Physician Impairment and Addiction Risks
PRACTITIONER IMPAIRMENT
Taking a proactive approach to
Taking a proactive approach to
practitioner impairment
practitioner impairment
Updated 2/23
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An impaired physician is one who is unable
to practice medicine with reasonable skill
and safety because of a mental illness; a
physical illness or condition that adversely
affects cognitive, motor, or perceptive skills;
or substance abuse.
Federation of State Medical Boards of the United States, Inc.
Report
of the ad
hoc committee on physician impairment. June 2005
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Education Law, Section 6530 (7) & (8)
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Practicing the profession while impaired by
alcohol, drugs, physical disability, or mental
disability
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Being a habitual abuser of alcohol, or being
dependent on or a habitual user of other
drugs, except a physician who is maintained
on an approved therapeutic regimen which
does not impair the ability to practice
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Estimates suggest that impairment related to a substance use
disorder will affect 8% to 18% of physicians sometime during their
life and that about 2% of physicians currently have an active
problem with substance use
Boisaubin
EV, Levine RE.
Identifying and assisting the impaired physician. Am J
Med
Sci
2001; 322(1):
31-6
Other data indicate that rates of alcohol use disorders among
physicians are equal to or greater than the general population:
21.4% - 25.6% among female physicians
12.9% - 13.9% among male physicians
Oreskovich MR, Shanafelt T, et al. The prevalence of substance use disorders in
American physicians. Am J Addict. 2015;24:30-8
Oreskovich MR, Kaups KL, et al. Prevalence of alcohol use disorders among
American surgeons. Arch Surg. 2012;147:168-74.
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.
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Some physicians have an impairment that is
not obvious to others and are not involved in
treatment.
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Others may have sought treatment on their
own and in confidence.
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Still others may continue to practice with
impairments while being "protected' by well-
intentioned family members, friends, and
colleagues.
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Compulsive
seeking
& use
of
prescription or
illegal
psychoactive substances
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Progressively deteriorating
course
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Continued
use
despite negative
consequences (magnified in medicine)
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Tendency to relapse
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Requires comprehensive recovery program
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Public Health Law 230-11 (e)
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Preserves physician/patient privilege
even when patient is a doctor or a
student
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No Office of Physician Medical Conduct
(OPMC) report is required for information
learned solely as a result of rendering
treatment to another physician
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Frequently absent from work, conferences or
rounds
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Creates improbable excuses for not fulfilling
professional obligations.
•
Rarely admits errors or blame for mistakes
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Unexplained absences
•
Takes long trips to restroom
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Unreliable
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Difficulty concentrating
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Persistent poor judgment
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Changes in behavior
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Change in baseline behavior
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Deteriorating personal hygiene
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Multiple physical complaints
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Unfocused, confused, distracted
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Mood swings
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Overreaction to performance feedback
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Change in speech pattern
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Isolation: avoidance of associates
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Frequent lateness, absence or illness
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Declining work performance
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Ignoring requests to catch up on paperwork
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Questionable orders
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Inappropriate response to patient needs or staff
requests
•
Uncooperative and defiant approach to problems
and/or performance feedback
•
Denial/blaming others for problems
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Anger/abusive language
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Reports of disruptive behavior
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n
t
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Pharmacological optimism
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Knowledge of drug actions
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Strong will, invulnerability
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Willing to take chances
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Believes use can be controlled
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Rationalizes inappropriate behavior
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m
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a
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n
t
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Access
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Self-medication
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Job stress, erratic hours
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Perfectionism
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Difficulty discussing feelings (relies on denial)
•
Professional independence
•
Rationalizes inappropriate behavior
·
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O
t
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r
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Healthcare practitioners don’t seek help for
themselves
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Help each other vs. seek outside help
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Denial, rationalization
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Fear of being exposed and/or losing license,
job, income and/or reputation
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Shame, embarrassment, guilt
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Conspiracy of silence - peers ignore and enable
inappropriate behavior
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Don’t want to become involved, i.e., “rock the
boat”
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Believes others are addressing the problem
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“I can handle it on my own”
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Don’t know where to turn or trust that others will
help
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R
e
s
o
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c
e
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Medical Society for the State of New York
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The Committee on Physician Health (CPH)
•
You may refer your
•
friend, peer
•
or yourself....
·
C
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y
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If you call CPH about a colleague, your phone
call will be held in the strictest confidence.
•
The identity of a referral source is never
revealed unless the caller agrees. All referrals
are treated confidentially.
Call 1 (800) 338-1833
Web site
http://www.mssny.org/cph/
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Please call the toll free number (NY State only):
1 (800) 338-1833
Or their office at:
(518) 436-4723
The Committee for Physician Health
99 Washington Avenue, Suite 1111
Albany, NY 12210
Fax: (518) 436-7943
Email:
terrv@cphnv.org
All calls are confidential!
When behavior is
caused by illness.
Treating the illness
changes behavior.
P
o
s
i
t
i
v
e
O
u
t
c
o
m
e
s
•
Returns to productive practice of medicine
•
Hospital retains valuable team member
•
Clinical quality is enhanced
•
Colleagues’ trust is restored
•
Communications with staff improves
•
Practice continues to grow
•
Professional liability risk is reduced
•
Restoration of career, health, family, personal life
A
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SBUH Administrative P&P #MS0011
https://policymanager.uhmc.sunysb.edu/dotNet/documents/?docid=25817
SBUH
Practitioner Well Being
Committee
Committee
Chair
631-263-6071
2023
Physician impairment due to mental illness, physical conditions, or substance abuse is a serious concern in the medical field. This article discusses the definition of impairment, signs of professional misconduct, and statistics related to substance use disorders among physicians. It emphasizes the importance of proactive approaches to identifying and assisting impaired physicians to ensure patient safety and physician well-being.
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Presentation Transcript
PRACTITIONER IMPAIRMENT Taking a proactive approach to practitioner impairment Updated 2/23
Definition of Impairment An impaired physician is one who is unable to practice medicine with reasonable skill and safety because of a mental illness; a physical illness or condition that adversely affects cognitive, motor, or perceptive skills; or substance abuse. Federation of State Medical Boards of the United States, Inc. Report of the ad hoc committee on physician impairment. June 2005 r
Definitions of Professional Misconduct Education Law, Section 6530 (7) & (8) Practicing the profession while impaired by alcohol, drugs, physical disability, or mental disability Being a habitual abuser of alcohol, or being dependent on or a habitual user of other drugs, except a physician who is maintained on an approved therapeutic regimen which does not impair the ability to practice
YES, it can happen to you!!!! Estimates suggest that impairment related to a substance use disorder will affect 8% to 18% of physicians sometime during their life and that about 2% of physicians currently have an active problem with substance use Boisaubin EV, Levine RE. Identifying and assisting the impaired physician. Am J Med Sci 2001; 322(1):31-6 Other data indicate that rates of alcohol use disorders among physicians are equal to or greater than the general population: 21.4% - 25.6% among female physicians 12.9% - 13.9% among male physicians Oreskovich MR, Shanafelt T, et al. The prevalence of substance use disorders in American physicians. Am J Addict. 2015;24:30-8 Oreskovich MR, Kaups KL, et al. Prevalence of alcohol use disorders among American surgeons. Arch Surg. 2012;147:168-74.
Not all impaired physicians become part of these statistics. Some physicians have an impairment that is not obvious to others and are not involved in treatment. Others may have sought treatment on their own and in confidence. Still others may continue to practice with impairments while being "protected' by well- intentioned family members, friends, and colleagues.
The slippery slope to physician impairment
Profile of Addiction Compulsive seeking & use of prescription or illegal psychoactive substances Progressively deteriorating course Continued use despite negative consequences (magnified in medicine) Tendency to relapse Requires comprehensive recovery program
Doctors Treating Doctors Public Health Law 230-11 (e) Preserves physician/patient privilege even when patient is a doctor or a student No Office of Physician Medical Conduct (OPMC) report is required for information learned solely as a result of rendering treatment to another physician
Warning Signs Frequently absent from work, conferences or rounds Creates improbable excuses for not fulfilling professional obligations. Rarely admits errors or blame for mistakes Unexplained absences Takes long trips to restroom Unreliable Difficulty concentrating Persistent poor judgment Changes in behavior
Sign and Symptom Patterns Personal Change in baseline behavior Deteriorating personal hygiene Multiple physical complaints Unfocused, confused, distracted Mood swings Overreaction to performance feedback Change in speech pattern Isolation: avoidance of associates
Sign and Symptom Patterns Hospital Frequent lateness, absence or illness Declining work performance Ignoring requests to catch up on paperwork Questionable orders Inappropriate response to patient needs or staff requests Uncooperative and defiant approach to problems and/or performance feedback Denial/blaming others for problems Anger/abusive language Reports of disruptive behavior
Risk Factors for Impairment Pharmacological optimism Knowledge of drug actions Strong will, invulnerability Willing to take chances Believes use can be controlled Rationalizes inappropriate behavior
Risk Factors for Impairment Access Self-medication Job stress, erratic hours Perfectionism Difficulty discussing feelings (relies on denial) Professional independence Rationalizes inappropriate behavior
Why We Dont Seek Help for Ourselves or Each Other Healthcare practitioners don t seek help for themselves Help each other vs. seek outside help Denial, rationalization Fear of being exposed and/or losing license, job, income and/or reputation Shame, embarrassment, guilt
Why We Dont Seek Help for Ourselves or Each Other Conspiracy of silence - peers ignore and enable inappropriate behavior Don t want to become involved, i.e., rock the boat Believes others are addressing the problem I can handle it on my own Don t know where to turn or trust that others will help
Resources Medical Society for the State of New York The Committee on Physician Health (CPH) You may refer your friend, peer or yourself....
Confidentiality If you call CPH about a colleague, your phone call will be held in the strictest confidence. The identity of a referral source is never revealed unless the caller agrees. All referrals are treated confidentially. Call 1 (800) 338-1833 Web site http://www.mssny.org/cph/
MSSNY Contact Info Please call the toll free number (NY State only): 1 (800) 338-1833 Or their office at: (518) 436-4723 The Committee for Physician Health 99 Washington Avenue, Suite 1111 Albany, NY 12210 Fax: (518) 436-7943 Email: terrv@cphnv.org All calls are confidential!
When behavior is caused by illness. Treating the illness changes behavior.
Positive Outcomes Returns to productive practice of medicine Hospital retains valuable team member Clinical quality is enhanced Colleagues trust is restored Communications with staff improves Practice continues to grow Professional liability risk is reduced Restoration of career, health, family, personal life
Additional Resources SBUH Administrative P&P #MS0011 https://policymanager.uhmc.sunysb.edu/dotNet/documents/?docid=25817 SBUH Practitioner Well Being Committee Committee Chair 631-263-6071 2023
