Annual Report2009

Physician Health Services, Inc., is dedicated to improving the health, well-being, and effectiveness of physicians and medical students in order to promote patient safety. This is achieved through education and prevention, as well as assessment, referral to treatment, and monitoring of those at risk. Dear Friends & Colleagues:

We are pleased to share with you the 2009 Annual Report from Physician Health Services, Inc. (PHS), a corporation of the Massa- chusetts Medical Society. PHS continues to be a confidential re- source for physicians and medical students who are at risk or need help with health concerns, including those that arise from the stress and demands of modern practice. In sharing this report, it is our goal to spread awareness to all health care providers and administrators of the scope of our services available to support the personal and professional well-being of our colleagues. e d w a r d j. k h a n t z i a n , m d A powerful story of hope from a past participant can be found on page 11. We hope that by hearing from a physician who has truly benefited from our services, you will recognize the importance of supporting your colleagues and our organization. Should you wish to contribute to PHS, a form for making donations via our Caring for Physician Health Campaign is included in this report.

As highlighted on page 29 of the Annual Report, PHS continues to offer an educational program entitled “Managing Workplace Conflict: Improving Personal Effectiveness.” This course is offered twice a year l u i s t. s a n c h e z , m d and includes a unique combination of didactic and participatory sessions to help physicians gain advanced skills and techniques for addressing interpersonal challenges in the medical workplace. We invite you to take advantage of this popular and successful program. Check our website for upcoming dates.

As always, we remain available to discuss PHS services and topics of physician health with you and your organization, and we welcome the opportunity to deliver a presentation to your staff. To schedule a presentation or find out more about any of the services PHS has to offer, contact us by phone at (781) 434-7404, by e-mail at jvautour@ mms.org, or visit our website for a speaking engagement form at www.physicianhealth.org.

We are grateful for the many supporters of PHS and look forward to being of service to you and the physicians and medical students in Massachusetts. Please share this report with individuals and institu- tions you feel would be interested. Additional copies are available.

Sincerely,

Edward J. Khantzian, MD Luis T. Sanchez, MD President Director

Physician Health Services, Inc., 860 Winter Street, Waltham, Massachusetts 02451 (781) 434-7404, (800) 322-2303, ext. 7404, www.physicianhealth.org Introduction & Greetings...... 4 Additional PHS Services...... 25 Table of About Physician Health Services, Inc...... 4 PHS Educational DVD ...... 25 www.physicianhealth.org...... 25 A Message from the President...... 6 Vital Signs...... 26 Contents Outreach & Education...... 27 A Message from the Director...... 6 13th Annual Participants’ Dinner...... 27

Giving Physicians & Medical Support Groups...... 28 Students Your Support: PHS Support Group List...... 28 The PHS Caring for Physician Continuing Medical Health Campaign...... 8 Education Program...... 29 Ways You Can Support PHS...... 8 Managing Workplace Conflict: Improving Personal Effectiveness...... 29 Thank You for Supporting PHS & Its Mission...... 9 Board of Registration in Medicine...... 30 Reasons to Give: A Personal Diversionary Status...... 30 Journey...... 11 Monitoring Program...... 31 Meet Physician Health Services..... 12 Monitoring Contracts Available The Board of Directors...... 12 to Physicians...... 31 The Advisory Committee...... 13 Quality Management...... 31 The Clinical Advisory Committee...... 13 Seeking Volunteer Monitors to Support The Research Committee...... 14 Physicians in Need...... 31 Medical Student Advisory Committee...... 15 The Associate Directors & Assessment PHS Strategic Goals...... 32 Director...... 16 Assessment & Monitoring Services...... 32 The Staff...... 18 Strategic Planning...... 32 Program Operations...... 32 Year in Review...... 20 Financial Management...... 32 Major Contributors...... 20 Fiscal Year 2009...... 22 National Efforts...... 32 Those Who Have Given Physicians Support for Their Health...... 21 PHS Speaking Engagement Case Activity...... 22 Request Form...... 33 Outreach Activities...... 24 Introduction & Greetings

About Physician Health Organizational Structure Services, Inc. The PHS Board of Directors governs the Physician Health Services, Inc., (PHS) is charity to carry out its mission, oversees the a nonprofit corporation founded by the PHS director/chief operating officer, and Massachusetts Medical Society to address oversees the financial management of the issues of physician health. PHS is designed organization (see page 12 for a complete to help identify, refer to treatment, guide, listing of members). In addition, PHS and monitor the recovery of physicians benefits from the expertise of a Clinical and medical students with substance use Advisory Committee, which provides disorders, behavioral health concerns, or guidance to the PHS director on specific mental or physical illness. Luis T. Sanchez, clinical matters. Committee members are MD, a board-certified psychiatrist with nominated by the PHS director and additional qualifications in addiction approved for one-year terms by the PHS psychiatry, has been the director of PHS Board of Directors (see page 13). This peer- since 1998. With the help of physician review committee meets five times each year associate directors located throughout to review de-identified case presentations. Massachusetts, Dr. Sanchez assists The PHS Advisory Committee provides physicians, medical students, hospitals, input into the organization’s non-clinical colleagues, and family members of matters. Appointed by the director, its physicians who may be at risk. members represent PHS’s major funding organizations and health care administrators and physicians who can offer knowledge on the impact physician health matters have on health care delivery.

4 Additionally, in order to address the need When an individual contacts PHS, the PHS assists with a wide variety of personal for scientific-based data on physicians with director and a designated associate director and professional situations. Any one of the health concerns, in 2001 PHS formed the assess the situation and guide him or her following issues may represent a reason to Research Committee. For a full description through the proper channels. Participation refer someone to PHS or contact us: of the committee’s current projects, see page with PHS is voluntary and confidential. * Difficulties managing a practice or 14. The Research Committee meets on a PHS will strongly urge a physician who is coping with a competitive work monthly basis. ill to get help, and although PHS does not environment provide direct treatment, we will suggest Finally, in 2004, PHS formed the Medical specific resource and treatment options. * Financial pressures Student Advisory Committee to provide PHS hosts a number of support group meet- Dealing with administrative burdens a forum for medical schools to effectively * ings for physicians and medical students in exchange information on issues of student * Difficulty balancing work and family recovery, as well as those who are seeking health (see page 15). Comprised of represen- peer support. * Marital problems tatives from the four medical schools in * Compulsive gambling Massachusetts, the committee has become a When PHS determines that a physician has springboard for assisting medical students a substance use disorder, is at risk for impair- * Domestic violence who have been or may be at risk for having ment, or has a behavioral health concern * Challenges with retirement planning health-related problems. It is the goal of that warrants monitoring, the physician is or a career change PHS to enhance the health practices of encouraged to enter into a PHS monitoring * Distressed or disruptive behavior future physicians through early outreach contract. The monitoring contract specifies and education during medical school. a course of treatment and documents the * Professional boundary issues physician’s compliance with that treatment * Depression or anxiety Confidentiality plan and progress of recovery. The standard * Post-traumatic stress disorders Confidentiality is a cornerstone of Physician contract requires individual therapy, group Health Services. PHS recognizes the impor- support meetings, regular meetings with a * Malpractice stress tance of respecting the privacy of those who designated PHS associate director, random * Coping with having witnessed and/or come forward to seek help and is committed urine drug tests (if indicated), and regular participated in an atrocity-producing to devoting its resources to protecting their interaction with a monitor and chief of situation privacy. It is critical to PHS for physicians to service who agree to help document the * Medically induced trauma feel confident that the information they physician’s progress. share will remain confidential and be pro- * Stress following an unexpected tected to the full extent of the law. PHS services are confidential, and most are outcome or medical error provided at no cost. Services include expert * Personality disorders How PHS Works consultation and assessment designed to * Co-morbid psychiatric disorders Physician Health Services, Inc., (PHS) encourage medical students and physicians is a confidential resource for physicians, to obtain help for substance use, behavioral * Concerns about loss of memory and residents, medical students, group practices, or mental health concerns, or physical age-related challenges illness. PHS and its practitioners are not HMO networks, and hospitals with medical * Alcohol and substance use concerns student or physician health concerns, in- direct treatment providers. However, PHS cluding behavioral or mental health issues, does provide the following services: substance use disorders, and/or physical ill- * Referral to treatment and counseling ness. PHS provides a safe environment for * Recovery monitoring and documentation physicians to talk to their peers about the * Support groups for physicians, medical stress and demands of modern medical prac- students, and their families tice. Our assessments are designed to identify * Networking opportunities with colleagues the health concerns impacting an affected experiencing similar issues individual’s life and provide recommenda- Educational programs and presentations tions and resources to assist that person. * for hospitals, HMOs, and medical staff Anyone is welcome and encouraged to meetings contact PHS on his or her own behalf. PHS * Guidance to hospitals and health care receives referrals from colleagues, family organizations for handling matters of members, friends, hospitals, medical schools, physician health and the Board of Registration in Medicine. * Grand rounds, lectures, and speeches at committee and specialty society meetings

5 “Having celebrated our 30th anniversary and dedicated efforts of an extraordinary this past year, PHS looks ahead to con- A Message staff, which includes our director, Dr. Luis tinue our commitment to offer support, Sanchez, and associate directors, Drs. Judith guidance, and advocacy to physicians. Eaton, Wayne Gavryck, John Knight, John Whether the issues involve behavioral from the Wolfe, J. Wesley Boyd, and Michael Palmer, difficulties or psychological issues, we director emeritus. Dr. Sara Bolton joins this maintain an ongoing dedication to serve President team of physicians as this report is being those who turn to us in times of need.” prepared. Our director of operations, Linda This past year, we proudly celebrated the Bresnahan, legal counsel, Debra Grossbaum, 30th anniversary of Physician Health Services. and outreach and education manager, Jessica — Edward J. Khantzian, MD Presumably, we will enjoy another 30 years Vautour, are essential to and extraordinarily of successfully assisting physicians who have important in assuring a smooth and effective responded adversely to the stresses and administrative underpinning for PHS. Their strains of exercising their commitment to Dr. Khantzian is a graduate of Boston University. efforts are supported by Deborah Brennan, He received his medical degree from Albany the practice of medicine. Unfortunately, secretary and medical transcriptionist, Medical College in New York in 1963. He served some physicians succumb to the stress and Mary Howard, monitoring services assistant, residencies in psychiatry at the Massachusetts distresses entailed in caring for others and Deborah Canale, client services assistant, Mental Health Center and the Cambridge suffer from emotional and behavioral diffi- and Shari Mahan, secretary. Hospital, and he completed his psychoanalytic culties. Most notably, these can take the training at the Boston Psychoanalytic Society form of lapses in their own self-care. The – Edward J. Khantzian, MD and Institute in 1973. He is a Distinguished PHS director, in concert with the associate President and Chair of the Board Life Fellow of the American Psychiatric Associa- of Directors, Physician Health Services tion (APA), a former vice chair of the APA directors and staff, work with the physicians Addiction Council, and a former chair of the that come to our program to offer support, Massachusetts Psychiatric Society Committee on monitoring, and referral for treatment. The Alcoholism and the Addictions. Dr. Khantzian assistance we offer is respectful, consistent, was founding chair of the Group for the Ad- and transforming. Self-confidence and self- vancement of Psychiatry Committee on Alcohol- respect, often shaken when physicians are ism and the Addictions. He is also a founding derailed by their problems, are restored, and A Message member and past president of the American Academy of Addiction Psychiatry. personal growth and change are stimulated. PHS can pride itself in helping physicians from the reestablish the assurance, dignity, and self- Dr. Khantzian is a clinical professor of care necessary to effectively administer to psychiatry at Harvard Medical School, a Director founding member of the Department of the needs of their patients and community. Psychiatry at the Cambridge Hospital, and The mission of a program such as PHS As I enter my eleventh year as the director associate chief emeritus of psychiatry at rests on a foundation of support beyond of PHS, I remain committed to our mission Tewksbury Hospital. He is a practicing and the work we do in assisting physicians psychiatrist and psycho­analyst, a participant the day-to-day operations provided by the in numerous clinical research studies on directors and program staff. Our mission is and medical students in need of support with substance abuse, and a lecturer and writer accomplished through the generosity of our their health-related problems and concerns. on psychiatry, psychoanalysis, and substance Medical Society, the malpractice insurance PHS continues to be very involved in reach- abuse issues. In addition, he is a recipient of carriers, and the donations of individuals ing out to the medical community and other the PHS Distinguished Service Award (1998) and organizations that so generously stakeholders in ensuring that physicians are and the Massachusetts Medical Society Award practicing with high standards of care be- for Excellence in Medical Service (2002). continue to support our work, including Baystate Health Systems, Berkshire Health cause their underlying health problems are Systems, Boston Medical Center, Cape Cod being appropriately diagnosed and treated. Health Care, Caritas Christi Health Care, The 2009 PHS Annual Report reviews in Connecticut Medical Insurance Company, detail what has been accomplished during Lahey Clinic, Physician Insurance Agency this past year and outlines our plans for the of Massachusetts (PIAM), ProMutual coming year. I encourage you to review the Group, Risk Management Foundation of report and to contact PHS with any ques- the Harvard Medical Institutions (CRICO/ tions you may have or to learn more about RMF), Southcoast Health System, Tufts our organization. Medical Center, and UMass Memorial Health Care Systems. The operation of PHS greatly benefits from the devoted

6 “Physicians are just people who have the Dr. Sanchez is responsible for the clinical same problems and concerns as our patients requirements of the program. He establishes and maintains all clinical systems necessary for effective do. To be good doctors, we need to be good outreach, intervention, and monitoring of physicians. patients. Medical schools provide us with the He also maintains PHS’s important relationships with knowledge and skills to be good doctors, but external agencies such as the Board of Registration during the process we can lose sight of how in Medicine. Dr. Sanchez graduated from Harvard to be good patients. We often need help Medical School and completed his internship and becoming patients and reaching out for help. residency in psychiatry at Cambridge Hospital. He became a member of the PHS Clinical Advisory That’s where I find PHS to be very helpful Committee in 1994, and since 1998, he has served and what makes my job so worthwhile.” as PHS director. Dr. Sanchez has been recognized nationally as a leader within the field and recently completed a term as president of the Federation of — Luis T. Sanchez, MD State Physician Health Programs until May 2009. He is now serving a two-year term as Past President.

As we complete another fiscal year, I am increased self-awareness and the opportunity Board of Directors, chair of the Publication heartened that referrals to PHS remain for physicians to solidify their understanding Committee, and on the Annual Meeting strong. We continue to be available to of effective communication techniques. Planning Committee. Deb Grossbaum is the assess physicians with substance use chair of the Bylaws Committee and serves I am pleased to announce that Sara M. problems, mental health issues, medical on the Audit Committee. Bolton, MD, is joining us in a newly created concerns, behavioral interaction difficulties, position as assessment director, serving in an This annual report message offers me the and problems related to the stress of medical independent contractor role similar to that opportunity to express my gratitude and practice. In addition, we remain committed of the five associate directors, but she will thanks to the PHS staff, associate directors, to assisting hospitals and medical practices be available to assess all new physician and board of directors, Advisory Committee, by offering seminars and symposiums, which student referrals. The other associate direc- Clinical Advisory Committee, and Medical provide valuable education as to the role tors will provide PHS with monitoring and Student Committee, along with MMS staff and availability of PHS in assisting those support for those who enter monitoring and departments, who are always available, in need. contracts. Dr. Bolton’s presence will afford eager to assist, and who truly understand the On January 1, 2009, the Joint Commission more efficiency in the referral and assess- importance of the work we do. enacted two new standards which require ment process so that PHS can accommodate And finally, I want to thank all of our major surveyed hospitals to establish processes the increasing need for services and support. funders for their continued support of our to deal with both disruptive behavior and On a national level, PHS continues to be work. As a nonprofit charitable organization, workplace conflict. Guidelines to meet actively involved in the Federation of State I am gratified by the increasing donations these standards include establishing a code Physician Health Programs. This past May, from individuals and organizations who are of conduct as a step in lessening disruptive I stepped down as president of this organiza- willing to offer their support. In these trying behavior. PHS can serve as another resource tion, having served in the role for the past economic times with a difficult recession to assist with meeting these standards. Spe- 3.5 years. I value the experience I had as and major health care reforms imminent, cifically, PHS accepts referrals to evaluate well as the opportunity to have become so physicians will predictably be increasingly physicians who are having difficulties well associated with the other state physi- stressed and in need of assistance with their with professional interactions to determine cian health programs in this country. We are own health and stress-related problems. whether their behaviors are being impacted all striving to provide confidential and effec- With the support of our funders and other by health challenges or life stressors. In tive support for physicians. I will remain on charitable donations, PHS continues to be addition, twice a year PHS offers a course the Board of Directors as the immediate past available for assistance. in managing workplace conflict to assist phy- president and on the Annual Meeting Plan- sicians dealing with interpersonal challenges – Luis T. Sanchez, MD ning Committee. Linda Bresnahan continues either personally or as an administrator. It is Director of Physician Health Services to have significant responsibilities as the our sense that these resources have been very Federation’s secretary, a member of the beneficial in improving behaviors through

7 Giving Physicians & Medical Students Your Support: The PHS Caring for Physician Health Campaign

The most effective form of support is peer- Ways You Can Support PHS to-peer. This concept is the basis on which In Honor or In Memoriam PHS was founded — “by physicians for Any contribution to PHS can be made in physicians.” Philanthropic support plays a honor of or in memory of someone to whom pivotal role in PHS’s stability and much- you wish to pay tribute. needed growth. Please consider supporting your colleagues by contributing to PHS. General Donation PHS preserves physicians’ health, which A gift of cash or a check is the simplest and can result in medical license retention and most immediate way to give to Physician improved health care for all. Health Services. PHS will accept unrestrict- The success of PHS and its ability to restore ed contributions toward the program’s opera- physicians’ health and well-being centers tions, which include research, educational on a partnership with those who support activities for physicians, support groups, and the services we provide to physicians. By special projects. Many of the health care donating to PHS, you can feel assured that organizations listed on page 24 of the 2009 your contribution is directly related to one PHS Annual Report provided generous or more of the following efforts: charitable contributions in appreciation of PHS’s educational lectures given at the * Confidential support, consultation, and donors’ institutions. monitoring for medical students, residents, and physicians in Massachusetts Restricted Gifts * The development of resources to increase Contributions can be designated to a specific referrals for substance abuse, mental area of personal interest within the scope of health concerns, physical illness, and PHS activities. expanding behavioral health services * Critical research necessary to document Endowed Donations outcomes of and successful strategies for A contribution can be made to PHS as a gift physician health treatment toward future growth. The principal is pre- served and the income supports the purposes * Increased educational offerings including of the fund, as specified by the donor. courses, newsletters, and lectures throughout the state * Support groups for physicians and medical students Thank you for your kind expression of * Improvements to the personal and support to Physician Health Services, Inc., professional lives of those we serve for your participation in the Caring for Physician Health Campaign, and for your All donations will be recognized in the PHS commitment to the health of our doctors. Annual Report, with your permission. Share the benefits of physician health with your colleagues. Invite them to donate.

8 Thank You for Supporting PHS & Its Mission

I/we would like to support PHS and its mission. Donor Name:______Address:______City/State/Zip:______Telephone:______E-mail:______

Enclosed is my/our gift in the amount of: $1,000 $500 $250 $100 $50 Other $______Check No. ______(Please make payable to Physician Health Services, Inc.) Visa MasterCard AMEX Discover Credit Card No.______Expiration Date: _____ /_____ Signature:______

This gift is made: In memory of In honor of On the occasion of ______

Please notify: Name:______Address:______City/State/Zip:______

Donor Recognition I authorize PHS to list my name as a contributor in the PHS Annual Report and PHS publications. This is how I would like my/our name(s) to appear in all donor ­recognition listings for which I/we may qualify:______I do not wish my/our name(s) to appear in donor listings. “All is going well. As time goes by, I realize what a gift PHS has been to Other Ways to Give physicians such as me. It’s so rare to get a second chance to change one’s I would like to include PHS in my estate planning. Please contact me. attitude and concentrate on what is really I would like to discuss other ways to give to PHS. Please contact me. important in life. Thanks to PHS, CDAD, and professionals such as you for allowing A written acknowledgment of your contribution will be provided to you. me the opportunity to get back on track!” Contributions to PHS are tax-deductible to the extent provided by law (tax identification number 22-3234975). — Anonymous Please call us with any questions at (781) 434-7404. To learn more about PHS, visit www.physicianhealth.org.

Return this completed form to: Physician Health Services, Inc., 860 Winter Street, Waltham, MA 02451

9

“The world breaks everyone and afterward many are strong at the broken places.”

— Ernest Hemingway, A Farewell to Arms, 1929

of daily life. I began to use it nightly as a find a reason to call my dealer or scrape up Reasons means of rewarding myself for success or what was left from the day before. I learned appeasing my failures of the day. I increas- the meaning of desperation, as only the ingly isolated myself from my family and my addicted know it. I could not bear to use nor to Give: friends. I saw marijuana as a vacation for could I bear to live without using. I needed one, something to shut out the rest of the to quit but was unable to do so on my own. A Personal world, even if only for a few moments. I struggled to keep my public, successful, professional persona separate from my My drug use changed from being an enjoy- private, desperate, addicted self. These able distraction to a focal point of my daily Journey two sides constantly felt as if they were routine. Friends fell away. My marriage dete- collapsing inward. Like so many of my colleagues, I am a riorated. Eventually, I left my wife and young hard-working and dedicated professional. I children, in part so I could use marijuana Thankfully, I learned about PHS from was a talented student and a popular athlete “the way I wanted to.” After that, my deteri- a friend, and I contacted Dr. Sanchez. throughout high school. I received academic oration was swift and relentless. My work I hoped after hearing my story he would say, honors and was educated at an internationally suffered, as did my relationships with my “Marijuana is not something we worry about.” respected college and medical school. I trained children and family. Or “Our program is for people who get in at top-flight medical centers and was rewarded serious trouble.” The addict in me was still One aspect common to many stories of addi- for my efforts with a prestigious academic job. looking for a way out. He said, “You have tion is setting self-imposed limits on using to Few, if any, of my colleagues have any idea a problem, and we can help.” I signed an assure ourselves and others that we don’t have that I was also an addicted physician, or agreement to receive treatment and be a “problem.” I crossed my “no smoking in the that, because of my addiction, I nearly lost monitored. So began my journey of recovery. car” boundary one summer night in 2005. I everything I worked so hard to achieve. was driving down the highway after leaving PHS has been a part of my life ever since. From early childhood, I harbored a smolder- work. There was a light rain falling, and I It hasn’t always been easy. I was consumed ing sense of inferiority — of being ill at ease was smoking a joint. The car in front of me by shame and a sense of loss in the early days. in social situations — that I now recognize is suddenly swerved into the barrier and spun I had terrible dreams of using and of getting common among many in recovery. Though around. While holding the burning marijuana caught. But as time passed, I emerged from the causes of these feelings may be diverse, cigarette in my hand, I was looking face-to- addiction into a new life. During 3 years of they result for many in a search for some face at the woman behind the wheel of the PHS monitoring, I became proud of passing external source of solace and serenity in a spinning car. We both skidded to a stop, a few my weekly drug tests. I attended PHS support turbulent, confusing, and stressful world. feet separating our cars. We were both visibly meetings with my peers. I became involved shaken but uninjured. As traffic buzzed past with 12-step recovery programs in my com- For me, the “answer” came during late high and we got back underway, I had a moment munity, where I learned to communicate with school when I first tried marijuana. Though of clarity. I realized that, unless I stopped, I people from all walks of life with openness I had experimented with alcohol, I never would lose everything I cared about in my and honesty. really enjoyed drinking. Marijuana was a life. My heart was pounding, and my ears Today, I continue to participate in a program different story. When I was high, I experi- were ringing. Tears rolled down my cheeks. of recovery and try to be of service to others. enced a pervasive sense of calm and clarity. Something seismic had shifted inside me. I’m a loving and involved father, a devoted I felt effusive, funny, outgoing, and at ease in I realized I could not afford to sink any lower. son, and a valued friend. I have a loving a way I had never known before. For many I resolved to quit using then and there. years, I used marijuana sparingly — on vaca- relationship with a wonderful woman who tion, with friends, or for special occasions. But it isn’t that simple. Few, if any, of us who supports my recovery. I have a life and a struggle with addiction can get sober alone. career second to none. I have learned to be But as the stresses of my life and medical During the next few months, I would “quit” grateful for these many blessings. I have training built, I began to use more often — every morning, sure that I would be able stay found some measure of serenity. My life is an and alone. During my residency and fellow­ clean for the day. But every night, after some unfolding miracle. PHS helped to make all ship, marijuana became an increasingly small success or disappointment, I would of this possible. Thank you. frequent means of escape from the pressures 11 Meet Physician Health Services

The Board of Directors Typically, PHS board members serve on a PHS is proud to present the leadership of PHS committee prior to being nominated to the organization to you. To guide the devel- the board. Board members are selected based opment of PHS and its strategic direction, on a diversity of corporate and governance members of the PHS Board of Directors are experience; medical specialty; expertise with nominated by the board and elected by the physician health matters such as substance PHS sole voting member, the MMS Board of use, mental disorders, physical illness, and Trustees, based on a demonstrated record of behavioral health problems; and familiarity involvement with physician health matters with the Massachusetts Board of Registra- e d w a r d j. k h a n t z i a n , m d , p r e s i d e n t a n d c h a i r and a comprehensive understanding of and tion in Medicine statutes and regulations. commitment to the mission of PHS.

j a m e s d. b u t t e r i c k , m d , c o r i n n e b r o d e r i c k , m s , b o o k e r b u s h , m d , j o h n a. f r o m s o n , m d , m a r y k r a f t , m d , v i c e p r e s i d e n t a n d d i r e c t o r d i r e c t o r d i r e c t o r d i r e c t o r v i c e c h a i r

a a r o n m. l e a v i t t , m d , m i c h a e l f a r r e l l , l u i s t. s a n c h e z , m d , d e b r a a. g r o s s b a u m , e s q ., d i r e c t o r t r e a s u r e r c h i e f o p e r a t i n g o f f i c e r c l e r k a n d d i r e c t o r

12 the clinical Advisory Committee b a c k r o w (l e f t t o r i g h t ): l i n d a b r e s n a h a n , m i c h a e l d r e w , m d , j o h n r e n n e r , j r, m d , j o h n w o l f e , m d , d a n i e l m c c u l l o u g h , m d , w i l l i a m s h e a , m d , j u d i t h e a t o n , m d , z e v s c h u m a n -o l i v i e r, m d , d a v i d l o v a s , m d , l u i s s a n c h e z , m d , d u b r a v k o k u f t i n e c , m d , d e b r a g r o s s b a u m , a a r o n l e a v i t t , m d , m a r k a l b a n e s e , m d . f r o n t r o w : g l e n n p r a n s k y , m d , k a r s t e n kueppenbender , m d , j o h n m a t t h e w s , m d , e d w a r d k h a n t z i a n , m d , m a l k a h n o t m a n , m d , m a r y k r a f t , m d , j a c q u e l i n e s t a r e r , m d . n o t p i c t u r e d : b o o k e r b u s h , m d , p e t e r c o n n o l l y , m d , j o h n l. d o h e r t y , m d , j o h n a. f r o m s o n , m d , w a y n e a. g a v r y c k , m d , j o h n r. k n i g h t , m d , b e r n a r d s. l e v y , m d , m i c h a e l s. p a l m e r , m d , t h o m a s s t i n s o n , m d .

The Advisory Committee John G. O’Brien, President and Chief Luis T. Sanchez, MD, Chair The PHS Advisory Committee consists of Executive Officer, UMass Memorial Mark J. Albanese, MD representatives from our major funding Health Care J. Wesley Boyd, MD, PhD organizations listed on page 20. The committee Luke Sato, MD, Chief Medical Officer and Booker Bush, MD meets approximately two to three times each Vice President, Risk Management Foundation year to provide additional perspectives and Peter Connolly, MD of the Harvard Medical Institutions assistance to PHS on the following matters: John L. Doherty, MD * The development of educational and Mary Anna Sullivan, MD, Chair of the Michael A. Drew, MD outreach programs Department of Psychiatry and the Division Judith Eaton, MD * Interfacing PHS with risk management of Medical Specialties and Medical Director John A. Fromson, MD of Quality and Safety, Lahey Clinic programs Wayne A. Gavryck, MD * Acting as a liaison to educational Paul Summergrad, MD, Frances Arkin Edward J. Khantzian, MD institutions Professor and Chair, Department of John R. Knight, MD * The identification of new opportunities Psychiatry, Tufts University School of Mary Kraft, MD for PHS involvement Medicine; Psychiatrist-in-Chief, Tufts Karsten D. Kueppenbender, MD Enhancing community participation Medical Center * Dubravko M. Kuftinec, MD Aaron M. Leavitt, MD David H. Bor, MD, Chief of Medicine, The Clinical Advisory Bernard S. Levy, MD Cambridge Health Alliance Committee David Lovas, MD Richard W. Brewer, President and Chief This distinguished committee of volunteer John D. Matthews, MD Executive Officer, ProMutual Group experts on physician health provides assistance on specific case matters such Dan McCullough, MD Loring S. Flint Jr., MD, Senior as evaluation, referral for treatment, and Malkah T. Notman, MD Vice-President of Medical Affairs, monitoring of physicians based on anony- Michael S. Palmer, MD Baystate Health Systems mous case presentations. The members Glenn S. Pransky, MD of the PHS Clinical Advisory Committee Robert Hanscom, Director of Loss include a broad representation of specialties. John A. Renner Jr., MD Prevention, Risk Management Foundation They serve as peer-review consultants to Zev D. Schuman-Olivier, MD of the Harvard Medical Institutions PHS for one-year terms and are nominated William Shea, MD Anne Huben-Kearney, RN, CPHQ, by the PHS director and approved by the Jacquelyn Starer, MD PHS Board of Directors. Our dedicated CPHRM, Vice President of Risk Thomas Stinson, MD Management, ProMutual Group committee members volunteer their time to John C. Wolfe, MD assist PHS.

13 the research Committee l e f t t o r i g h t : l o n s h e r r i t t , j o h n k n i g h t , m d , l u i s s a n c h e z , m d , j o h n f r o m s o n , m d , l i n d a b r e s n a h a n , a n d m a r y h o w a r d . n o t p i c t u r e d : j. w e s l e y b o y d , m d , p h d .

The Research Committee 66%, p=.04). Survival analysis indicated The PHS Research Committee was that time to relapse was significantly shorter established in 2001 as part of a strategic for women compared to men on both types effort to increase the scientific knowledge of contracts (log rank test for equality of base in the field of physician health. The survival distribution, p<.001 for MBH and goal of our first study was to assess PHS p=.001 for SUD). We concluded that physi- participants’ satisfaction.1 We found that cians with MBH problems can be monitored participants’ ratings of PHS services were in a similar fashion to physicians with SUDs high, and satisfaction was associated with and with similarly positive outcomes. How- lack of relapse (mean rank=47.6 versus ever, greater attention should be given to 30.0, p=.005) but not with gender (p=.47), services for women in physician health type of contract (p=.39), source of referral monitoring programs. (p=.75-.05), or Board of Registration in During the past year, we completed a Medicine involvement (p=.24). We concluded satisfaction survey of those who have served that participants’ satisfaction with the PHS as chiefs of service, workplace monitors, program was influenced more by positive psychiatrists, or therapists for our clients. clinical outcome than other factors. We reported the results at the 2009 Annual The goal of our second study was to assess Meeting of the Federation of State Physician the outcomes of the PHS monitoring pro- Health Programs. The committee’s future gram. Prior reports indicated varying rates of goal is to advance PHS’s data-collection success for physician treatment and monitor- capabili­ties in order to better determine the ing programs, and definitions of success correlates of optimal outcomes and possible and methods of assessing it varied widely. predictors of relapse. The goals of our next Applying vigorous criteria to define success, study will be to examine the association we analyzed the outcomes of PHS partici- between dilute laboratory specimens and In addition to his associate director responsibili- ties, Dr. John Knight serves as chair of the pants who initiated a first contract between relapse and the association between Research Committee. He is also the director 1993 and 2003. Our report was the first pub- prescriptions for psychoactive drugs and of the Center for Adolescent Substance Abuse lication of results of physician monitoring relapse. Research at Children’s Hospital Boston and an for mental and behavioral health.2 We found associate professor of pediatrics at Harvard that, of 58 physicians with mental and be- 1. Knight JR, Sanchez LT, Sherritt L, Bresnahan LR, Silveria Medical School. Dr. Knight is the principal havioral health (MBH) contracts, 43 (74%) investigator of several grants from the National JM, Fromson JA. Monitoring physician drug problems: completed successfully, 7 (12%) relapsed, Institutes of Health to conduct his innovative attitudes of participants. J Addict Dis. 2002;21(4):27-36. research into the early recognition and treat- and 8 (14%) did not complete for other rea- 2. Knight JR, Sanchez LT, Sherritt L, Bresnahan LR, ment of adolescent substance abuse. These sons. Of 120 total physicians with substance Fromson JA. Outcomes of a monitoring program for awards include an Academic Career Award use disorder (SUD) contracts, 90 (75%) physicians with mental and behavioral health problems. (K07) from the National Institute on Alcohol completed successfully, 10 (8%) relapsed, J Psychiatr Pract. 2007;13(1):25-32. Abuse and Alcoholism and three Independent and 20 (17%) did not complete for other Investigator Awards (R01) from the National reasons. Successful completion of SUD Institute on Drug Abuse, including an Interna- contracts was significantly associated with tional Supplement for Drug Abuse Research in the Czech Republic. licensing board involvement (84% versus

14 “There are many complex issues to consider when dealing with medical students’ academic performance, health, and personal situations — balancing individual confidentiality, providing optimal treatment and assistance during training, and realistically preparing them for licensing and residency. Having the opportunity in this committee to discuss these issues with colleagues from our four different medical schools in the context of Dr. Sanchez and his associates’ extensive experience with practicing physicians has been invaluable.”

— Laurie Raymond, MD

Medical Student Medical School Representatives Advisory Committee Boston University School of Medicine The PHS Medical Student Advisory John Polk, MD, Assistant Dean of Committee’s purpose is to provide a forum Student Affairs for the exchange of information among Harvard Medical School medical schools on issues of student health, Laurie Raymond, MD, Director, wellness, and professionalism in order to Office of Advising Resources develop effective strategies to educate and assist medical students who have or are at Harvard University Health Services risk of having problems with substance use, Peter J. Massicott, MD, Director, behavioral health, or mental or physical Medical Area Health Service illness. Tufts University School of Medicine The Medical Student Advisory Committee Janet S. Kerle, Associate Dean for Students is a standing committee that was appointed by the PHS Board of Directors in 2004. Tufts University School of Medicine The committee established its mission state- Deborah B. Quinn, Director, Student ment, goals and objectives, and developed Advisory and Health Administration Office medical student monitoring contracts for University of Massachusetts Medical School both substance use and behavioral health James Broadhurst, MD, Director, monitoring. Additionally, the committee AIMS Program formed a subcommittee that is seeking fund- ing to conduct research to help identify University of Massachusetts Medical School stressors and barriers for medical students Ruthann Rizzi, MD, Director, who want to get help while attending Student Counseling Service, Assistant medical school. PHS continues to explore Professor of Psychiatry funding alternatives to help support the University of Massachusetts Medical School growing need for medical student outreach, Mai-Lan Rogoff, MD, Associate Dean support, and monitoring. for Student Affairs, Associate Professor of Psychiatry

Medical Student Advisory Committee b a c k r o w (l e f t t o r i g h t ): d e b r a g r o s s b a u m , e s q ., j­ a n e t k e r l e , j a m e s b r o a d h u r s t , m d , l­ a u r i e r­ a y m o n d , m d , l u i s s a n c h e z , m d , ­p e t e r m a s s i c o t t , m d , r u t h a n n r i z z i , m d , a n d j e s s i c a v a u t o u r . f r o n t r o w : d e b b i e q u i n n , j o h n p o l k , m d , m a i -l a n r o g o f f , m d , a n d l i n d a b r e s n a h a n .

15 The Associate Directors & J. Wesley Boyd, MD, PhD, joined Physi- Assessment Director cian Health Services in 2004. Dr. Boyd Functioning as independent contractors, completed his medical degree and a doctoral PHS associate directors provide outreach, degree in religion and culture at the Univer- intervention, treatment referrals, clinical sity of North Carolina at Chapel Hill, and monitoring, and assessment for any physician, then trained in the adult psychiatry residency resident, or medical student referred to PHS. program at Cambridge Hospital/Harvard The success of PHS is based on the program’s Medical School. During his residency, he confidentiality protections and the personal also completed a fellowship in medical collegial support provided by its associate ethics through Harvard Medical School. directors who guide physicians through He has taught medical ethics and the treatment and recovery. humanities in various venues. In addition to his work with PHS, Dr. Boyd is on staff Sara Bolton, MD, joined Physician Health in psychiatry at Cambridge Health Alliance Services as the assessment director in July and on the faculty at Harvard Medical 2009. Dr. Bolton completed her medical School in the Department of Psychiatry. degree at Harvard Medical School. She trained at the McLean-Mount Auburn Judith Eaton, MD, has been an associate Combined Program in Psychiatry with a director for PHS since its inception. She fellowship in neuropsychiatry at Harvard was in practice for 27 years. She retired Medical School. She is currently a candidate from her private practice of psychiatry in of the Boston Psychoanalytic Society and Worcester in January 2008. She is certified Institute. She is board certified by the by the American Board of Psychiatry and American Board of Psychiatry and Neurology Neurology. and is an assistant clinical professor of psychiatry at Harvard Medical School and associate psychiatrist at McLean Hospital She is also a consultant at The Levinson Institute and holds various leadership roles with the institute’s affiliations.

16 Wayne A. Gavryck, MD, is certified by the American Board of Internal Medicine and the American Society of Addiction Medicine. He currently practices internal medicine in Turners Falls. He has been an associate director for PHS since its inception. Dr. Gavryck is also a certified medical review officer, and he serves PHS in this capacity. s a r a m. b o l t o n , m d , j. w e s l e y b o y d , m d , p h d , a s s e s s m e n t d i r e c t o r — b o s t o n a n d s o u t h e a s t a l l r e g i o n s r e g i o n John R. Knight, MD, is a fellow of the American Academy of Pediatrics and board certified in developmental-behavioral pediatrics. He is director of the Center for Adolescent Substance Abuse Research at Children’s Hospital Boston and an associate professor of pediatrics at Harvard Medical School. Dr. Knight has served as an associate director for PHS since its inception, and he is the program’s research consultant. j u d i t h e a t o n , m d , w a y n e a. g a v r y c k , m d , Michael S. Palmer, MD, is board certified w o r c e s t e r r e g i o n springfield /w e s t e r n massachusetts r e g i o n in internal medicine and has practiced both internal medicine and emergency medicine. He is a clinical instructor in medicine at Tufts University and previously served on the faculties of Harvard Medical School and the University of Cincinnati School of Medicine. He has been working in the area of physician health since 1982. He is currently an associate director emeritus, having taken leave from his work with PHS while writing books. j o h n r. k n i g h t , m d , m i c h a e l s. p a l m e r , m d , b o s t o n -c e n t r a l r e g i o n a s s o c i a t e d i r e c t o r John C. Wolfe, MD, FACP, joined e m e r i t u s Physician Health Services as an associate director in 2004. Dr. Wolfe is a graduate of Cornell University Medical College. He completed an internship and residency in internal medicine and a yearlong fellow- ship in infectious disease at the New York Hospital-Cornell Medical Center. After training, Dr. Wolfe served in the U.S. Army Medical Corps, was the chief of medicine at Addison Gilbert Hospital, and served on the Board of Trustees of Partners Community j o h n c. w o l f e , m d , f a c p , n o r t h s h o r e r e g i o n Health, Inc. He is a certified medical review officer. He currently gives a summer course in addiction medicine for counselors at Rutgers University. He retired from his internal medicine practice in 2008.

17 The Staff Our staff expertly handles the diverse array of tasks required to keep the program devel- oping and operating on a day-to-day basis while offering the best possible service and assistance to physicians. Physician Health Services is proud to introduce a professional, experienced, and dedicated staff.

l i n d a r. b r e s n a h a n , m s , d e b r a a. g r o s s b a u m , Linda R. Bresnahan, MS, is responsible for d i r e c t o r o f p r o g r a m e s q ., s e n i o r a s s o c i a t e o p e r a t i o n s c o u n s e l the daily operations of PHS. She establishes and manages all administrative, educational, and operational activities. She coordinates PHS’s governance meetings and committee activities, and she oversees information technology and the procedures necessary to support physician case management. Ms. Bresnahan received her bachelor’s degree in economics with a concentration in management information systems from Boston College. She received her master of j e s s i c a l. v a u t o u r , m m , d e b o r a h j. b r e n n a n , o u t r e a c h a n d s e c r e t a r y a n d m e d i c a l science degree in health care management e d u c a t i o n m a n a g e r transcriptionist with a specialization in substance abuse services from Lesley College and has worked in physician health for more than 16 years. Ms. Bresnahan also contributes nationally to the work of physician health, serving as a board of director’s officer of the Federation of State Physician Health Programs.

Debra A. Grossbaum, Esq., oversees all legal aspects of PHS, including issues of confidentiality, interpretation of relevant m a r y m. h o w a r d , s h a r i l. m a h a n , m o n i t o r i n g s e r v i c e s s e c r e t a r y regulations and statutes, and PHS contracts. a s s i s t a n t She reviews all participant contracts, negoti- ates vendor agreements, and works closely with the Board of Registration in Medicine. She also represents PHS with respect to corporate legal matters since PHS is a 501(c) (3) subsidiary corporation of the Massachu- setts Medical Society. Ms. Grossbaum chairs the Bylaws Committee of the Federation of State Physician Health Programs, and she is a member of the American Bar Association, d e b o r a h m. c a n a l e , the Massa­chusetts Bar Association, and the c l i e n t s e r v i c e s a s s i s t a n t American Society of Medical Association Counsel. Ms. Grossbaum is a graduate of Brown University and the Boston University School of Law.

18 Jessica L. Vautour, MM, is responsible for Deborah J. Brennan handles all of the Shari L. Mahan provides administrative the supervision of administrative staff and medical transcription for PHS. She also support and assistance to PHS, preparing oversees training for all administrative assists with other projects and special events correspondence and coordinating special activities. She is responsible for managing and provides administrative support and mailings and events. She also provides and implementing all PHS outreach and assistance to PHS on a part-time basis. administrative support and assistance to educational programs. Ms. Vautour received Ms. Brennan has an extensive background PHS regarding expense reports, payment her bachelor’s degree in accounting from in health care as an administrative assistant requests, and travel coordination. Ms. Bentley College and her master’s degree with the Massachusetts Medical Society Mahan also oversees laboratory billing and in management from Cambridge College. and PHS for more than 18 years. facilitates the PHS donation process. Ms. She has an extensive background in health Mahan received her bachelor’s degree in Mary M. Howard coordinates all monitor- care management and has been with the psychology from Oklahoma State University. ing service activities and quality manage- Massachusetts Medical Society for more ment, which consists of primary support for Deborah M. Canale monitors and than 16 years. Additionally, Ms. Vautour the random drug testing program, placing maintains all client activity data including has been a member of the Massachusetts random test calls, reviewing lab results, and the intake data process, new contracts, Association of Medical Staff Services tracking and maintaining reports of positive monitor changes, and case transactions. (MAMSS) for more than 11 years. She results and prescribed medications. She also She provides administrative assistance is currently serving on the MAMSS Board coordinates the quarterly report process for for all documentation related to clients, of Directors as part of the organization’s PHS participants under contract and for including coordinating requests for leadership. the Board of Registration in Medicine. Ms. information from third parties, such as Howard received her bachelor’s degree in compliance documentation and consent biology from Brown University. She has a forms. Ms. Canale received her bachelor’s background in bookkeeping and data admin- degree in psychology from the University istration as well as health care and research. of Lowell.

19 Year in Review

Major Contributors to PHS at a minimum level of $30 per The following organizations provide insured physician and contribute greater PHS with essential financial support in than $5,000. Physician Health Services and recognition of the critical value of good the Massachusetts Medical Society gratefully health in the performance of physicians. acknowledge their consistent support in The contributors featured here are improving the health of physicians. committed to annual contributions

b a y s t a t e h e a l t h s y s t e m s b e r k s h i r e h e a l t h s y s t e m s b o s t o n m e d i c a l c e n t e r c a r i t a s c h r i s t i l o r i n g s. f l i n t , m d , a l e x n. s a b o , m d , e l a i n e u l l i a n , p r e s i d e n t h e a l t h c a r e s e n i o r v i c e p r e s i d e n t c h a i r a n d p r o g r a m a n d c h i e f e x e c u t i v e r a l p h d e l a t o r r e , m d , o f m e d i c a l a f f a i r s d i r e c t o r , d e p a r t m e n t o f f i c e r p r e s i d e n t a n d c h i e f o f p s y c h i a t r y a n d e x e c u t i v e o f f i c e r b e h a v i o r a l s c i e n c e s

connecticut l a h e y c l i n i c p h y s i c i a n s i n s u r a n c e p r o m u t u a l g r o u p m e d i c a l i n s u r a n c e d a v i d m. b a r r e t t , m d , a g e n c y o f massachusetts r i c h a r d w. b r e w e r , c o m p a n y (c m i c ) p r e s i d e n t a n d c h i e f (t h e independent p r e s i d e n t a n d c h i e f s u l t a n a h a m e d , m d , e x e c u t i v e o f f i c e r i n s u r a n c e s u b s i d i a r y e x e c u t i v e o f f i c e r m b a , p r e s i d e n t a n d o f t h e massachusetts c h a i r m e d i c a l s o c i e t y ) j o h n f. k i n g , p r e s i d e n t

The success of Physician Health Services stems from the partnership of the profession of medicine with the Massachusetts Medical Society and our group of outstanding contributors. r i s k m a n a g e m e n t t u f t s m e d i c a l c e n t e r u m a s s m e m o r i a l f o u n d a t i o n o f t h e p a u l s u m m e r g r a d , m d , h e a l t h c a r e PHS’s contributors recognize the risk h a r v a r d m e d i c a l f r a n c e s a r k i n j o h n g. o’b r i e n , p r e s i d e n t institutions (c r i c o /r m f ) p r o f e s s o r a n d c h a i r a n d c h i e f e x e c u t i v e management benefits of our services. l u k e s a t o , m d , c h i e f o f t h e d e p a r t m e n t o f f i c e r m e d i c a l o f f i c e r a n d o f p s y c h i a t r y , v i c e p r e s i d e n t t u f t s u n i v e r s i t y s c h o o l o f m e d i c i n e ; psychiatrist -i n -c h i e f , t u f t s m e d i c a l c e n t e r

20 Fiscal Year 2009: June 1, 2008, to May 31, 2009

r i s k m a n a g e m e n t Financial Sources f o u n d a t i o n o f t h e h a r v a r d b e r k s h i r e h e a l t h s y s t e m s 0.5% m e d i c a l institutions t u f t s m e d i c a l c e n t e r 2.1% (c r i c o /r m f ) connecticut m e d i c a l 25.5% i n s u r a n c e c o m p a n y (c m i c ) 1.9% massachusetts p h y s i c i a n s i n s u r a n c e a g e n c y m e d i c a l s o c i e t y o f massachusetts 1.5% 37.8% b o s t o n m e d i c a l c e n t e r 1.3% l a h e y c l i n i c 1.0% p r o m u t u a l b a y s t a t e h e a l t h s y s t e m s 1.1% g r o u p u m a s s m e m o r i a l h e a l t h c a r e 0.5% 18.2% o t h e r c a p e c o d h e a l t h c a r e 0.2% 7.9% c a r i t a s c h r i s t i h e a l t h c a r e 0.5%

a s s o c i a t e d i r e c t o r s Expenses 26.6% m e e t i n g e x p e n s e s 3.2% p r o g r a m s 2.5% r e s e a r c h 1.1% o v e r h e a d 4.7% a l l o t h e r 6.9% s t a f f 55.0%

Pre-audit

Those WHO have GiVEn Department of Opthalmology, North Shore Medical Center Physicians SUPPORT FOR Massachusetts Eye and Ear P. Herbert Leiderman, MD THEIR HEALTH Donna Singer Consulting, LLC Quincy Medical Center Medical Staff In addition to the contributors listed on Dr. & Mrs. Edward J. Khantzian Richard W. Brewer page 20, individuals and numerous health Dr. & Mrs. Walter J. Rok care organizations have also contributed Sheldon Roth, MD to PHS. PHS is enormously appreciative of Dr. Edith M. Jolin & Dr. Richard Pieters Southcoast Hospital Group the generosity of its donors. There are also Dr. Geoffrey Sherwood Winchester Hospital Medical many participants in the PHS program who Drew Brodsky, MD & Allied Healthcare Staff contribute each year to the Annual Dinner Drs. Stephen & Kathleen Hoye In honor of Michael Palmer, MD Fund, which supports physicians, residents, Greater Fall River CME Program Anonymous and medical students who would otherwise HealthAlliance Physicians be unable to attend this special event. In honor of Dr. Jack Evjy Every effort has been made to ensure the Jack and Sheila Evjy Drs. Joseph L. & Joanne Wilkinson Dorsey accuracy of our donors’ names. We regret James Broadhurst, MD, MHA In honor of Dr. Luis Sanchez any errors or omissions. Please notify us John Katzenberg, MD George E. Ghareeb, MD with any questions or concerns. Jordan Hospital Medical Staff In memory of Barbara Niemi David & Debra Grossbaum Alan P. Moss, MD L. Corey Hanley, MD In memory of Barbara Niemi Andrew Balder, MD Lee S. Perrin, MD & Karen Mann Linda & John Bresnahan Anna Jaques Hospital Mary Anna Sullivan, MD In honor of Dr. Alex Sabo Massachusetts Association of Austen Riggs Center Rebecca L. Johnson, MD Medical Staff Services Cooley Dickinson Hospital In honor of Bernard Levy, MD Morton Hospital and Medical Center Corinne Broderick W. Scott Liebert Nashoba Valley Medical Center In memory of Robert H. Downes

21 Case Activity for Fiscal Year Case Descriptions 2009: June 1, 2008, to May 31, 2009 During the past year, PHS provided services During the past year, PHS has improved aimed at: improving physicians’ health; physicians’ lives in the following ways: saving physician lives, families, and careers; assisting physicians with health issues to * 247 physicians have been helped practice their profession with skill and directly through personalized consultative safety; and educating physicians, other support services and monitoring contracts. healthcare professionals, and healthcare organizations about physician health and * 127 new physicians and medical recovery. During the past year, 30 physicians students were referred this year successfully completed monitoring contracts. (see referrals in Figure 1). PHS addresses a broad range of physician health issues (listed by category in Table 1). 140 health care professionals consulted * Behavioral health continues to be the largest with PHS for resources. These services are group (n=51), followed by substance use provided to physicians, hospital administra- disorders (n=38) and single-diagnosis mental tors, attorneys, and anonymous individuals health (n=26). Eight physicians had co- who contact PHS for advice regarding occurring mental health and substance use administrative, clinical, and legal matters disorders, and 3 physicians had physical pertaining to physicians with health or disabilities. behavioral concerns.

* 43 educational sessions were provided by PHS for physicians, hospitals, and individual practices. An estimated 3,200 physicians, medical students, and health care professionals were in attendance at the physician health education offerings this year.

Figure 1: Physicians Referred to PHS Over the Past Six Years

150 146 135 135 128 130 127 120

90

60

30

0 2004 2005 2006 2007 2008 2009

N= physicians referred to PHS.

22 Table 1: PHS Physician referrals by presenting problem — Fiscal Year 2009

presenting problem N % Behavioral Health* 75 59 Mental Health** 1 .8 Alcohol 20 15.7 Drug 4 3.2 Physical Illness 5 3.9 Drug & Mental Health 1 .8 Drug & Alcohol 6 3.2 Alcohol & Mental Health 4 1.6 Drug, Alcohol, & Mental Health 2 4.7 Other*** 9 7.1

N=127 physicians referred to PHS this year. *Behavioral health includes personality problems, interpersonal conflicts, boundary issues, and stress. **Mental health includes depression, anxiety, and bipolar disorder. ***Other includes clinical competency, career counseling, and financial issues.

Table 1: PHS Physician referrals by specialty and level of training — Fiscal Year 2009

Specialty N %

Internal Medicine 33 26 Surgery‡ 20 15.7 Family Practice 8 6.3 Anesthesiology 9 7.1 Psychiatry 10 7.9 Pediatrics 13 10.2 OB/GYN 6 4.7 Emergency Medicine 6 4.7 Radiology 2 1.6 Other§ 3 2.4 level of training Residents (All Specialties) 11 8.7 Medical Students 6 4.7 Total 127

‡Surgery includes ophthalmology, general surgery, and urology subspecialties. §Other includes pathology and research.

23 Outreach Activities: * Leominster Hospital June 1, 2008, to May 31, 2009 * Marsh/Mercer/Kroll/Mercer Oliver Wyman PHS presentations provide information * Massachusetts Psychiatry Society — Risk on physician health issues and the role of Management PHS, including a discussion on how to MetroWest Medical Center (House identify those at risk, factors that can impact * Officer Lecture Series) patient care, ways to access help, and steps to improve the physician-patient * Middlesex Central District Medical relationship. Society * Modern Medicine on AM590 WROW An estimated 3,200 physicians and * Morton Hospital & Medical Center medical students were in attendance at these Nashoba Valley Medical Center physician health education offerings this * year. * National Organization of Bar Counsel Mid-Year Meeting 3rd Spanish Congress on Doctor’s Health * * Newton-Wellesley Hospital Programs (PAIME) — Barcelona * North Shore Medical Center — Union * AMA-BMA-CMA International Hospital Conference on Physician Health * Quincy Medical Center * Anna Jaques Hospital * Saint Anne’s Hospital * Annual Dermatology Meeting * St. Luke’s Hospital Annual Mississippi Addictions * Tufts Medical Center — Psychiatry Conference * Residents * Baystate Medical Center * Tufts University Family Medicine * Beth Israel Deaconess Medical Center — Residency Program (Malden) Anesthesiology Grand Rounds, Patient Tufts University School of Medicine — Care Assessment and Quality Committee, * 2nd Year Students and PGY1s UMass Medical Center — Medical Boston University School of Medicine — * * Students First-Year Class * Winchester Hospital * Bournewood Hospital * Brigham & Women’s Hospital — Board of Trustees If we haven’t been to your hospital or * Brigham & Women’s Hospital health care organization, please contact (Anesthesia Department and Residents) us at (781) 434-7404 or complete the * Charlton Memorial Hospital speaking engagement request form on page 33. * CMA Physicians and Dentists Confidential Line * Cooley Dickinson Hospital * Dana-Farber Cancer Institute * Harvard Anesthesia Review Course * Harvard Medical School — Introduction More than 3200 physicians and medical to Lifestyle Medicine students were in attendance at PHS * Harvard Medical School — Liability presentations across Massachusetts this Prevention for Physicians and Health past year. Care Professionals: Strategies and Update, 2008 * Indian Medical Association of New England (IMANE) * Jordan Hospital * Lawyers Concerned for Lawyers, Inc. * Lemuel Shattuck Hospital

24 Facing the Loss of a Physician PHS experiences great sadness when a physician is lost as a result of an illness or unexpected death. During times such as these, PHS makes an effort to provide support to the physician’s family and colleagues. We recognize the tremendous grief a family faces and share each loss with the medical community. It is important for PHS to ensure that outreach is supportive, comprehensive, and helpful while also remaining respectful of physician confidentiality.

Additional PHS Services

www.physicianhealth.org The website has helped enhance outreach, The Physician Health Services website, education, and fundraising opportunities www.physicianhealth.org, can be accessed for PHS. It is our goal to make our services directly or via a link at the bottom of the known to every physician and health care Massachusetts Medical Society homepage, organization in the state. PHS has carefully www.massmed.org. The PHS site features selected menu options displayed across the integrated search capabilities and user- top of the homepage and down the left- friendly accessibility. The site’s primary hand side to support easy navigation and PHS Educational DVD audiences are physicians, their families, highlight primary informational topics. We The PHS educational DVD is available at and health care organizations. invite you to view our website and learn no cost to hospitals, medical schools, and more about PHS. health care professionals. It can be viewed The key areas of the website are as follows: independently or as a complement to a PHS * About PHS lecture given by a physician associated with How to Make a Referral PHS. The DVD includes an overview of * the mandated reporting statute and the * Helping Yourself or a Colleague exception to reporting as it pertains to (This special section includes personal substance use disorders. stories from physicians who have participated in the program.) For a copy of the DVD, please call (781) * Education and Resources 434-7404 or e-mail [email protected]. * The Joint Commission Requirement * Relationship to the Medical Board * How to Make a Donation

25 June 2008 to May 2009 * Support 30 More Years of Caring for Massachusetts Physicians, Volume 13, Issue 6 (June/July 2008) * Single Parenting Can Be Particularly Challenging for Medical Professionals, Volume 13, Issue 7 (August 2008) * The Role of the BRM’s Physician Health and Compliance Unit, Volume 13, Issue 8 (September 2008) * Recognizing Stress Is the First Step in Easing It, Volume 13, Issue 9 (October 2008) * PHS Associate Directors Author Chapter on Substance Use Disorders among Physicians, Volume 13, Issue 10 (November 2008) * Survey Shows High Level of Satisfaction with Physician Health Services, Volume Vital Signs 14, Issue 1 (December 2008/January 2009) Physician Health Services features a * Guidelines for Pain Management in monthly column in the Medical Society’s Physician-Patients, Volume 14, Issue 2 member newsletter, Vital Signs. The column (February 2009) is dedicated to timely topics of interest * Malpractice Carriers See Benefits of related to physician health and wellness. Managing Physicians’ Health Risks, You can contact PHS for a copy of any of Volume 14, Issue 3 (March 2009) the articles, or visit www.massmed.org and Physicians May Be Included in the Ranks click on “News and Publications.” For a * of High-Functioning Alcoholics, Volume complete listing of articles on related topics, 14, Issue 4 (April 2009) search for “physician health” within the Peer-to-Peer Conversations Can Raise Vital Signs section. * Awareness of Disruptive Physician Behavior, Volume 14, Issue 5 (May 2009)

26 Outreach & Education As of January 1, 2001, the Joint Commission 13th Annual Participants’ Dinner Articles, Presentations, and Consulting adopted a physician health requirement One of the most important activities of (Physician Health MS.2.6). In 2004, the PHS organizes a special dinner event PHS is educating physicians, residents, Joint Commission further expanded the each fall for PHS participants. The medical students, health care administrators, requirement to all health care professionals dinner provides an opportunity to (LIP Health MS.11.01.01). This provision hospitals, HMOs, and the public regarding update participants on program activities, requires the medical staffs of all hospital the prevention, early identification, and introduce the associate directors and organizations to implement a process to treatment of addiction and other illnesses staff of PHS, and share experiences of identify and manage the health of licensed, that affect physicians. Areas emphasized strength and hope. Physicians who have independent practitioners separate from include stress prevention, prescribing successfully completed the PHS program the medical staff disciplinary functions. practices, communication skills, and time in the past or who are presently involved One element of the Joint Commission management. PHS also provides education in the program are invited to attend. regarding the types of services we offer, requirement is annual education on matters which are not limited just to substance use of physician health. PHS consults with disorders. Our services include assistance medical staff, medical executive committees, with physical, emotional, and behavioral and hospitals throughout the state to assist problems as well. them in implementing and maintaining this requirement by providing presentations. Articles regarding issues of physician well-being are a regular feature in Vital Signs, In addition, effective January 1, 2009, the monthly member publication of the for all accreditation programs, the Joint Massachusetts Medical Society. These Commission has a new leadership standard articles also appear on the Massachusetts (LD.03.01.01) that addresses disruptive Medical Society website at www.massmed. and inappropriate behaviors in two of its org. PHS regularly exhibits materials at elements of perfor­mance. First, the hospital/ conferences and professional meetings, organization must have a code of conduct where we are able to personally meet with that defines acceptable and disruptive and physicians and present the various ways in inappropriate behaviors (EP 4). Second, which the program can be of service to leaders must create and implement a process them. for managing disruptive and inappropriate behaviors (EP 5). Additionally, standards PHS Is Available to Your Hospital or in the medical staff chapter have been Medical Practice organized to follow six core competencies PHS is available to provide tailored to be addressed in the credentialing educational programs appropriate for process, including interpersonal skills and hospital grand rounds, group medical professionalism (see the introduction to practices, health care organizations, and MS.4). PHS is available for consultation specialty society meetings. Our goal is with medical staff and hospital leadership to reach every health care organization on policies in these areas, individual and medical school on an annual basis. circumstances, or educational programs. Presentations are eligible for CME credit Presentations provide up-to-date informa- and meet the criteria for risk management tion on physician health issues and the study. Please contact us to coordinate an role of PHS, including a discussion on how educational program at your organization. to identify those at risk, factors that can impair patient care, ways to access help, and steps to improve the physician-patient relationship. An educational DVD about PHS, brochures, and other supportive materials are also available.

The speaking engagement request form can be found on page 33.

27 “The Physician Health Services peer support group meets three times a month with 10 to 15 people present each time. It is a joy for me to see them change. Calling themselves different people now, they often describe becoming wiser, more careful, each a more educated and better doctor with a much better perspective. They say they feel good that they can bring their worst nightmares here, public and private. One of their goals is to teach other beginning doctors what they have learned.”

— Diana Barnes Blood, Support Group Facilitator

Support Groups

For physicians, medical students, and resi- group meets on the second and fourth dents seeking support from other physicians Wednesday and fourth Monday of each in recovery, PHS coordinates several weekly, month from 6:30 to 7:45 p.m. in Waltham. confidential physician support group meetings * Greenfield Group — This group meets on throughout the state. Please contact PHS Wednesdays from 7:00 to 8:00 p.m. in at (781) 434-7404 for more information Greenfield. regarding the times and locations of these * Tuesday Evening Support Group — This meetings. Some groups require meeting with group meets from 7:00 to 8:00 p.m. in a facilitator before attending the first meet- Falmouth. ing. As always, contact and involvement Faith-Based Support Group — This with PHS is confidential. * weekly men’s group, affiliated with the Vineyard Christian Fellowship PHS Support Group List of Cambridge, provides support to Monday and Thursday Support * professionals and others within a faith- Group — This facilitated group follows based context. The group meets on AA guidelines and is held on Mondays Mondays from 8:00 to 10:00 p.m. in and Thursdays at 7:00 p.m. in Waltham. Brookline. First and Third Wednesday Support * Worcester Monday Doctors’ 12-Step Group — This group is open to spouses * Group — This group is open to any and significant others in addition to the doctoral-level health care professional affected physician. It is sponsored by with substance use concerns. It meets PHS and meets on the first and third every other Monday from 7:30 to 8:30 p.m. Wednesday of each month from 7:00 to in Worcester. 8:30 p.m. in Waltham. Health Care Professionals Recovery Physician Health Support Group * * Group — This weekly meeting is a self- (second and fourth Wednesday and help format group open to any licensed fourth Monday) — This three-times- health care professional. The group meets per-month behavioral health support every Tuesday from 7:00 to 8:00 p.m. in group meeting is designed to respond to Pittsfield. the needs of physicians, residents, and medical students who are experiencing the rigors of medicine and who could benefit In addition to PHS support groups, a list of from collegial support. The focus is on AA meetings is available from AA Central strengthening the ability to effectively Service, 368 Congress Street, Boston, (617) deal with patients, employers, hospitals, 426-9444. PHS can provide information coworkers, colleagues, peers, family on a number of other professional peer- members, and significant others. The support groups as well.

28 Following are some Continuing Medical comments from course attendees: Education Program “I feel like I have learned to think more positively.”

Managing Workplace Michele G. Kayden, PhD, Organizational “The whole session was enlightening as Conflict: Improving Personal Psychologist, Executive Behavioral Coach, well as inspiring.” Effectiveness and Principal, Kayden Enterprises “The peer interaction was very useful.” Jointly sponsored by the Massachusetts Kenneth Kraft, PhD, Clinical and Medical Society and Physician Health Organizational Psychologist “I believe I will be more effective in Services, Inc. Joseph Pereira, LICSW, CAS, Clinical communicating with other physicians.” Recognizing that disruptive behaviors can Social Worker, Outlook Associates of New “A great course that I will recommend to impact and interfere with a physician’s England my colleagues. Thank you.” ability to practice medicine effectively, PHS Julia M. Reade, MD, Director, Harvard designed the Managing Workplace Conflict Forensic Psychiatry Fellowship, and Clinical “The content increased my self- program to help attendees assess difficult Associate in Psychiatry, Massachusetts awareness in stressful situations.” relationships and stressful situations and General Hospital consider ways to respond differently to “I now have better tools for management minimize conflict. Jessica L. Vautour, MM, Outreach and of conflict.” Education Manager, Physician Health Twice each year, PHS offers this interactive Services, Inc. “I feel I can achieve more without program, which combines didactic presenta- conflict.” tions, role-playing exercises, and focused Course Instructors feedback for physicians with motivation to Ronald Schouten, MD, JD, is a psychiatrist make changes in the way they interact with at Massachusetts General Hospital, a clinical their colleagues and patients. Pre-, post-, and affiliate in psychiatry at the McLean Hospital, follow-up evaluations demonstrate improve- and an associate professor of psychiatry at ments in the skills of the physicians who Harvard Medical School. He is the founder attend (an average increase of 2.5 to 4.6 on and president of KeyPeople Resources, Inc., a scale of 1 to 6). Both hospitals and physi- an organizational and behavioral health cians welcome this tangible resource to assist consulting firm. physicians with interpersonal communica- tion, conflict resolution, and stress manage- Charles W. Swearingen, MD, is a consul- ment. PHS is proud to have developed such tant in psychiatry at Massachusetts General a successful program. Hospital and is the founder and principal of Pierian Consulting. The course is available to all physicians, residents, and medical students interested Luis T. Sanchez, MD, is the director of in learning methods to improve relationships Physician Health Services. Dr. Sanchez is at work and interpersonal skills based on certified by the American Board of Psychiatry difficulties in the workplace. and Neurology and has added qualifications in addiction psychiatry. Advisory Committee Linda R. Bresnahan, MS, Director of Diana Barnes Blood, MSW, LICSW, has Program Operations, Physician Health private practices in Lincoln and Brookline, Services, Inc. working with individuals and couples in psychotherapy. She currently facilitates a Caroline Carregal, Director, Continuing three-times-monthly support group designed Education and Certification, Massachusetts to provide physicians with strategies to Medical Society enhance coping skills.

Next course offering — November 19 & 20, 2009

29 Important Exception to Mandatory Reporting to the Board of Registration in Medicine Diversion to PHS is possible when all of the following criteria apply: * The circumstances involve a drug or alcohol problem * There is no allegation of patient harm or other violation of law * The physician agrees to participate in PHS * The reporter receives confirmation from PHS within 30 days that the physician is compliant with the program [243 CMR 2.07 (23)]

PHS is independent of the Board of Regis- regulations. This includes reporting when Board of tration in Medicine (BRM), the state agency there is a reasonable basis to believe that responsible for the licensure and discipline a physician is practicing medicine while of physicians in Massachusetts. However, impaired by drugs or alcohol. However, Registration PHS serves as an important resource for under specific circumstances, a report can physicians dealing with licensing issues as a be “diverted” from the BRM, and instead, in Medicine result of health impairment or other health a referral can be made to PHS, allowing the concerns. PHS helps facilitate physicians’ physician to obtain remedial services. Diver- interactions with the BRM by educating sion is possible when there is no allegation physicians about licensing procedures, by of patient harm and no other violation of providing documentation of compliance the law, the physician agrees to participate for physicians being monitored, and by offer- in PHS, and the reporter receives timely ing resources for outside services and legal confirmation from PHS that the physician is representation to assist with board actions. in compliance with our program. By serving as an approved diversionary program, PHS is PHS interacts regularly with the BRM’s able to provide confidential support services Physician Health and Compliance (PHC) and assistance to a wider range of physicians unit, the division of the BRM responsible for who face drug and alcohol problems. Cur- health-related matters. PHS meets monthly rently, diversion is approved only for drug with the PHC unit to provide continuity for and alcohol issues. However, PHS is hopeful physicians who are under monitoring agree- that the exception will be extended in the ments with both PHS and the BRM and to future to other health conditions including enhance communication regarding areas of mental health issues. mutual concern, including physician support services, remediation, and protection of At times, the BRM itself enters into disci- the public. PHS also meets separately with plinary or nondisciplinary agreements with designated BRM members and staff to ad- physicians who face health challenges such dress policy and programmatic issues likely as substance use disorders, mental illness, be- to impact physicians facing health problems. havioral health concerns, or physical health concerns that require support and monitor- Diversionary Status ing. In these circumstances, the BRM asks PHS serves as a BRM-approved “diversion- PHS to provide monitoring. PHS then pro- ary” program. Massachusetts law requires vides the BRM with confirmation that the certain health care professionals to report to physician is compliant with a treatment plan the BRM when they become aware that a while simultaneously providing the physi- physician has violated BRM rules or cian with professional and personal support.

30 The monitoring program is designed Monitoring Program to support the recovery process for physicians and medical students and to Monitoring Contracts Extended Voluntary Monitoring Contracts help assure the safe practice of medicine. Available to Physicians These contracts are available to physicians Our Substance Use and Behavioral Health who have successfully completed a substance PHS would like to extend special thanks Monitoring Contracts help guide physicians use or behavioral health monitoring contract to those physicians who have supported and medical students in recovery. They and choose to participate in extended moni- their colleagues by serving as volunteer serve as tools for documenting the recovery toring. The contract includes contact with monitors. Please encourage your process and helping physicians return to an associate director, therapist, and partici- colleagues to assist PHS in this capacity. the practice of medicine. The success of our pation in random testing when indicated. program has not only been dependent on the physicians who willingly participate but Quality Management To Volunteer also on the countless number of physician PHS recognizes its accountability to physicians If you are interested in assisting PHS by volunteers who are instrumental in making and the community and strives to assure con- serving as a monitor to a colleague in our peer-support network and monitoring tinuous assessment and improvement of the your hospital or practice, please call PHS contracts successful. quality of the program. Quality management at (781) 434-7404. is part of an ongoing process for evaluating PHS drug test collection procedures are and improving the quality of the support and based on validated National Institute on monitoring activities of the program. Drug Abuse (NIDA) standards. Collections are primarily performed at Quest Diagnostics The purpose of PHS’s quality management is Laboratory Collection Centers. In regions as follows: where such centers are limited, PHS seeks * To identify and monitor critical aspects of the assistance of volunteer physician test the support and monitoring services monitors. All test monitors (including Quest * To focus attention on administrative and Diagnostics Laboratories Collection Centers) clinical processes that affect outcomes are provided with procedural guidelines To resolve identified problems, improve for collections and are trained to follow * services, and evaluate the effectiveness of them. Numerical identification badges the services are issued to physicians in order to ensure proper identification while maintaining Each year, PHS identifies specific projects confidentiality. that assess the quality or outcome of an aspect of the PHS program. This past year, PHS Substance Use Monitoring Contract focused on a participant and monitor satisfac- This contract is a minimum of three years in tion survey. In addition, there are numerous length and is designed to guide and document annual internal processes in place to guide a physician’s abstinence from substances of the efficiency and completeness of all of the abuse. Components of the contract include, aspects of the PHS monitoring program. but are not limited to, face-to-face monthly meetings with an associate director, attendance Seeking Volunteer Monitors at support group meetings, participation in ran- to Support Physicians in Need dom drug testing, and regular contact with a An essential element of each PHS contract therapist, work monitor, and chief of service. that contributes to the recovery of physicians is the assistance and support volunteer moni- Behavioral Health Monitoring Contract tors provide to their colleagues. Workplace PHS developed the behavioral health moni- monitors, test monitors, hospital chiefs of toring contract to address physicians’ mental service, and therapists are asked to participate and behavioral health issues resulting from in physician monitoring and provide ongoing stress, emotional problems, and mental ill- support to their fellow physicians and infor- ness. The contract duration is a minimum of mation to the program. PHS dedicates re- two years and includes, but is not limited to, sources to ensure monitors are provided with monthly meetings with an associate director, information that details the importance of regular attendance at a support group meet- their role to the contracting physician’s ing, and regular contact with a therapist, recovery. work monitor, and chief of service. 31 PHS National Strategic Efforts

Goals The Federation of State Physician Health Programs (FSPHP) is a national organization PHS conducts a retreat every two to three whose purpose is to facilitate the exchange years to review the organization’s strategic of information and development of common priorities and determine future goals. The goals and standards for physician health. most recent retreat, which took place in the PHS is an active member of the federation. fall of 2007, included representation from At the 2009 annual meeting of the FSPHP, the PHS Board of Directors, associate direc- Dr. Luis Sanchez completed an extended tors and staff, the Advisory Committee, 3.5-year term as president of the FSPHP the Clinical Advisory Committee, and the Board of Directors. He will continue to serve Medical Student Advisory Committee. Past in a leadership role as Past President for the program participants shared their powerful next 2 years. He also has served as chair of stories of recovery and offered valuable the FSPHP Annual Meeting Program commentary on the future direction of PHS. Committee. PHS priorities are reviewed and updated with the invaluable insight of the distinguished Linda Bresnahan serves as an officer of the and experienced health care professionals FSPHP Board of Directors. She is currently who are dedicated to improving the health serving a two-year term as Secretary. She and lives of the physicians and students also serves on the Program Committee, the PHS serves. Following are the organization’s Publications Committee, and the Task Force current priorities: on Research. Debra Grossbaum serves as chair of the Bylaws Committee and is also a Assessment & Monitoring member of the Audit Committee. Services As referrals to physician health programs To enhance assessment processes, improve increase, the programs are challenged to treatment options, increase service offerings provide increased services. At the FSPHP for behavioral health clients, and maintain conferences, speakers respond to this need credibility of the monitoring services by sharing strategies for development and program growth in the areas of behavioral health, fundraising, providing efficient and effective Strategic Planning services, and improvements in random drug To provide strategic plans and direction for testing, treatment, and spirituality. PHS to include increased visibility and awareness of the value of PHS

Program Operations To continue to enhance a positive working environment for staff — one built on respect and trust — in support of our physician participants. It is also PHS’s aim to oversee the casework of associate directors.

Financial Management To ensure financial results meet or exceed the approved budget plan

32 Complete and mail this form PHS Speaking to the following address: Physician Health Services, Inc. Engagement 860 Winter Street Waltham, MA 02451

Request Form You may also fax this form to (781) 893-5321. Date of Request: ______Once PHS receives the request form, Name of Organization: ______we will contact you ­directly to begin ­program arrangements. Requested Date for Presentation: ______If you have questions or need assistance, Second Choice: ______Third Choice: ______please call us at (781) 434-7404 or (800) 322-2303, ext. 7404. Times: ______PHS will provide a DVD for each The length of a PHS lecture can be adapted to meet your needs. ­sponsoring organization, an outline, and brochures. Location of Presentation: ______CME Credit: Each accredited organization Address: ______can offer CME credit for this program. Name of Meeting Room: ______

CME Contact Person: ______Phone: ______

Fax: ______E-mail:______

Audience (Primary Specialty in Attendance): ______

Number of Attendees Expected: ______

An honorarium is not required. However, please consider a contribution to PHS in lieu of an ­honorarium. Our tax identification number is 22-3234975. Contributions to PHS are tax-deductible­ to the extent provided by law. Your ­organization will be acknowledged in the PHS ­Annual Report and PHS publications.

In lieu of an honorarium, I would like to contribute to Physician Health Services.

$1,000 $500 Other: $______

Enclosed is my check payable to Physician Health Services, Inc.

American Express MasterCard Visa Discover Card

Credit Card No.______Expiration Date: _____ /_____

Signature:______

Faculty will be selected from the following list based on availability:

J. Wesley Boyd, MD, PhD John R. Knight, MD Linda R. Bresnahan, MS Michael Palmer, MD Judith Eaton, MD Luis T. Sanchez, MD Wayne A. Gavryck, MD John C. Wolfe, MD Debra A. Grossbaum, Esq.

33

PHS and the Massachusetts Medical Society extend special thanks to the organizations that have served as the primary funders of PHS. This financial support will make growth and outreach efforts possible. The level of funding from the following organizations has been essential to the stability and success of PHS: * Baystate Health Systems * Berkshire Health Systems * Boston Medical Center * Caritas Christi Health Care * Connecticut Medical Insurance Company (CMIC) * Lahey Clinic * Physicians Insurance Agency of Massachusetts (PIAM) * ProMutual Group * Risk Management Foundation of the Harvard Medical Institutions (CRICO/RMF) * Tufts Medical Center * UMass Memorial Health Care

Photography provided by George P. Santos, MD, secretary-treasurer of the Massachusetts Medical Society (MMS) from 1997 to 2002; Mary Howard and Debra Grossbaum of Physician Health Services; and Jupiterimages. Produced by the MMS Departments of Premedia and Publishing Services, Printing Services, and Distribution Services.

PHS is available to assist any Massachusetts medical student, resident, or physician. Physician Health Services, Inc. 860 Winter Street Non-Profit Org. Waltham, Ma 02451-1411 U.S. Postage PAID Boston, MA Permit No. 59673

Annual Report2009