The prevalence of substance use disorders among physicians ranges between 10% and 14%, a rate that is similar to that of the general population. “Research has shown that several specialties have a higher-than-expected rate of these disorders, most notably anesthesiology, emergency medicine, and psychiatry,” says John S. Rose, MD. Despite the reported higher rates of substance use disorders and participation in Physician Health Programs (PHPs) among these specialties, few studies have focused specifically on the prognosis and recovery of emergency physicians (EPs) in PHPs.

Important New Data

There are little data on whether EPs who receive treatment by PHPs have similar outcomes with these programs as other physicians. To address this research gap, Dr. Rose and colleagues conducted a study using data from 16 state PHPs that followed participants with substance use disorders for 5 or more years. Published in the Western Journal of Emergency Medicine, the study compared outcomes of EPs with other practitioners who were enrolled in state PHPs. “Research has been limited regarding whether EPs perform as well as other physicians after treatment from PHPs,” Dr. Rose says. “We wanted to determine if there were any characteristics for EPs that were significantly different from those of other physicians.”

For the study, investigators reviewed data on 904 physicians with a diagnosis of substance use disorders between 1995 and 2001. They compared 56 EPs with 724 other physicians and assessed rates of relapse, successful completion of monitoring, and return to clinical practice within 5 years. Overall, EPs had a higher-than-expected rate of substance use disorders. “EPs were almost three times as likely to be enrolled in a PHP as other physicians involved in the study,” says Dr. Rose.

SubstanceUse-ED-Callout

Treatment Is Effective

During monitoring by PHPs, 13% of EPs in the study had at least one positive drug test, compared with a 22% rate that was observed among other physicians. This difference, however, was not considered statistically significant (Table 1). At the end of the 5-year follow-up period, 71% of EPs and 64% of other physicians had completed their contracts and were no longer required to be monitored (Table 2). The analysis noted that 13% of EPs and 20% of other physicians failed to complete the PHP. These results indicated that EPs were as likely as other physicians to complete the PHP, to fail to complete the program, or to extend the monitoring period beyond the original 5 years specified in their agreements.

“Importantly, 84% of EPs continued their medical practice after completing the PHP,” adds Dr. Rose. Although not statistically better, Dr. Rose says EPs trended toward higher rates of returning to clinical practice than other physicians involved in the study. There was also a trend that fewer EPs had their license revoked after participating in PHPs. These data support the notion that EPs do well following treatment of their substance use disorders with monitoring in PHPs and generally return to practice emergency medicine.

More to Learn

While findings from the study are encouraging for the prognosis of EPs who enter PHPs, Dr. Rose says more information is needed on why EPs are over-represented in these programs. “It has been hypothesized that job stress, access to controlled substances, and other factors may contribute to this phenomenon,” he says. “It’s also possible that EPs enjoy high stress situations. This may over-stimulate the brain’s reward center, an area affected by addiction. Furthermore, there are many genetic, psychological, and social factors that contribute to the development of substance use disorders. It’s possible that EPs are at higher risk for these factors than other individuals. This is an important area for future research because there is no published evidence substantiating these potential causes.”

Efforts are needed to better educate EPs in practice and those in training about substance use disorders. “Greater awareness is needed about the potential situations and risk factors that may contribute to the development of substance use disorders and the resources available to treat physicians,” Dr. Rose says. “Addiction can lead to negative physical, psychological, and legal consequences for physicians and the patients they treat. Addiction can also be a progressive and fatal problem if left untreated.”

Dr. Rose adds that early and effective interventions are needed to help EPs recover from substance use disorders and prevent the negative consequences of addiction. “The hope is that we’ll overcome the stigma, shame, and guilt associated with addiction so that physicians aren’t afraid to seek care,” he says. “By fully embracing the lifestyle changes that are necessary for a healthy recovery, physicians can overcome substance use disorders and go on to have fulfilling and successful careers.”

References

Rose J, Campbell M, Skipper G. Prognosis for emergency physician with substance abuse recovery: 5-year outcome study. West J Emerg Med. 2013 Jul 15 [Epub ahead of print]. Available at: http://escholarship.org/uc/item/6m2122s7#page-1.

Skipper GE, Campbell MD, Dupont RL. Anesthesiologists with substance use disorders: a 5-year outcome study from 16 state physician health programs. Anesth Analg. 2009;109:891-896.

Cottler LB, Ajinkya S, Merlo LJ, et al. Lifetime psychiatric and substance use disorders among impaired physicians in a Physicians Health Program: comparison to a general treatment population: psychopathology of impaired physicians. J Addict Med. 2013;7:108-112.

DuPont RL, McLellan AT, Carr G, et al. How are addicted physicians treated? A national survey of Physician Health Programs. J Subst Abuse Treat. 2009;37:1-7.

Skipper GE, DuPont RL. Anesthesiologists returning to work after substance abuse treatment. Anesthesiology. 2009;110:1422-1423.

Domino KB, Hornbein TF, Polissar NL, et al. Risk factors for relapse in health care professionals with substance use disorders. JAMA. 2005;293:1453-1460.