Physician Health Programs: The Current State of Evaluation, Evidence, and Access
Author: Lisa A. Long, Psy.D.
Dr. Long & Associates | drlisalong.com
Last Updated: 8/17/2026
Dr. Lisa Long is a licensed clinical and forensic psychologist and one of three psychologists on the North Carolina Professional Health Program (NCPHP) approved evaluator panel. She is PSYPACT-authorized to conduct telehealth evaluations across 43 states. For inquiries about PHP evaluation services, submit a referral here.
1. Introduction: The Scope of the Problem
Healthcare professionals develop substance use disorders and mental health conditions at rates comparable to — and in some cases exceeding — the general population. Estimates consistently place the lifetime prevalence of substance use disorders among physicians at 10–15% (Bryson & Silverstein, 2008; Tyssen, 2007), with anesthesiologists facing particular risk due to occupational access to potent opioids (Domino et al., 2005). A scoping review of physician mental health in North America found high prevalence rates of depression, anxiety, and burnout across all career stages (Mihailescu & Neiterman, 2019), and more than 400 physicians die by suicide annually in the United States (Stehman et al., 2019).
These are not abstract statistics. Each represents a licensed professional whose clinical judgment, patient interactions, and procedural competence may be compromised — and whose career, family, and life are at stake. The system that exists to address this problem is the Professional Health Program (PHP), a state-level organization that provides confidential monitoring, assessment referral, and support as a therapeutic alternative to public disciplinary action by licensing boards.
PHPs currently operate in 47 states and the District of Columbia through 51 member programs of the Federation of State Physician Health Programs (FSPHP). The model has demonstrated strong outcomes: in the landmark five-year cohort study of 904 physicians across 16 state PHPs, McLellan, Skipper, Campbell, and DuPont (2008) found that 78.7% were licensed and working at five-year follow-up, with 80.7% completing treatment and returning to supervised practice. These outcomes — roughly four times the success rate of standard substance use disorder treatment — have established PHPs as the gold standard for managing impaired healthcare professionals.
But the PHP model has a structural bottleneck that undermines its own effectiveness: a critical shortage of qualified, independent evaluators who can conduct comprehensive psychological assessments within the tight timelines PHPs require. This article examines that bottleneck, reviews what the research says a comprehensive PHP evaluation should include, and presents the evidence supporting independent, telehealth-based assessment as a solution to a problem that is growing more complex, not less.
2. Why Healthcare Professionals Are Uniquely Vulnerable
The prevalence of substance use disorders and mental health conditions among healthcare professionals is not incidental. It is driven by occupational factors that distinguish healthcare from virtually every other profession — factors that any evaluator conducting PHP assessments must understand in order to produce clinically useful findings.
2.1 Occupational Access to Controlled Substances
Healthcare professionals — particularly physicians, anesthesiologists, nurses, and pharmacists — work in environments where potent, addictive medications are routinely available. Anesthesiologists handle fentanyl, sufentanil, propofol, and other agents with high abuse potential as part of daily practice. Bryson and Silverstein (2008) documented that as recently as 2005, the drug of choice for anesthesiologists entering treatment was still an opioid, and Domino et al. (2005) found that healthcare professionals whose primary substance was a major opioid faced significantly higher relapse risk than those with alcohol or non-opioid dependencies. The combination of pharmacological knowledge (knowing exactly what a substance does and how to dose it), physical access (handling it daily), and occupational stress creates a risk profile unique to healthcare.
2.2 The Culture of Invulnerability
Medicine has historically operated under what researchers have called a "culture of invulnerability" — an implicit expectation that physicians do not get sick, do not struggle, and do not need help. This culture manifests in concrete ways: medical school socialization that rewards stoicism and self-sacrifice, residency training programs that normalize 80-hour work weeks and sleep deprivation, and professional norms that treat seeking mental health care as a sign of weakness rather than clinical judgment.
Vayr, Hérin, Jullian, Soulat, and Franchitto (2019), in a systematic review of barriers to help-seeking among physicians with substance use disorders, identified fear of career consequences as the dominant barrier — ahead of stigma, cost, and logistical difficulty. Physicians delay seeking help not because they do not recognize the problem, but because they believe — often correctly — that disclosure could end their career. Licensing applications in many states still ask about mental health treatment history, creating a documented deterrent to care-seeking that the Dr. Lorna Breen Health Care Provider Protection Act (2022) was specifically designed to address.
2.3 Chronic Stress, Moral Injury, and Burnout
The mental health burden on healthcare professionals extends well beyond substance use. Stehman, Testo, Gershaw, and Kellogg (2019) documented that physician burnout — characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment — affects emergency physicians at rates exceeding 60%, with system-level causes including electronic health record burden, administrative demands, loss of clinical autonomy, and inadequate institutional support.
The COVID-19 pandemic intensified these pressures across all healthcare professions. Gold (2020), writing in The BMJ, described the pandemic's impact on healthcare workers' mental health as producing "adverse mental health outcomes" driven by "uncertainty and inadequate support," with consequences extending to patient safety, workforce retention, and healthcare system capacity. Mihailescu and Neiterman (2019) had already documented high prevalence of depression and anxiety among physicians and trainees in North America before the pandemic accelerated the crisis.
The concept of moral injury — the psychological damage resulting from being forced to act in ways that violate one's moral code, or being prevented from acting in accordance with it — has emerged as a framework for understanding healthcare professional distress that burnout alone does not capture. A physician who cannot provide adequate care because of staffing shortages, a nurse who watches patients suffer because of resource constraints, a clinician who is punished for reporting safety concerns — these experiences produce psychological harm that differs from burnout and requires different clinical understanding.
2.4 Why This Matters for PHP Evaluation
These occupational factors have direct implications for how PHP evaluations should be conducted:
An evaluator who does not understand the occupational culture will misinterpret defensive or minimizing behavior during the clinical interview. Healthcare professionals are trained to project competence. Impression management during evaluation is not merely a personality style — it is a survival skill reinforced by decades of professional socialization.
An evaluator who focuses only on substance use will miss co-occurring burnout, moral injury, depression, anxiety, or emerging cognitive decline that may be contributing to or complicating the presenting problem.
An evaluator who is unfamiliar with occupational access patterns will not ask the right questions about diversion, self-prescribing, or workplace-specific substance use behaviors.
An evaluator who does not understand the fear of career consequences will not appreciate why the professional may be underreporting symptoms, minimizing history, or presenting in ways that suggest lower severity than clinical testing reveals.
Comprehensive PHP evaluation requires clinical expertise in forensic assessment methodology and working knowledge of the occupational environment that produces the conditions being assessed. The two are inseparable.
3. The Alternative-to-Discipline Model: How PHPs Work
The alternative-to-discipline (ATD) model rests on a straightforward principle: healthcare professionals who are identified early, assessed comprehensively, treated effectively, and monitored rigorously can return to safe, competent practice. The alternative — public disciplinary action, license revocation, career destruction — serves neither the professional, the profession, nor public safety.
3.1 How Professionals Enter PHP Programs
| Pathway | Description | Confidentiality |
|---|---|---|
| Self-referral | The professional contacts the PHP directly | Highest — can remain anonymous to the licensing board if no patient safety concern exists |
| Board mandate | The licensing board orders evaluation after a complaint, incident, or application concern | No anonymity — board is aware |
| Employer/hospital referral | A hospital, clinic, or employer identifies a concern and refers to the PHP | Variable — depends on whether a board report is required |
| Colleague/peer report | A colleague or peer reports concerns about impairment | Variable |
| Attorney referral | Personal counsel or malpractice attorney recommends proactive engagement | Typically confidential if self-initiated |
3.2 The Assessment–Treatment–Monitoring Continuum
When a professional enters a PHP, the typical pathway is:
Assessment: A comprehensive psychological evaluation determines the nature and severity of the condition, establishes diagnoses, and recommends a level of treatment.
Treatment: The professional completes the recommended treatment program (intensive outpatient, residential, individual therapy, or a combination).
Monitoring: Upon completion of treatment, the professional enters a monitoring contract — typically five years for substance use disorders — that includes random drug screening, regular therapy, support group participation, worksite monitoring, and periodic re-evaluation.
The assessment stage is where the PHP model begins — and where a growing structural problem resides.
3.3 The Expanding Scope
PHPs were originally developed for physicians with substance use disorders. Today, most programs serve a much broader population:
Multiple professions: Physicians, physician assistants, nurses, pharmacists, dentists, veterinarians, psychologists, counselors, and other licensed professionals
Multiple conditions: Substance use disorders, mood disorders, anxiety disorders, personality disorders, cognitive impairment, disruptive behavior, and boundary violations
Increasing complexity: A recent analysis of the Colorado Physician Health Program found that case complexity has increased significantly over the past five years, with more professionals presenting with co-occurring conditions, behavioral concerns beyond substance use, and complications requiring multidisciplinary evaluation (Crane et al., 2025)
This expanding scope has direct implications for evaluation. A professional referred for alcohol use disorder alone requires a different assessment than one referred for disruptive behavior with underlying personality pathology and cognitive decline. The evaluator must be equipped to assess across multiple domains — and most assessment centers were designed for a narrower population.
4. The Assessment Bottleneck
4.1 Supply Does Not Meet Demand
The disparity between the number of healthcare professionals requiring PHP evaluation and the number of qualified assessment providers is significant. Consider:
Over 1 million actively licensed physicians practice in the United States (FSMB, 2024), with millions more nurses, physician assistants, pharmacists, dentists, and other professionals subject to PHP oversight.
3,000–5,000 new referrals per year require evaluation across all state PHPs (estimated from FSPHP member program data).
Only five entities nationally hold FSPHP-ETA (Evaluation and Treatment Accreditation) — the Federation's accreditation standard for assessment centers: Florida Recovery Center (UF Health), Windrose Recovery Chicago, Pavillon International, Bradford Health Services, and All Points North Lodge. Five centers for the entire country.
Individual evaluator panels are small. The NCPHP (North Carolina Professional Health Program), for example, maintains an approved psychologist panel of just three practitioners for the entire state.
4.2 The In-Person Multi-Day Model
The traditional PHP evaluation model requires the professional to travel to an assessment center for a multi-day, in-person evaluation lasting two to five days. This model was developed decades ago and has persisted largely unchallenged. Its limitations are structural:
Travel and time away from practice. A multi-day evaluation requires the professional to leave their practice, arrange clinical coverage, and travel — often across state lines — to one of a handful of assessment centers. For rural practitioners, this may involve flights, hotels, and multiple days away from patients. The absence itself is difficult to explain without raising questions among colleagues and staff, undermining the confidentiality that motivates professionals to seek help in the first place.
Cost. Assessment center evaluations typically range from $6,000 to $18,000, not including travel and lost income. The PACE Program at UC San Diego, which focuses on competency assessment, charges $13,000–$18,000 for a multi-day evaluation. For independent psychological evaluations referred through PHPs, the range is $6,000–$10,000. These costs are borne entirely by the professional being assessed — insurance rarely covers PHP-referred evaluations.
Scheduling delays. Assessment centers have limited availability. Wait times of two to four weeks or longer are common. PHPs typically give professionals two-to-four-week windows to complete evaluations. The combination of limited center availability and tight PHP deadlines creates scheduling friction that delays assessment and, by extension, delays treatment.
4.3 The Conflict of Interest Problem
A structural concern that has drawn increasing academic and journalistic scrutiny is the relationship between assessment centers and treatment programs. Several of the largest assessment centers are operated by or affiliated with treatment facilities. The evaluator who determines that a professional needs residential treatment may be affiliated with the institution that provides — and profits from — that treatment.
Published reform recommendations have specifically called for referrals to "first-rate academic facilities or private practitioners with solid credentials who don't offer extended treatment themselves," noting that assessment centers that also operate treatment programs face inherent conflicts in their recommendations (Manion, 2020). Lawson and Boyd (2018), writing in Substance Abuse Treatment, Prevention, and Policy, documented that state PHP descriptions of physician impairment are drawn so broadly that "almost everyone might potentially be suspected of being impaired," raising questions about the scope of PHP authority and the independence of evaluation processes.
This criticism does not invalidate PHP programs — whose outcomes, as McLellan et al. (2008) demonstrated, are strong. It does, however, underscore the importance of evaluator independence as a structural safeguard within the PHP assessment process.
5. What a Comprehensive PHP Evaluation Should Include
The primary purpose of a PHP psychological evaluation is to answer specific clinical and regulatory questions: What is the nature and severity of the condition? Does it impair the professional's ability to practice safely? What level of treatment is appropriate? What monitoring plan will protect public safety while supporting recovery?
Answering these questions comprehensively requires more than a clinical interview. It requires a structured, multi-method assessment that produces evidence capable of withstanding scrutiny by licensing boards, hospitals, and — if necessary — courts. The following components represent the standard of care for comprehensive PHP evaluation.
5.1 Comprehensive Clinical Interview
The clinical interview in a PHP evaluation is not a therapy session. It is a structured forensic interview covering:
Psychiatric and substance use history: Onset, duration, substances of choice, prior treatment episodes, periods of sobriety and relapse
Occupational history: Specialty, practice setting, practice stressors, relationship to substances in the workplace, prior disciplinary actions or performance concerns
Medical history: Chronic pain, injury, surgeries, prescribed medications — all of which may intersect with substance use or cognitive function
Developmental and family history: Family history of substance use disorders, adverse childhood experiences, and developmental factors
Current functioning: Daily activities, social support, stressors, sleep, appetite, mood, and cognitive complaints
This interview should be conducted over 2–4 hours, with sufficient time to explore inconsistencies, follow up on concerning areas, and develop a clinically complete picture. A 30–45 minute screening interview does not meet this standard.
5.2 Standardized Psychological Testing
Testing provides the objective, normed data that clinical interviews alone cannot:
Personality and psychopathology assessment (MMPI-2/MMPI-3, PAI): These instruments identify personality patterns, psychopathology, substance use indicators, and — critically — response style. The validity scales embedded in the MMPI and PAI detect impression management, defensiveness, and underreporting of symptoms, all of which are common in professionals whose careers depend on the evaluation outcome.
Cognitive screening (selected measures of processing speed, memory, executive function): Williams, Flanders, Welindt, and Williams (2018), studying physicians referred for performance concerns, found that neuropsychological screening identified cognitive deficits in a substantial proportion of referrals, including cases where the referral was for behavioral rather than cognitive concerns. This finding underscores the importance of routine cognitive screening in PHP evaluations, regardless of the presenting complaint.
Substance use assessment (standardized instruments measuring severity, consequences, and motivation for change)
Symptom-specific measures (depression, anxiety, PTSD, as clinically indicated)
5.3 Effort and Validity Testing
Healthcare professionals being evaluated for fitness to practice have powerful incentives to present favorably. Effort and validity testing — measures such as the Test of Memory Malingering (TOMM) and structured validity indicators embedded within personality instruments — assesses whether the professional's test performance is consistent with genuine engagement. Valid effort testing strengthens the evaluation's credibility when the professional is genuinely impaired and protects the process's integrity when they are not.
5.4 Record Review
The evaluator reviews all available records before the clinical interview: prior evaluations, treatment records, licensing board correspondence, employer reports, PHP intake documents, and any relevant medical records. The record review provides the longitudinal context that a single evaluation session cannot — identifying patterns, discrepancies, and clinical history that inform the interview and the diagnostic formulation.
5.5 Collateral Information
When appropriate, the evaluator contacts collateral sources — treating clinicians, colleagues, supervisors, or family members — to obtain additional perspective on the professional's functioning. Collateral information is particularly valuable in cases involving anosognosia (lack of awareness of impairment), impression management, or conditions that manifest differently across contexts (e.g., a professional who presents well in structured settings but decompensates under workplace stress).
5.6 Fitness-to-Practice Determination
The evaluation report must address the specific regulatory and clinical questions at issue:
Diagnosis: Clear DSM-5-TR diagnoses supported by the evaluation data
Fitness determination: A clear statement regarding whether the professional is fit to practice, unfit, or fit with conditions
Risk assessment: The level of risk the professional's condition poses to patients and to the professional
Treatment recommendations: The level of care recommended (intensive outpatient, residential, individual therapy, psychiatric management, or a combination), based on the clinical findings rather than the availability of a specific facility
Monitoring plan: Recommendations for the duration and components of post-treatment monitoring, including drug screening frequency, therapy requirements, and worksite monitoring parameters
The report should be written for a multidisciplinary audience — licensing board staff, PHP case managers, attorneys, and hospital credentialing committees — with sufficient clinical specificity to support regulatory decisions and sufficient clarity to be understood by non-clinicians.
6. Telehealth-Based PHP Evaluation: What the Evidence Supports
The proposition that comprehensive psychological evaluation can be conducted effectively via telehealth is no longer theoretical. A substantial and growing evidence base supports the reliability, validity, and clinical equivalence of telehealth-based mental health assessment compared with in-person evaluation.
6.1 Telemental Health Assessment: Equivalent Outcomes
Sugarman and Busch (2023), writing in The BMJ, conducted a comprehensive review of the telemental health literature and concluded that "meta-analyses have examined the reliability (concordance) of assessment and the efficacy/effectiveness of telemental health compared with in-person care. Results indicate that telemental health assessment and clinical outcomes are similar compared with in-person care." This finding — published in one of the world's most rigorous medical journals — establishes the general principle that psychological assessment via videoconference produces equivalent results to in-person assessment.
Hubley, Lynch, Schneck, Thomas, and Shore (2016), in a systematic review published in the World Journal of Psychiatry (516 citations), found that telepsychiatry demonstrated comparable outcomes to in-person care across diagnostic assessment, treatment delivery, and patient satisfaction. Stubbings, Rees, Roberts, and Kane (2013) found no significant differences in clinical outcomes between in-person and videoconference-based cognitive behavioral therapy for mood and anxiety disorders in a randomized controlled trial.
6.2 Teleneuropsychology: Validated and Endorsed
For cognitive assessment specifically — a component of many PHP evaluations — the evidence base expanded rapidly during and after the COVID-19 pandemic. The Inter Organizational Practice Committee (IOPC), representing the American Academy of Clinical Neuropsychology, the National Academy of Neuropsychology, Division 40 of the American Psychological Association, and other major professional organizations, issued formal guidance endorsing teleneuropsychology (TeleNP) for clinical practice (Bilder et al., 2020).
Parks, Davis, Spresser, Stroescu, and Ecklund-Johnson (2021), studying the validity of in-home teleneuropsychological testing in a mixed clinical sample, found that test profiles obtained via telehealth were clinically equivalent to those obtained in person, with comparable diagnostic conclusions. This study, published in Archives of Clinical Neuropsychology, directly addressed the concern that unsupervised home-based testing might compromise validity — a concern relevant to PHP evaluations conducted via telehealth.
Thomas, McDonald, de Boer, Brand, and Nedeljkovic (2021), reviewing the empirical literature on videoconferencing for psychological therapy and assessment, found an "established evidence base" supporting the clinical equivalence of videoconference-based service delivery, with high patient and clinician satisfaction.
6.3 PSYPACT: The Legal Framework for Interstate Telehealth Practice
The Psychology Interjurisdictional Compact (PSYPACT) — now enacted in 42 jurisdictions (40 states, the Commonwealth of the Northern Mariana Islands, and the District of Columbia) — provides the legal framework for licensed psychologists to practice across state lines via telehealth. The Authority to Practice Interjurisdictional Telepsychology (APIT) credential, issued under PSYPACT, authorizes psychologists to conduct telehealth evaluations for clients located in any PSYPACT member jurisdiction.
PSYPACT does not exclude forensic or fitness-to-practice evaluations from its scope. A psychologist authorized under PSYPACT can conduct a PHP evaluation for a professional located in any of the 42 member jurisdictions — a geographic reach that no in-person assessment center can match.
6.4 Implications for PHP Evaluation Modality
The convergence of the evidence base for telehealth assessment validity with the PSYPACT legal framework raises a practical question for PHP programs: should telehealth-based evaluation be available as an option alongside — not as a replacement for — the traditional in-person assessment center model?
Both modalities have appropriate applications. Multi-day, in-person assessment remains the standard for cases requiring hands-on neurological examination, residential-level observation, or comprehensive multi-disciplinary team evaluation. It is also required when a referring body — a licensing board, a court — specifically mandates in-person assessment.
Telehealth-based evaluation, conducted by qualified forensic psychologists using standardized instruments and validated telehealth protocols, offers distinct advantages for cases where the clinical questions can be addressed through structured clinical interview, psychological testing, record review, and collateral consultation: faster scheduling, reduced travel burden and practice disruption, preservation of confidentiality (no unexplained multi-day absence), and expanded geographic access through PSYPACT authorization. For the substantial proportion of PHP referrals that involve focused substance use evaluation, personality assessment, or fitness-to-practice determination — rather than comprehensive residential assessment — telehealth represents a validated, evidence-supported modality.
The question is not which modality is better. The question is whether PHP programs have access to both — and whether the current concentration of evaluation capacity in a small number of in-person centers adequately serves a population that is growing in both size and complexity.
7. Barriers to Assessment and the Consequences of Delay
The assessment bottleneck described in Section 4 is not merely an inconvenience. Delays in evaluation produce consequences that cascade through the PHP model.
7.1 Barriers to Help-Seeking
Vayr, Hérin, Jullian, Soulat, and Franchitto (2019), reviewing the literature on barriers to help-seeking among physicians with substance use disorders, identified several categories of barrier: fear of career consequences (license revocation, loss of hospital privileges), stigma (both internalized and institutional), concerns about confidentiality, and practical barriers including the cost and logistical difficulty of accessing assessment.
The Dr. Lorna Breen Health Care Provider Protection Act (2022), reauthorized through 2030, represents a federal policy response to these barriers, authorizing grants for healthcare worker mental health programs and specifically addressing the stigma that prevents professionals from seeking help. Named for an emergency physician who died by suicide during the COVID-19 pandemic, the Act signals growing recognition that the healthcare workforce cannot be protected by systems that professionals are afraid to use.
7.2 The Cost of Delay
When assessment is delayed — because centers are booked, travel cannot be arranged, or cost is prohibitive — the professional remains in practice without the clinical information needed to determine whether practice is safe. The PHP cannot make treatment recommendations without an evaluation. The monitoring contract cannot begin without a baseline assessment. Every week of delay is a week during which an impaired professional may be treating patients without appropriate oversight.
For the professional, delay compounds the problem. Untreated substance use disorders progress. Mood disorders deepen. Cognitive decline accelerates. The clinical presentation that a timely evaluation might have caught at a manageable stage may present as a crisis by the time the evaluation finally occurs.
Reducing the barriers to assessment — making evaluation faster, more accessible, less costly, and less disruptive — is not a matter of convenience. It is a matter of public safety and professional welfare.
8. Emerging Trends: The Future of PHP Evaluation
8.1 Expanding Beyond Physicians
The original PHP model was designed for physicians. Increasingly, states are expanding coverage to all licensed healthcare professionals — nurses, pharmacists, dentists, physician assistants, and others. A 2025 retrospective study of the Utah Professionals Health Program found that monitoring outcomes for non-physician healthcare professionals with substance use disorders were comparable to those reported in the physician literature, supporting the extension of the PHP model across professions (Olufemi et al., 2025). A 2020 analysis in the Journal of Addictions Nursing similarly called for parity in standards of care between physician PHPs and nursing alternative-to-discipline programs (McGauley, 2020).
This expansion multiplies the demand for evaluation services. The five accredited assessment centers and the small panels of individual evaluators that currently serve the PHP system were designed for a physician-only population. A system that also serves millions of nurses, pharmacists, and other professionals requires a fundamentally larger — and more accessible — evaluation infrastructure.
8.2 Increasing Case Complexity
Crane, Kimmel, Early, Davidson, and Martin (2025), analyzing referral data from the Colorado Physician Health Program, documented a significant increase in case complexity over recent years. Professionals are increasingly presenting with co-occurring conditions — substance use disorder with personality pathology, behavioral disruption with underlying cognitive decline, mood disorder with chronic pain — that require multidisciplinary evaluation expertise. A recent scoping review by Roberts and colleagues (2025) catalogued the full range of health conditions that impact physician fitness-to-practice, reinforcing the need for evaluators who can assess across diagnostic categories rather than focusing narrowly on substance use.
This trend has direct implications for evaluation methodology. A focused substance use assessment may be insufficient for a professional presenting with co-occurring personality pathology and cognitive symptoms. Comprehensive psychological testing — personality assessment, cognitive screening, symptom validity measures — becomes more important, not less, as the population grows more complex.
8.3 State-Level Perspectives
Individual state PHPs have begun publishing on the evolution of their programs. Bresnahan and Jordan (2024), writing in the North Carolina Medical Journal, described the role and importance of PHPs in a landscape of increasing demand and expanding scope, noting that programs originally designed for physician substance use disorders now serve broader professional populations with more complex clinical presentations. This pattern — originally narrow scope broadening under growing demand — is consistent with national trends documented by the FSPHP and underscores the need for evaluation infrastructure that can scale alongside the expanding mission.
9. The Specialized Skill Set: What PHP Evaluation Requires
Not all psychologists are equipped to conduct PHP evaluations. The intersection of forensic methodology, clinical assessment, substance use expertise, and regulatory knowledge required for PHP work is specialized. The literature and the FSPHP guidelines point to several domains of competence that distinguish PHP-qualified evaluators from general clinical practitioners.
9.1 Forensic Evaluation Training
PHP evaluations are forensic evaluations — the evaluator's obligation is to the accuracy of the findings, not to the therapeutic welfare of the examinee. As Strasburger, Gutheil, and Brodsky (1997) established, the treating clinician role and the forensic evaluator role are structurally incompatible. A PHP evaluator should have training and experience in forensic assessment methodology, including objective data integration, multi-source corroboration, and the distinction between clinical impressions and evidentiary conclusions.
9.2 Comprehensive Testing Capability
An evaluator who conducts only a clinical interview — without standardized personality assessment, cognitive screening, or validity testing — does not meet the standard for comprehensive PHP evaluation. The evaluation should include normed, validated instruments selected for the clinical questions at hand, administered and interpreted by a psychologist trained in their use.
9.3 Independence from Treatment Programs
An evaluator who is affiliated with a treatment program — or whose practice revenue depends on treatment referrals — faces an inherent conflict of interest in making treatment recommendations. The most credible PHP evaluations come from independent practitioners who assess and report without financial interest in the recommendations they make.
9.4 Understanding of the Regulatory Framework
The evaluator must understand the PHP model, the licensing board's role, the monitoring contract structure, and the regulatory questions the evaluation is expected to answer. A clinical psychologist who writes a standard diagnostic report — without addressing fitness to practice, risk level, treatment intensity, and monitoring recommendations — has not answered the questions the PHP needs answered.
9.5 Telehealth Competence and Legal Authorization
For evaluators offering telehealth-based services, PSYPACT authorization (or equivalent state telehealth authorization) is required for interstate practice. The evaluator should be familiar with telehealth assessment protocols, including validated methods for administering psychological tests via videoconference and procedures for maintaining test security in a remote environment.
10. Conclusion
Professional Health Programs represent one of the most effective models in behavioral health for managing substance use disorders and mental health conditions in high-stakes professional populations. The outcomes data — 78% of physicians licensed and working at five years, with monitoring completion rates far exceeding those of standard SUD treatment (McLellan et al., 2008) — speak to the power of combining therapeutic intervention with structured accountability.
The PHP model depends on timely, comprehensive evaluation at the front end. Without quality assessment, treatment recommendations lack clinical foundation. Without rapid access to assessment, impaired professionals remain in practice during the delay. And as Crane et al. (2025) documented, the complexity of referrals is increasing — more co-occurring conditions, more behavioral presentations beyond substance use, more professionals from non-physician disciplines — placing greater demands on evaluation resources that were designed for a narrower population.
Three developments converge to shape the next phase of PHP evaluation infrastructure. First, the evidence base for telehealth-based psychological assessment has matured to the point where major professional organizations and peer-reviewed meta-analyses support its clinical equivalence to in-person assessment (Sugarman & Busch, 2023; Bilder et al., 2020). Second, the PSYPACT legal framework has expanded to 42 jurisdictions, enabling licensed psychologists to conduct evaluations across state lines without separate licensure in each state. Third, the expansion of PHP coverage to non-physician healthcare professionals — and the recognition that effective evaluation requires forensic methodology, not just clinical screening — has intensified demand for qualified evaluators.
These developments do not diminish the role of established assessment centers. They suggest that the evaluation infrastructure needs to expand — in capacity, in geographic reach, and in the diversity of modalities available to PHP programs and the professionals they serve. The alternative-to-discipline model works. The question going forward is whether the evaluation systems that support it can scale to match the growing scope of the mission.
References
Bilder, R. M., Postal, K., Barisa, M., Aase, D. M., Cullum, C. M., Gillaspy, S. R., ... & Woodhouse, J. (2020). InterOrganizational practice committee recommendations/guidance for teleneuropsychology (TeleNP) in response to the COVID-19 pandemic. The Clinical Neuropsychologist, 34(7-8), 1314–1334. https://doi.org/10.1080/13854046.2020.1767214
Bresnahan, L. R., & Jordan, J. P. (2024). The role and importance of physician and health care professional programs. North Carolina Medical Journal, 85(5). https://doi.org/10.18043/001c.123262
Bryson, E. O., & Silverstein, J. H. (2008). Addiction and substance abuse in anesthesiology. Anesthesiology, 109(5), 905–917. https://doi.org/10.1097/ALN.0b013e3181895bc1
Crane, L. A., Kimmel, A. L., Early, S. R., Davidson, J. M., & Martin, L. F. (2025). Trends in case complexity and implications for physician health programs: An analysis of referrals to the Colorado Physician Health Program. Journal of Medical Regulation, 111(3), 14–24. https://doi.org/10.30770/2572-1852-111.3.14
Domino, K. B., Hornbein, T. F., Polissar, N. L., Renner, G., Johnson, J., Alberti, S., & Hankes, L. (2005). Risk factors for relapse in health care professionals with substance use disorders. JAMA, 293(12), 1453–1460. https://doi.org/10.1001/jama.293.12.1453
DuPont, R. L., McLellan, A. T., Carr, G. D., Gendel, M. H., & Skipper, G. E. (2009). How are addicted physicians treated? A national survey of physician health programs. Journal of Substance Abuse Treatment, 37(1), 1–7. https://doi.org/10.1016/j.jsat.2009.03.010
Gold, J. A. (2020). Covid-19: Adverse mental health outcomes for healthcare workers. BMJ, 369, m1815. https://doi.org/10.1136/bmj.m1815
DuPont, R. L., McLellan, A. T., White, W. L., Merlo, L. J., & Gold, M. S. (2009). Setting the standard for recovery: Physicians' Health Programs. Journal of Substance Abuse Treatment, 36(2), 159–171. https://doi.org/10.1016/j.jsat.2008.01.004
DuPont, R. L., Compton, W. M., & McLellan, A. T. (2015). Five-year recovery: A new standard for assessing effectiveness of substance use disorder treatment. Journal of Substance Abuse Treatment, 58, 1–5. https://doi.org/10.1016/j.jsat.2015.06.024
Hubley, S., Lynch, S. B., Schneck, C. D., Thomas, M. R., & Shore, J. H. (2016). Review of key telepsychiatry outcomes. World Journal of Psychiatry, 6(2), 269–282. https://doi.org/10.5498/wjp.v6.i2.269
Lawson, N. D., & Boyd, J. W. (2018). How broad are state physician health program descriptions of physician impairment? Substance Abuse Treatment, Prevention, and Policy, 13, 29. https://doi.org/10.1186/s13011-018-0168-z
Manion, K. (2020). To heal or not to heal, physician, that is the question. Qualitative Research in Medicine & Healthcare, 3(3). https://doi.org/10.4081/qrmh.2019.8665
McGauley, M. C. (2020). Creating parity in standards of care between physicians and nurses. Journal of Addictions Nursing, 31(3), 216–219. https://doi.org/10.1097/JAN.0000000000000356
McLellan, A. T., Skipper, G. S., Campbell, M., & DuPont, R. L. (2008). Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. BMJ, 337, a2038. https://doi.org/10.1136/bmj.a2038
Merlo, L. J., Campbell, M. D., Skipper, G. E., Shea, C. L., & DuPont, R. L. (2016). Outcomes for physicians with opioid dependence treated without agonist pharmacotherapy in physician health programs. Journal of Substance Abuse Treatment, 64, 47–54. https://doi.org/10.1016/j.jsat.2016.02.004
Mihailescu, M., & Neiterman, E. (2019). A scoping review of the literature on the current mental health status of physicians and physicians-in-training in North America. BMC Public Health, 19, 1363. https://doi.org/10.1186/s12889-019-7661-9
Olufemi, M. O., Merlo, L. J., Cheng, M., Zhao, H., & Yang, J. (2025). Monitoring outcomes of substance use disorder among healthcare professionals in Utah: A retrospective study of the professionals health program. American Journal on Addictions. https://doi.org/10.1111/ajad.70106
Parks, A., Davis, J. F., Spresser, C. D., Stroescu, I., & Ecklund-Johnson, E. (2021). Validity of in-home teleneuropsychological testing in the wake of COVID-19. Archives of Clinical Neuropsychology, 36(6), 887–896. https://doi.org/10.1093/arclin/acab002
Roberts, R., Jackson, T., Gerdes, R., Deibert, D., Dennett, L., & Bhatt, M. (2025). Health conditions that impact fitness-to-practice in physicians: A scoping review. International Journal for Quality in Health Care, 37(4). https://doi.org/10.1093/intqhc/mzaf108
Skipper, G. E., Campbell, M. D., & DuPont, R. L. (2009). Anesthesiologists with substance use disorders: A 5-year outcome study from 16 state physician health programs. Anesthesia & Analgesia, 109(3), 891–896. https://doi.org/10.1213/ane.0b013e3181adc39d
Stehman, C., Testo, Z., Gershaw, R. S., & Kellogg, A. (2019). Burnout, drop out, suicide: Physician loss in emergency medicine, Part I. Western Journal of Emergency Medicine, 20(3), 485–494. https://doi.org/10.5811/westjem.2019.4.40970
Strasburger, L. H., Gutheil, T. G., & Brodsky, A. (1997). On wearing two hats: Role conflict in serving as both psychotherapist and expert witness. American Journal of Psychiatry, 154(4), 448–456.
Sugarman, D. E., & Busch, A. B. (2023). Telemental health for clinical assessment and treatment. BMJ, 380, e072398. https://doi.org/10.1136/bmj-2022-072398
Thomas, N., McDonald, C. E., de Boer, K., Brand, R., & Nedeljkovic, M. (2021). Review of the current empirical literature on using videoconferencing to deliver individual psychotherapies to adults with mental health problems. Psychology and Psychotherapy: Theory, Research and Practice, 94(3), 854–883. https://doi.org/10.1111/papt.12332
Tyssen, R. (2007). Health problems and the use of health services among physicians: A review article with particular emphasis on Norwegian studies. Industrial Health, 45(5), 599–610. https://doi.org/10.2486/indhealth.45.599
Vayr, F., Hérin, F., Jullian, B., Soulat, J., & Franchitto, N. (2019). Barriers to seeking help for physicians with substance use disorder: A review. Drug and Alcohol Dependence, 199, 116–124. https://doi.org/10.1016/j.drugalcdep.2019.04.004
Williams, B., Flanders, P., Welindt, D., & Williams, M. V. (2018). Importance of neuropsychological screening in physicians referred for performance concerns. PLoS ONE, 13(11), e0207874. https://doi.org/10.1371/journal.pone.0207874
About the Author
Lisa A. Long, Psy.D. is a licensed clinical and forensic psychologist and the Clinical Director of Dr. Long & Associates, a national telehealth psychology practice. Dr. Long is one of three psychologists on the North Carolina Professional Health Program (NCPHP) approved evaluator panel and is PSYPACT-authorized to practice across 43 states. She has conducted comprehensive psychological evaluations for healthcare professionals referred through PHP programs, including fitness-to-practice assessments, substance use evaluations, and personality assessment. Dr. Long has presented original research at the American Academy of Forensic Sciences (AAFS) and the Association of Family and Conciliation Courts (AFCC) and serves as a peer reviewer for Psychology, Public Policy, and Law (APA).
Disclaimer
This article is provided for informational and educational purposes only. It does not constitute legal advice, medical advice, or a guarantee of any particular outcome. Every fitness-to-practice evaluation is unique, and outcomes depend on the specific facts, evidence, and circumstances of the individual case. Dr. Long & Associates conducts independent psychological evaluations objectively — evaluation findings are reported accurately regardless of whether they support or do not support the examinee's return to practice. Healthcare professionals with questions about their PHP program should contact their state PHP directly.
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