Physician Interrupted Podcast

In this episode, we discuss the remaining key takeaways from our 2 part presentation last month “Physician Health Programs (PHPs): A Critical Look.”

For the full article, along with pithy footnotes, jump on over to the written article of the same title.

Convenient links:

Here’s a link to the replay of Part 1 of the webinar. (We’re redoing Part 2 as there was such a plethora of technological snafus that it can turn you into a conspiracy theorist.)

And, here’s the link to the May 3rd Town Hall I mention in the episode.

Upcoming – “PHPs: Closer Look” Town Hall, May 3, 8pm ET

And if you or a colleague need help with navigating your way through the MRTC or are facing ensnarement in the PHP system, be sure to check out an idea I’m developing for a weekly strategy group.

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Getting guidance and support from me and similarly situated peers!

I’ve been thinking about the best way to create a safe, affordable space for docs to gather on a weekly basis so that together we can make sense of the PHP-type challenge each is up against. We’d share up-to-the-minute knowledge about the PHP system, its pivotal role in the overall MRTC, and how best to navigate it. And we’d do this with the dual aim of helping each survive the storm and pooling our knowledge and experience to help light the way for future docs facing the same overwhelming PHP challenges.

It’s a unique opportunity to tap into my fourteen years of experience and intensive study of this disturbing franchise to help other docs make the best decisions so that they can successfully navigate these perilous waters.

If you’re interested in learning more, here’s a link. Let me know when’s best to talk and at what preferred # [and be sure to put that in the message box], and I’ll call you. To ensure safety and confidentiality, and to make sure it’ll fit your needs, I conduct a preliminary interview with all prospective members. I’ll be getting a blurb out on it imminently. But meanwhile, if you know docs who might be interested, be sure to pass along.

Thanks for listening!

This is Part 2 of a series on the state auditor’s blocked performance audit of the NC Medical Board (NCMB). The fact of a state professional licensing agency actually BLOCKING the elected state auditor from evaluating their investigations department and its internal protocols and assurances of compliance with state and federal laws has profound implications for all professionals who require some form of state licensure. Because without assurance that a state agency (or an organization that’s been given a state function) is performing in a fully fair, accountable, and non-self-serving manner, there is no guarantee that that agency has not in some way veered towards self-interest and potential weaponization of its powers. This is especially true of any state agency or designated function such as NCMB that operates with utterly no governmental oversight and complete immunity from suit.

In this piece, we explore NCMB’s pushback against State Auditor Beth Wood via a cluster of hollow objections, the purpose of which seems none other than to delay scrutiny (with the potential for spoliation of evidence) and likely also to stir up legislative and governor support for not supporting the Auditor’s investigation and preventing the audit from proceeding behind a pseudo-valiant campaign to protect physician and patient privacy.

We see the preliminary observations and findings she was able to make from the very limited data (less than 5% of the records, at that most unusable) she could access. And we explore the overall rationale of the auditor’s duty, and why this particular performance audit is so critically important with profound implications not only for NCMB and the physicians it regulates, but for every medical board, so-called physician health program (PHP), and every licensed physician in the country. Even more broadly, it potentially has as much significance as the FTC v. NC Dental Board decision in which the US Supreme Court determined that the NC Dental Board was guilty of an anti-trust violation and, even though an alleged state agency supposedly protected from suit, was in fact NOT so protected. It likewise has major implications for the mandatory role of active state oversight (as articulated by FTC Guidance to all occupational licensing boards in 2016) and whether - and what - federal laws apply to a state medical board. Whether it proceeds or is blocked, it has profound importance. If blocked, it is likely that federal intervention would ensue.

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This podcast is the first of a series (subsequent to the Overview episode) exploring the NCMB Performance Audit.

I initially podcasted what I thought would be a single episode on the topic and was preparing to publish the written version. However, as I reviewed the material, I thought it best to dig deeper into the array of issues that I believe need to be explored.

So that initial podcast has been re-titled as an Overview. There is no accompanying written article to it.

Starting here with episode 1, I’ll post a series of articles and podcast episodes of the same name concurrently. To make it easy to distinguish, they’ll be named NCMB Audit Part 1 [2, 3 …] and continue through the full sequence. As this is so timely, I thought it best to post several a week to cover all the interwoven aspects. Each of the articles (not the podcast notes which have to be succinct) has an array of footnotes that offer additional resources and important commentary. Please refer to the articles for the footnotes. The podcast script follows the articles quite closely so you can listen and follow along. I believe the audit, and NCMB’s non-cooperation, are of critical importance to all docs and medical professionals, in NC and throughout the country. If you haven’t already, be sure to subscribe to Physician Interrupted.

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[This podcast provides the overview of the NCMB Performance Audit. Since publishing it, and as it was so well received, I decided to go deeper into each of the topics covered here. Consequently, I’ve decided to post a series of articles and podcast episodes of the same name; to make it easy to distinguish, they’ll be named NCMB Performance Audit Part 1 [2, 3 …] and continue through the full sequence. As this is so timely, I thought it best to post several a week to cover all the interwoven aspects. Each of the articles has an array of footnotes that offer additional resources and important commentary. Please refer to the articles for the footnotes. The podcast script follows the articles quite closely so uou can listen and follow along. I believe the audit and NCMB’s non-cooperation are of critical importance to all docs and medical professionals, in NC and throughout the country. If you haven’t already, be sure to subscribe.]

The NC State Auditor tried over the past year to conduct a performance audit of the NC Medical Board’s Investigations Division. As you’ll discover, NCMB completely blocked access, on mostly specious grounds.

This podcast explores the serious implications of this.

It could result in a showdown between the legislature and the auditor. While it may not be apparent to most, even those who’ve followed Center for Physician Rights and Physician Interrupted’s periodic analyses of state medical boards and physician health programs, I sense that this standoff has immense implications for all of the parties involved. It could be instrumental not only in holding NCMB accountable but in newly defining the limits of their authority and immunity.

Should the audit reveal civil or criminal violations of federal law, the financial implications for the board and the state are quite significant. The legislature may not want the auditor to probe NCMB’s workings as, should violations be found, the state could end up footing a chunky bill for its lack of oversight. And if NCMB is not overseen by a designated state official, then maybe responsibility - and liability - fall to the Board.

But it's almost impossible for NCMB to continue to block the audit.

No party will be unaffected by the outcome of this matter. There is much to be learned here. It could get nasty.

Here’s a link to the audit.

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This is the podcast of the article by the same name on Substack. The article may contain some additional material in the form of footnotes, links to other materials etc. Be sure to check it out.

In this podcast, we continue a series that began with a look at an emerging bevy of state laws proposing to create a sort of “mental health safe harbor” for physicians to get mental health care. We saw that while termed a “safe harbor,” it was anything but.

In this podcast, we explore the broader concept of confidentiality in mental health which serves as a backdrop to understanding the major intrusion on privacy and safety that Delaware’s law causes. And we look at why physicians in particular are in great danger should they be “reported” by a state-mandated confidentiality-breaching therapist.

You comments and sharing the podcast are especially welcome.

If you’ve not yet done so, consider subscribing (free!, no junk mail or sales pitches) to Physician Interrupted. It’s produced as both a newsletter “post” and - somewhat less regularly - as a podcast. The podcast pretty much mirrors the article but occasionally offers impromptu asides. The written form offers footnotes that can contain richer explanations, links to important articles, and even witty (sometimes maybe just snarky) commentary.

Subscribe to Physician Interrupted! A unique focus on less common goings-on in medicine, including an occasional peek at its underbelly.

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In this episode, we do a deeper dive into the significance of US DOJ’s Letter of Finding regarding its investigation of a nurse’s complaint regarding the Indiana Board of Nursing IN BON and its professional assistance/rehabilitation program “ISNAP” violation of the Americans with Disabilities Act. The violation specifically pertained to IN BON’s and ISNAP’s refusal to allow participation in the program – necessary for removal of licensure restrictions – of any nurse who had a diagnosis of an opioid use disorder and who was currently on a medication-assisted treatment for it.

As significant as the findings and proposed charges are, the fact of DOJ’s intent to levy not only civil (and perhaps criminal?) penalties and its decision to advocate on behalf of all of the nurses harmed by this policy in the form of holding them liable for compensatory damages (lost income as well as pain and suffering), is extraordinary.

But even beyond this opioid use disorder ADA-based case and other ADA cases regarding MAT (medication-assisted treatment) and ADA cases regarding impermissible questions on licensure, I suspect there are larger implications to the aggregate DOJ enforcement activity. Considering also the FTC v NC Dental Board case, what’s going on here is a multi-federal agency challenge to state agencies who have been acting with impunity in imperially ruling their licensing agencies in overt defiance of federal laws and the established rights of others.

You can view the article here; it’s essentially a transcript of this podcast.

Your comments and sharing are most welcome.

Thanks for listening to the Physician Interrupted podcast. Please do share it.

Welcome to the Physician Interrupted podcast.

Here’s the link to the transcript/post of this podcast. There’s a trove of footnotes and resources there.

And of course, I’d love to hear your comments and your sharing this podcast and article with others, especially those whose ADA rights to MAT and preservation of their career has been wrongfully obstructed.

Sharing helps a wider network of physicians and leaders become more informed of challenges to physicians’ rights so that they can take action to protect those rights.

If you’d like to learn more about CPR - The Center for Physician Rights, click here.

Thanks for listening to the Physician Interrupted podcast. This podcast and related posts are public so feel free to share them, esp with colleagues who urgently need to know their rights.

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In this episode, we examine the array of causality of clinician burnout and why it’s so important to drill down. Like a bacterial infection, if you don’t know the bug that’s causing it, then all you’re left with is throwing non-targeted killer drugs at it, none of which might be the anti-bug you need.

And we also look at some overarching principles in approaching and remedying burnout.

I’d love to hear your thoughts and would be delighted if you’d take a moment to share the podcast.

And … if you haven’t subscribed yet, this is a fine time to do so. You’ll be the first to get the notice that a new podcast or article is posted. And you get first dibs at commenting ;)

Wanna bring me in to do a presentation, workshop, or retreat? Yes, even virtually. Let’s be in touch. In fact, I’m putting together the outline for a virtual retreat right now. We’re overdue for having the opportunity to come together, support each other and find ways to replenish ourselves while we strive to continue to do the work we dedicated our lives to do.

Welcome to the Physician Interrupted Podcast.

In this piece, Kernan reflects on an OpEd posted on Medscape by medical ethicist Art Caplan exploring clinician anger while treating anti-vax patients.

It’s a privilege to have you as a listener. I’d love to hear your reactions as well as any feedback you have on the podcast itself. It’s still a work in progress.

Got a topic consistent with our focus that you’d like us to do a podcast on? Lemme know! Want to be my guest to dialog about burning topics in medicine? Would love to hear from you and explore further.

We’re growing our audience of listeners and readers so be sure to share and encourage your people to subscribe - it’s free! No spam, no nonsense. The main reason to sign up is so that you can get notice of our posting a new article or podcast. I’m not yet on a regular posting schedule, so I wouldn’t want you to miss a rich piece simply because it fell off your radar. But even better, you get the actual article in your email! And a link to the podcast!

And you can now pick up the Physician Interrupted podcast on most major podcast services!

Happy New Year to you and yours and hope you’re staying safe, well, upbeat, and hopeful.

Thanks for listening to the Physician Interrupted Podcast! Subscribe for free to receive notice of new posts and episodes.

And, while you’re at it, feel free to share it.

The amorphous matrix of clinician distress.

Here is Part 7, the last of our series exploring the Matrix of Clinician Distress.

We offer a somewhat expanded representative scenario and can more clearly discern its individual components. Lumping all of these component syndromes together under the designation “burnout” as has been routinely done through the present is obviously problematic. By not naming and addressing the component elements of a clinician’s distress and enabling appropriate approaches, these syndromes have been ignored. In essence, they’ve been painted over by the broad brush of “burnout.”

The Matrix Deconstructed

Not only do the component syndromes not get the professional attention they need, the clinician is led to believe that the generic stress management remedies applicable to burnout should suffice to make everything better. Of course, the implication is that if one doesn’t get full relief, then something must be wrong with the clinician or they're not utilizing the offered remedies, or the burnout is so severe that these broadly applicable remedies can’t work and thus the clinician must be mentally ill. Almost never has it been considered that the assumed diagnosis - burnout - might be erroneous.

I suggest that perhaps the burnout construct itself an inherently flawed and needs to be revised to give consideration to a wider understanding of what’s plaguing clinicians and making them so miserable that they’re leaving the profession.

We recap some key takeaways from the series and close with some action recommendations especially for coaches and therapists; organizational leaders; and clinicians who themselves are grappling with one or more of the component syndromes.

I hope you’ve enjoyed the series and would welcome your comments and your sharing the series.

If I can be of help to you as you explore how best to approach clinicians’ distress, please let me know. You can send me an email directly from Substack. Or drop me a line at [email protected].

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