Nearly a Third More Cases in 2 Years for Spain's Sick Doctors Programme 

Dr Javier Cotelo

October 21, 2019

MADRID - The Integrated Healthcare Programme for Sick Doctors (PAIME) in Spain, has dealt with approximately 30% more cases in the last 2 years compared with the previous period.

Programme data show mental health conditions continue to rise amongst doctors, and are the main reason for accessing the programme. There was a particular increase in cases among women and doctors under 30 years old.

The speciality with the most users of the system is family and community medicine.

More than half of the doctors requested some form of voluntary help. In more than 2 decades of the history of the programme, 90% of the doctors treated have recovered and have returned to their professional life.

This, officials said, shows the success of the programme and that timely intervention helps doctors make a full recovery.

World Leading Programme

In a professional context, the Integrated Healthcare Programme for Sick Doctors is unique in Spain and has become a benchmark for Europe and the world.

Spain's system was created as an initiative by the Medical Association of Barcelona and covers all autonomous regions within Spain's medical associations.

According to data from the Social Welfare Foundation of the Spanish College of Physicians, since its creation in 1998, the programme has seen a total of 5171 doctors with mental health and/or addiction disorders.

The Integrated Healthcare Programme for Sick Doctors reflects the ethical commitment of the medical profession and provides healthcare, social care, legal support, and career advice to doctors experiencing psychological and/or addictive disorders.

It is estimated that between 10 and 12% of Spain's practising doctors may experience a mental health condition or an alcohol or drug addiction during their working life.

Miquel Casas, professor of psychiatry at the Autonomous University of Barcelona, director of the Corporate Programme of the Catalan Institute of Health, and spokesperson for the Spanish Psychiatric Society, told Medscape in Spanish : "The World Health Organisation states that approximately 25% of the world population will experience a severe psychiatric disorder at some point in their lives. When these percentages are translated to the adult professional population they are reduced to 10-12%. This is probably because many people with psychiatric disorders during adolescence were not able to continue to higher education.

"Therefore, the percentages show the medical community is within typical figures for professional groups that have had a university education."

The Integrated Healthcare Programme for Sick Doctors is jointly financed by the Medical Associations, the Social Welfare Foundation of the Spanish College of Physicians and health administrations. Funding differs in some autonomous regions.

Programme Created By Doctors for Doctors

The Integrated Healthcare Programme for Sick Doctors was created by doctors and aimed specifically at clinicians. In Madrid, the Medical Association manages the programme, and all licensed and working doctors are entitled to use it. This is because it was created for doctors with psychiatric and/or addictive disorders to enable them to return to their professional career in the best condition and to provide a guarantee of good care to their patients.

In Madrid, doctors can access the service by phone and email. If required, a first meeting will be arranged for an initial assessment. After this, if the coordinator deems it to be appropriate, the doctor will be included in the programme and will be referred to one of its psychiatrists.

All sick doctors who enter the programme must sign an informed consent form for care, which details the treatment offered as well as the commitments of the affected person once they are admitted, with assurance of confidentiality.

The Madrid Medical Association webpage states that if a sick doctor refuses specialist care, and this could lead to a risk of malpractice, anyone aware of this has an ethical duty to inform the secretary of the College of Physicians.

Emerging Trends

A report on the programme is published every 2 years.

The latest data covered 2017 and 2018 in which 877 new cases were dealt with. This is almost 30% more than in the previous 2 years, during which the annual average was 300 doctors undergoing treatment.

In 2015, the number of women affected overtook men, and this trend has continued, with a progressive increase in inter-gender differences since then.

The percentage of female doctors affected by mental health or addiction disorders in 2018 was 58.6%, compared with 41.4% of male doctors.

There has also been an increase in the average age of females experiencing these problems, moving from 36 years old in 2014, to 44 years old in 2017 and 42 years old in 2018.

Professor Casas said the rise in female cases reflects more women entering the medical profession. "A separate issue is that female medical professionals find it easier to ask for help. This is probably due to cultural patterns and a different sensitivity towards the fear of stigma about asking for help for a mental health problem. This fear is clearly less than it is for male doctors."

By age, the most affected group is between 51 and 60 years old (27.8%), followed by the age 31 to 40 (23.5%), 41 to 50 (23.3%), under 30 (15.6%) and over 61 (9.8%). There has been a striking increase in the number of cases in doctors under 30 years old, which went from 13.7% in 2015, and 7.8% in 2016 to 14.2% in 2017 and 17% in 2018. There has also been an increase in the 31 to 40 age group, particularly in 2018 when it was 26.1%, whereas in previous years it was around 20%.

Professor Casas pointed out that, "in the case of young doctors, there is no greater prevalence than with doctors of previous generations, but there are specific programmes in place to help resident internal medicine specialists with difficulties, and teaching centres are more and better involved in the health of these professionals in training".

In terms of autonomous regions, the three with the highest number of recorded cases for this period were Catalonia (303), Andalusia (131) and Madrid (106). In contrast, the regions with the fewest number of recorded cases were Ceuta and Melilla (0) and La Rioja (1).

Professor Casas added: "These results show the study of the Integrated Healthcare Programme for Sick Doctors throughout Spain, but do not show the differences between the different Official Medical Associations of the 17 autonomous regions.

"The fact that some Official Medical Associations have a higher number of professionals treated under the Integrated Healthcare Programme for Sick Doctors is because they have a higher number of members, or that they started implementing the programme earlier."

Mental Health Conditions and Addiction

In the last reporting period, mental disorders were the main reason for admission to the Integrated Healthcare Programme for Sick Doctors, at 74.4%, followed by dual pathology 10.9%, alcohol addiction 9.3% and other addictions 5.3%.

With regard to specific clinical diagnoses, the highest number of cases (31.5%) was related to mood disorders, followed by consumption of alcohol and other substances (23.6%), adjustment disorders (21.2%) and anxiety disorders (12.8%). With regard to alcohol consumption separate from other substances, the percentage of cases at 9.3% is the lowest recorded in the last 8 years. This shows a clear downward trend.

With regard to the access method to these programmes, more than half of the doctors (56%) did so on their own initiative; 13.1% came through a colleague; 10.5% via the occupational health and safety department; 9.8% were referred by a psychiatrist; 5% by a superior; 4.5% by a family member and 0.5% by workplace management.

With regard to the care given to the doctors with these disorders, the majority were treated as outpatients by professional clinicians attached to the programme, with 1028 consultations for new and relapsed cases in the last 2 years.

The number of doctors treated who required hospitalisation during this period was 184 (21%), with an average duration of admission of 32 days.

The vast majority of doctors treated (63.4%) were working at the beginning of the programme; 34.3% were on temporary disability leave and 1.7% were unemployed or temporarily disqualified from practising medicine (0.6%).

The average duration of leave was 106 days in 2017 and 115 days in 2018. As well as the cases recorded as complex during these 2 years, 147 posed a risk of malpractice, 56 had conflicts in the workplace and 15 doctors had to change work location.

Family Doctors the Largest Users

With regard to specialities with the greatest number of people accessing the programme, 42% were family doctors, followed by anaesthetists (7.3%), paediatricians (6.1%) and psychiatrists (4.2%). The increase in anaesthetists is striking, rising from an average of between 5 and 6% to more than 7%. Similarly there has been an increase in the number of professionals working in inpatient or outpatient emergency wards, from 1.8% in 2015 and 3% in 2016, to 3.5% in 2017 and 5.1% in 2018.

"These disorders similarly affect all healthcare fields. They appear more frequently in some medical specialities than others because the number of doctors working in them, [for instance in] primary healthcare, is greater than in other specialities", Prof Casas said.

Lastly, he added, "the early diagnosis and treatment of any mental health problem is essential to avoid psychiatric conditions becoming chronic.

"Nevertheless, especially in medicine, we should be advocating for and committing to strategies that promote the prevention of mental disorders among professional colleagues. This means improving working conditions, specific psychological education for doctors, and [attention to] admission requirements for candidates to study medicine. In addition we need [particularly] to assist newly qualified doctors whose preferred speciality is internal medicine, and continue to ensure awareness of mental health problems among team leaders, service directors, managers and health authorities. We must especially fight the stigmatisation of colleagues with mental health problems, as this is the primary factor responsible for delay in seeking help.

"The best advice you can give to a colleague you believe has a mental health problem is that they confide in the Integrated Healthcare Programme for Sick Doctors at their official medical association, and that they do so as soon as possible", Prof Casas concluded.

Translated and adapted from Medscape in Spanish.

Spanish College of Physicians. Integrated Healthcare Programme for Sick Doctors. The PAIME Latin American Meeting. Consulted electronically.

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