Monitoring physician drug problems: attitudes of participants

"The objective of this study was to measure satisfaction with a physician alcohol/drug and behavioral health monitoring program. Participating physicians rated the program's effectiveness, staff professionalism, monitoring and advocacy, relapse services, and sensitivity to women's issues. Correlations between satisfaction and successful recovery, source of referral, and legal involvement were computed. Responders' (N = 87, 82% male) contracts were 82% alcohol/drug and 9% behavioral health; 76% first contracts (no relapse). Sources of referral were self (32.2%), a friend/colleague (31%), the state medical board (14.9%), a hospital chief (11.5%), or a family member (3.4%). Satisfaction was associated with no relapse (mean rank = 47.6 vs. 30.0, p = .005), but not with gender (p = .47), type of contract (p = .39), source of referral (p = .75-.05), or board involvement (p = .24). Participants' reactions to the PHS program were influenced more by positive clinical outcome than other factors."

Prognosis for the recovery of surgeons from chemical dependency: a 5-year outcome study

Anesthesiologists with substance use disorders: a 5-year outcome study from 16 state physician health programs

Background: Anesthesiologists have a higher rate of substance use disorders than other physicians, and their prognoses and advisability to return to anesthesiology practice after treatment remain controversial. Over the past 25 yr, physician health programs (PHPs), created under authority of state medical regulatory boards, have become primary resources for management and monitoring of physicians with substance abuse and other mental health disorders.

Getting back on track: a systematic review of the outcomes of remediation and rehabilitation programmes for healthcare professionals with performance concerns

Objective: To provide an overview of the evidence regarding outcomes of remediation and rehabilitation programmes for healthcare professionals with performance concerns, and to explore if outcomes differ for specific concerns and professions.

Setting the standard for recovery: Physicians’ Health Programs

Abstract: "A sample of 904 physicians consecutively admitted to 16 state Physicians' Health Programs (PHPs) was studied for 5 years or longer to characterize the outcomes of this episode of care and to explore the elements of these programs that could improve the care of other addicted populations. The study consisted of two phases: the first characterized the PHPs and their system of care management, while the second described the outcomes of the study sample as revealed in the PHP records. The programs were abstinence-based, requiring physicians to abstain from any use of alcohol or other drugs of abuse as assessed by frequent random tests typically lasting for 5 years. Tests rapidly identified any return to substance use, leading to swift and significant consequences. Remarkably, 78% of participants had no positive test for either alcohol or drugs over the 5-year period of intensive monitoring. At post-treatment follow-up 72% of the physicians were continuing to practice medicine. The unique PHP care management included close linkages to the 12-step programs of Alcoholics Anonymous and Narcotics Anonymous and the use of residential and outpatient treatment programs that were selected for their excellence."

The three missing elements in the treatment of substance use disorders: Lessons from the physician health programs

Abstract: "To make recovery, and not relapse, the expected outcome of the treatment of moderate to severe substance use disorders, 3 currently missing elements would need to be emphasized: (1) the definition of long-term recovery as the goal of all treatment and post-treatment interventions; (2) the provision of sustained post-treatment monitoring and professional and peer support, including drug testing; and (3) the insistence by others around the patients on sustained abstinence as crucial for those suffering from moderate to severe and prolonged substance use disorders. Each of these 3 elements is central to the distinctive care management system of the state physician health programs. This approach to the long-term management of substance use disorders fits with the new direction of healthcare for serious, chronic diseases-away from isolated, and expensive acute care episodes of care and toward sustained chronic disease management with long-term monitoring, support, and early re-intervention if and when needed."

A new paradigm for long-term recovery

Physician Health Programs: The US Model

Physician Mental Health and Well-Being Chapter 12

Physician Wellness and Burnout

Federation of State Medical Boards Report and Recommendations of the Workgroup on Physician Wellness and Burnout  

The Prevalence of Substance Use Disorders in American Physicians

"There have been few studies on the prevalence of substance use disorders (SUDS) in the physician population at large nor have any studies compared the prevalence of SUDS in American physicians by specialty."