for patient care – not your employer’s bottom line. And by doing so you advocate for yourself.

Never ever forget this!

Regrettably it seems globally PHP programs often times create more mental health problems than they resolve. So many times – as in the case of Dr Neufeld – there are opportunities missed that may have made all the difference – to communicate boundaries and say no!. Yes, you may lose your job, but it’s far better to lose one battle and live to fight another day than to capitulate and lose it all.

David MH Lambert, DDS
Diplomate, ABOMS
Chief Informatics Officer, CE Dojo

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