To the Editor: The survey study by Dr DesRoches and colleagues1 reported data regarding physicians' experiences with impaired colleagues. Although the authors concluded that a large number of practicing physicians do not support the current process of self-regulation, we believe that the discussion lacked consideration of relevant issues that would put these results into more meaningful context.
The association between a state’s malpractice environment and likelihood of reporting an impaired colleague could represent cause or effect. Malpractice claims may be lower in states in which more impaired physicians are reported because such physicians could access the help they need before any patients are harmed. Thus, the quality of the state's physician health program (PHP) may have a more meaningful effect on the reporting climate within a state. PHPs were implemented to help physicians access treatment while maintaining public safety.2 There are no national standards for PHPs, so the structure, size, and quality of the programs vary. For example, some PHPs mandate disciplinary action by the state board of medicine, whereas others allow physicians to obtain treatment confidentially and without punitive action (eg, Florida, Alabama). In addition, some states recently lost a PHP (California) or do not have a PHP (Georgia).2- 3