The Impaired Physician

How Impaired Physicians Can Be Helped

Neil Chesanow

Disclosures

February 24, 2015

In This Article

Excellent Track Records

Dr Earley, whose scholarly work includes "Physician Health Programs and Addiction Among Physicians," a chapter in a textbook on addiction medicine,[1] believes that PHPs have been so effective in saving the careers of physicians with drug and alcohol abuse problems precisely because they use a chronic disease model to treat addiction—and also because physician addicts generally love being doctors and are highly motivated to rescue their careers.

"Eighty percent of these physicians have zero positive urine drug screens over 5 years nationally, which is remarkable," Dr Earley observes. "Even among those who relapse, 50% who have a positive urine drug screen have only one relapse over that period. Their treatment process is then shored up, and they do fine. The long-term recovery rate among physicians is almost 90%."

According to the National Institute on Drug Abuse, the relapse rate for addicts in the general population is 40%-60%.[2]

Still, many physicians who need help aren't getting it.

"I think most PHPs actually do what they're supposed to do," says Dr Hall. "The problem is their effectiveness in penetrating the population being served. That's the limiting factor. If you have adequate funding, you can do more education. You can reach out more. You can build the organizational infrastructure that allows you to try to get to the percentage of ill doctors who need to be gotten to."

With a rapidly growing physician shortage, society has—or should have—a stake in helping sick physicians recover and get back to work. "It costs up to $300,000 to replace a physician who leaves medicine," Dr Gundersen points out.

But it isn't just lack of funding that prevents PHPs from reaching all the doctors who need help. Most doctors are at least vaguely aware that PHPs exist, experts maintain. Hospital wellness committees, which the Joint Commission mandates, generally are. What enables sick doctors is the propensity of many physicians to turn a blind eye to a colleague whose behavior should be triggering red flags.

"I would say to our profession: We need to be treating each other like we treat our patients," Dr Hall says. "Reach out and help colleagues who need it. Don't enable the problem to continue. It always gets worse."

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