The PEER program was developed by the OMA 15 years ago. Its development was in response to the need for a way to assist physicians whose medical practices had been questioned and who were faced with possible limitation of practice, privileges or access of patients. It should be stated from the onset that the PEER Program is a physician advocate. By advocate we do not mean taking the physicians side and "defending" them, but rather by evaluating the concerns or perceived problems in their practice with the goal of defining and correcting the problems identified.

The program consists of three basic parts:

• the initial or diagnostic assessment and development of educational or remedial plan—Cost: $6000*

• the educational or remedial phase—Cost: $4500*

• the post educational assessment to see if the goals set out in the initial assessment have been accomplished. This includes long-term follow-up—Cost: $4500*

It must be emphasized that each case is somewhat different. Some involve only a lack of proper documentation in the patient's chart, others pertain to the standard of care, while still others are a combination of several concerns. All too often the client's difficulties involve interpersonal problems with the patient, peers, nursing personnel, or insurance companies. We are just beginning to appreciate how important a role this plays in the physicians referred to the program. We are exploring how to integrate into our program evaluation and remediation for this problem.

Initially the typical physician client is not happy to be involved with us, but by the time he or she is referred the alternatives are not pleasant and we are seen as the helping hand even though the client feels threatened by the situation. By far the majority of physicians who complete the program feel that they practice better medicine, feel better about themselves and view the program as a positive experience. The referring body, whether it be the BME, hospital, hospital medical staff, IPA, government agency or payor similarly feel that PEER has aided them and their interests as well as having served the physician. The program is not a quick fix, it is an in-depth program that is time and labor intensive, but it does work. Society cannot afford to lose good physicians because of problems that can be solved.

For further information, e-mail skog@theoma.org.

*Costs assume Active OMA membership and may be subject to adjustment to reflect specific services provided and duration of each phase.