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stable environment insulated, as much as possible, from changing political pressures. PHPs must also have a clearly defined mission and avoid any potential negative impact resulting from leadership and/or philosophical changes within the state medical association, state medical boards or others. Consequently, the Committee optimally recommends that state boards contract with PHPs that have an independent organizational structure. Endorsement by organized medicine adds to PHP status. PHPs and their board of directors, medical associations and state boards should avoid conflicts of interest and dual roles. They should maintain appropriate boundaries between the medical association, the PHP and the state board. A PHP should be empowered to conduct an intervention based on clinical reasons suggestive of potential impairment. Unlike the board, which must build a case capable of withstanding legal challenge, a PHP can quickly intervene based on a reasonable concern. The PHP can, therefore, be a significant benefit to public safety and a cost savings to licensure boards. Since 1995, FSMB policy has supported physician remediation via an effective PHP as an alternative to, or in conjunction with, discipline. The FSPHP has adopted guidelines that, along with this document, serve as a resource in selecting and evaluating any particular PHP. Furthermore, it is recommended PHPs comply with FSPHP Guidelines. A formal contract should be executed between the board and PHP, setting forth the relationship. Ideally, such a contract will be based on the principles of mutual trust, respect, accountability, collaboration, and communication. Transparency of program policies and procedures while maintaining the appropriate confidentiality of individual participants is important. A PHP should comport with FSPHP Guidelines, including the following functional elements: 1. Administration/Personnel: To adequately and appropriately manage and administer the PHP clinical and administrative functions, PHP staff should include: a) Physician Medical Director: PHPs should employ a medical director with qualifications in addressing addictive, mental and behavioral illness. If possible, the PHP should be adequately funded for the employment of a full-time physician medical director. A full-time physician as medical director can offer clinical knowledge necessary to effectively evaluate physician impairment issues. b) Executive Director: The PHP executive director has responsibility to oversee the administrative and operational aspects of the PHP as well as its corporate responsibilities. Some state PHPs may wish to combine the functions of the physician medical director with the executive director into the position of Executive Medical Director. c) Support Staff: The PHP should include adequate clerical, case management and other appropriate staff to support the physician medical director and executive director. There are instances noted in this report in which PHP personnel report information about identified participants to the board. Otherwise, with regard to the identities of participants, PHP directors and all PHP staff should follow professional standards to protect confidentiality and not disclose information about participants without appropriate releases to do so. Such releases may be in the form of language included in the PHP participant contracts/agreements. 2. Legislation – Medical boards in consultation with PHPs should periodically review laws and regulations and recommend changes in order to ensure that the PHPs function effectively and are legally able to keep abreast of evolving best practices. 13 Policy on Physician Impairment 3. Organized Medicine Support – PHPs should seek the support of organized medicine and others, including but not limited to, professional associations, hospitals, medical groups, legislatures, licensing authorities, malpractice insurers, medical schools and residency programs, consumer groups and the general public. 4. Intervention – PHPs should have a process for intervening when information indicates a reasonable concern that a physician may have a potentially impairing illness. The individuals conducting the