CPHP strongly believes that the effectiveness of our work with physicians and physician assistants will be enhanced by research about physician health problems, best treatment and follow-up practices. We hope that not only will the health of physicians be enhanced by these efforts, but public policy concerning physicians’ stress, illness, and recovery can be placed on a national/international platform, protecting both physicians and their patients. Research at CPHP is funded only by grants or contributions.
CPHP Publications
A Retrospective Cross-Sectional Review of Resident Care-Seeking at a Physician Health Program.
Brooks E, Early SR, Parry AL.
Abstract
Background: Residents often face several personal struggles during training, such stress and burnout. Early intervention helps to reduce the negative consequences caused by such issues however, many residents are reluctant to seek care. Objective: To improve outreach and treatment referrals for this group, we examined presentation patterns and the reasons residents present to a physician health care program.
Method: Pulling data from administrative records, we used a retrospective case-control design to compare demographic characteristics, referral sources, and presentation patterns between residents (n= 312) and attending physicians (n=1348) who presented to a physician health program (PHP) between 2003 and 2013. We further examined differences in clinical characteristics among the group of residents only. Descriptive statistics were used for all analyses. Results: Residents were less likely to voluntarily refer themselves to care than attending physicians, although voluntary presentations in both groups rose during the study period. Administrative sources (e.g., residency programs) were instrumental in referring residents to the PHP, peer-referrals were less common. Several indicators suggest that mental health issues are important factors associated with resident care-seeking.
Conclusions: Additional research is needed to determine if strategies like PHP education of residents, program directors, and school administration would increase voluntary care-seeking. At a minimum, residents should understand how and where to utilize formal peer assistance services, the known benefits of early treatment and how to refer their colleagues. Limits of confidentiality and residents’ fears of practice or academic implications should be clearly addressed.
Helping the Healer: Population-Informed Workplace Wellness Recommendations for Physician Well-being
Brooks E, Early SE, Gendel, MD, Miller L, Gundersen DC.
Abstract
Background: The need to keep physicians healthy and in practice is critical as demand for doctors grows faster than the supply. Workplace wellness programmes can improve employee health and retain skilled workers. Aims: To broaden our understanding about ways to help doctors coping with mental health problems and to develop population-informed workplace wellness recommendations for physician populations.
Methods: Researchers surveyed physicians to document potential warning signs and prevention strategies. A survey was issued to doctors who presented to a physician health programme with mental health complaints. The survey captured respondents’ feedback about how to identify and prevent mental health problems. Data were analyzed using simple descriptive statistics. Results: There were 185 participants. Half of respondents believed their problems could have been recognized sooner and 60% said they exhibited signs that could aid in earlier detection. Potential warnings included fluctuations in mood (67%), increased comments about stress/burnout (49%) and behavioural changes (32%). To improve detection, prevention and care-seeking for mental health problems, doctors endorsed multiple items related to the use of interpersonal supports, personal factors and organizational dynamics throughout the survey.
Conclusions: The findings confirmed earlier work demonstrating the value of social and organizational support in maintaining physician health. It further indicated that earlier identification and/or prevention of mental health problems is not only possible, but that medical organizations are uniquely situated to carry out this work.
When Doctors Struggle: Current Stressors and Evaluation Recommendations for Physicians Contemplating Suicide
Brooks E, Gendel, MD, Early SE, Gundersen DC.
Abstract
The objective of this study was to document current risk factors associated with physicians’ suicide ideation among a group of doctors enrolled in a Physician Health Program. A retrospective cohort study was drawn from administrative data. The study compared intake information between doctors who reported recent thoughts of suicide (n = 70) and those who did not (n = 1,572) using adjusted regression analysis. Current stressors included personal, financial, health, and occupational problems; ideation was more likely with multiple stressors. Physicians endorsing suicidal ideation lacked personal supports and scored differently on Short Form-36 measures. Evaluators treating physicians should assess enduring risks and current stressors, particularly multiple stressors, to help detect suicidal patients. Current stressors should not be viewed as transitory and it is critical to bring in collateral information.
Investing in Physicians Is Investing in Patients: Enhancing Patient Safety Through Physician Health and Well-being Research
Brooks E, Gundersen DC, Gendel MH.
Abstract
Keeping medical practitioners healthy is an important consideration for workforce satisfaction and retention, as well as public safety. However, there is limited evidence demonstrating how to best care for this group. The absence of data is related to the lack of available funding in this area of research. Supporting investigations that examine physician health often “fall through the cracks” of traditional funding opportunities, landing somewhere between patient safety and workforce development priorities. To address this, funders must extend the scope of current grant opportunities by broadening the scope of patient safety and its relationship to physician health. Other considerations are allocating a portion of doctors’ licensing fees to support physician health research and encourage researchers to collaborate with interested stakeholders who can underwrite the costs of studies. Ultimately, funding studies of physician health benefits not only the community of doctors but also the millions of patients receiving care each year.
Occupational Medicine (Lond),first published online September 30, 2016
Challenging cognitive cases among physician populations: case vignettes and recommendations
Brooks E, Gundersen DC, Early SR, Humphreys SA, Parry AP, Gendel MH.
Abstract
Background: Physicians are not immune to cognitive impairment. Because of the risks created by practising doctors with these issues, some have suggested developing objective, population-specific measures of evaluation and screening guidelines to assess dysfunction. However, there is very little published information from which to construct such resources.
Aims: To highlight the presentation characteristics and provide evaluation recommendations specific to the needs of physicians with actual or presumed cognitive impairment.
Methods: A retrospective database and chart review of cognitively impaired doctors who presented to a physician health programme (PHP). Complex cases were highlighted using simple descriptives and clinical vignettes.
Results: A total of 124 cases were included. Clients presented with a variety of issues other than cognitive concerns. We identified four principal domains of impairment: (i) diseases of (or in) the brain (48%); (ii) mood/ anxiety disorders or treatment side effects (28%); (iii) substance use (9%) and (iv) traumatic brain injury (7%). Age was not a good predictor of impairment and brief screening using the Montreal Cognitive Assessment demonstrated a ceiling effect with this cohort. Although many clients underwent some type of professional or personal transition, impairment did not necessarily indicate worse functioning after care.
Conclusions: Physician cognitive evaluations should consider a variety of secondary sources of information, particularly vocational performance reports. It may take time before cognitive impairment can be diagnosed or ruled-out in this population. Prior assumptions, especially for non-cognitive referrals, can lead to inaccurate diagnosis and referrals. PHPs must manage cognitive cases carefully, not only in their clinical complexity but also in their psychosocial aspects.
Occupational Medicine (Lond),first published online September 30, 2016
Physician Health Programmes and Malpractice Claims: Reducing Risk Through Monitoring
Brooks E, Gendel MH, Gundersen DC, Early SR, Schirrmacher R, Lembitz A, Shore JH.
Abstract
Background: Physician health programmes (PHPs) are peer-assistance organizations that provide support to physicians struggling with addiction or with physical or mental health challenges. While the services they offer are setting new standards for recovery and care, they are not immune to public debate and criticism since some have concerns about those who are enrolled in, or have completed, such programmes and their subsequent ability to practice medicine safely.
Aims: To examine whether medical malpractice claims were associated with monitoring by a PHP using a retrospective examination of administrative data.
Methods: Data on PHP clients who were insured by the largest malpractice carrier in the state were examined. First, a business-model analysis of malpractice risk examined relative risk ratings between programme clients and a matched physician cohort. Second, Wilcoxon analysis examined differences in annual rates of pre- and post-monitoring claims for PHP clients only.
Results: Data on 818 clients was available for analysis. After monitoring, those enrolled in the programme showed a 20% lower malpractice risk than the matched cohort. Furthermore physicians’ annual rate of claims were significantly lower after programme monitoring among PHP clients (P < 0.01).
Conclusions: This is the only study examining this issue to date. While there are a variety of reasons why physicians present to PHPs, this study demonstrates that treatment and monitoring is associated with a lowered risk of malpractice claims and suggests that patient care may be improved by PHP monitoring.
Occupational Medicine, Volume 63, Issue 4, 1 June 2013, Pages 274–280
Self-prescribed and other informal care provided by physicians: scope, correlations and implications.
Gendel MH, Brooks E, Early SR, Gundersen DC, Dubovsky SL, Dilts SL, Shore JH.
Abstract
While it is generally acknowledged that self-prescribing among physicians poses some risk, research finds such behaviour to be common and in certain cases accepted by the medical community. Largely absent from the literature is knowledge about other activities doctors perform for their own medical care or for the informal treatment of family and friends. This study examined the variety, frequency and association of behaviours doctors report providing informally. Informal care included prescriptions, as well as any other type of personal medical treatment (eg, monitoring chronic or serious conditions). A survey was sent to 2500 randomly-selected physicians in Colorado, 600 individuals returned questionnaires with usable data. The authors hypothesised: (1) physicians would prescribe the same types of treatment at home as they prescribed professionally; and (2) physicians who informally prescribed addictive medications would be more likely to engage in other types of informal medical care. Physicians who wrote prescriptions for antibiotics, psychotropics and opioids at work were more likely to prescribe these medications at home. Those prescribing addictive drugs outside of the office treated more serious illnesses in emergency situations, more chronic conditions and more major medical/surgical conditions informally than did those not routinely prescribing addictive medications. Physicians reported a variety of informal care behaviour and high frequency of informal care to family and friends. The frequency and variety of informal care reported in this study strongly argues for profession-wide discussion about ethical and guideline considerations for such behaviour. These areas are discussed in the paper.
Comparing substance use monitoring and treatment variations among physician health programs.
Brooks E, Early SR, Gundersen DC, Shore JH, Gendel MH.
Abstract
There is growing evidence that physician health programs (PHPs) are an important component in physicians’ recovery from substance disorders, although we do not know how variations in treatment and monitoring affect physician recovery. This study was designed to understand how programmatic differences impact clients’ overall program completion. This study was part of a larger investigation, the Blueprint Project, which evaluated outcomes for clients enrolled in PHPs nationally. Here we compared physicians presenting to a Colorado-based PHP for substance use to a nationally based referent, contrasting treatment, monitoring, and outcomes (Colorado n = 72, National n = 730). The samples were similar demographically although more Colorado physicians were polysubstance users. We found variations in treatment and monitoring patterns with Colorado physicians participating in more types of primary treatment and monitoring services and were allowed to work more at some point during monitoring. There was greater relapse among Colorado physicians, but these differences disappeared when we controlled for prior treatment. The great majority of clients in both samples showed successful recovery. This data provides a foundation on which to understand population characteristics, contractual differences, and outcome variations among PHPs and serves to inform internal PHP programmatic structures and regulatory agencies.
Am J Addict. 2012 Jul-Aug;21(4):327-34. doi: 10.1111/j.1521-0391.2012.00239.x. Epub 2012 Apr 23.
Physician boundary violations in a physician’s health program: a 19-year review
Brooks E, Gendel MH, Early SR, Gundersen DC, Shore JH.
Abstract
Managing and treating physicians with professional boundary violations is of paramount importance with vast implications for public safety. Physician Health Programs (PHPs) evaluate and monitor many, if not most, physicians receiving care for these abuses. We conducted a chart review of 120 physicians monitored for boundary violations. We made intergroup and intragroup comparisons (i.e., examining nonpatient, patient nonsexual, and patient sexual offenses). The violator group as a whole differed from the general PHP population, in that more were men between 40 and 49 years of age. More of the violators were mandated for evaluation and reported an abusive history. The rate of psychiatrists exceeded that typically seen by the PHP. Other differences were found according to the type of violation committed. Post hoc analysis revealed that physician-patients with a history of prior boundary violations were more likely to commit violations of a sexual nature. No further incidents were reported for 88 percent of the cohort.
Tobacco use by physicians in a physician health program, implications for treatment and monitoring.
Stuyt EB, Gundersen DC, Shore JH, Brooks E, Gendel MH.
Abstract
The use of tobacco by physicians with substance abuse histories is drastically understudied. A chart review of 1319 physicians enrolled in a physician health program found tobacco use highest for those referred for substance abuse problems (58.1%). Among a subset of currently monitored substance abusers, all those who relapsed during monitoring were using tobacco and had more difficulty maintaining sobriety following initial treatment (p = 0.0137) than non tobacco users. Because tobacco was a risk factor for relapse, reasons why physician health programs should address its use and treatment facilities should establish tobacco-free environments to provide optimum learning and recovery are explored.
Research Opportunities
Note: Participation in any listed research study is completely voluntary, not part of CPHP participation. Your participation in this study will not affect your status at CPHP in any way. CPHP does not receive compensation or knowledge about any participation in listed studies. We share these opportunities to allow those who wish to participate in research within the field of physician health to do so at their own discretion.
Federation of State Physician Health Programs (FSPHP)-National Institute on Drug Abuse (NIDA) Imaging Biomarker Study
If you are interested, please do NOT come to the CPHP staff to ask questions. This is for two reasons. 1) If you decide to participate, you must do so in a completely voluntary fashion. We, will not know of your decision until you have already made it. 2) It is important for you to hear the details of the study directly from the researchers. Your decision to participate in this study will not affect your status at CPHP in any way, positively or negatively.
