While exacting statistics regarding addicted physicians are sometimes challenging to arrive at, one study by the Mongan Institute for Health Policy at Massachusetts General Hospital—which surveyed over 2,000 doctors nationwide across multiple specialties—found that 17% of physicians have encountered a doctor who is impaired by substance abuse or has a substance use disorder, causing problems either in their practice or at a hospital.[1] As well, the DEA’s data indicates 12 percent of healthcare workers become addicted at some point in their life.[2]
A major problem, however, lies in another point made by the physician survey mentioned above: 31% objected to the idea they should have a responsibility to report physicians who are impaired.[3]
The daunting task of helping physicians with substance use disorders get treatment and back on track can be difficult, but interacting with them and assisting them to resume being valuable members of the healthcare profession is an endeavor worthy of the efforts involved.
What are some of early warning signs a physician may be struggling with substance use issues?
- Changes in his or her behavior. Typically punctual doctors who are impaired may become chronically late and protest or make excuses when questioned.
- Physical appearance. One’s personal hygiene and/or attire can go wayward, oftentimes displaying an unprofessional or disheveled appearance; in some cases, clothing may be conspicuously used to cover one’s arms to hide needle tracks.
- Personality swings. Moodiness, angry outbursts or even offensive treatment of co-workers may arise or become habitual.
- Indications of depression, isolation or being withdrawn or aloof.
- Inappropriate behavior toward patients.
- Not being available when he or she is on-call.
- Increased tendency to make careless medical decisions.
If the physician’s office/workplace dispenses prescription drugs (especially opioids), he or she may frequently work extended hours to divert or steal such.
What can a co-worker or supervisor do when such evidence arises? Remaining aware and vigilant is the first step, paying attention to see whether or not any further evidence accrues. Maintaining a low threshold for following up on suspicious behavior (i.e., indicators of possible substance abuse) is another strong recommendation. Also, staying educated about addiction and behavior indicating substance abuse will be helpful all around.
Two more suggestions: 1) Keeping up a natural sensitivity to the reluctance of staff or co-workers to report problems, and addressing possible problems directly and swiftly; and 2) Creating an anonymous means for reporting possible substance abuse issues within a staff.
Because an impaired healthcare worker has harmful, potentially life-threatening effects on his or her patients, as well as negatively impacting one’s co-workers and staff, all those associated with a medical practice, group or hospital who suspect a physician is impaired are morally and ethically responsible to take steps so that the appropriate leadership can investigate and, whenever necessary, help him or her get treatment.
Taking prompt action is vital, to avoid risk of putting patients at risk for injury or improper treatment, as well as permanent damage to his or her reputation and that of the medical practice or hospital.
Once a suspicion is reported, those in position to follow through with the physician are responsible to get all of the facts from as many people—including co-workers and staff—as possible, in order to be certain there indeed is a substance use problem.
Fortunately, almost every state has a Physician Health Program (PHP) for dealing with impaired physicians. Those working within the auspices of PHPs share information confidentially, which ensures issues of substance use can be divulged without fear of retaliation. The PHP arranges for a comprehensive assessment of the physician to help identify a substance abuse problem and any possible co-occurring mental health disorder. If the PHP and the selected committee of medical professionals and addiction specialists determines any treatment is necessary, the physician can voluntarily follow their recommendations. If the physician chooses not to, he or she could be reported to the state board and face serious consequences.
Physicians who complete treatment and adhere to the follow-up guidelines—including structured aftercare and ongoing monitoring—typically have a high success rate of recovery and long-term sobriety. A nine-year study reported a recovery rate of more than 80% with no relapses at the end of two years.[4]
Am impaired physician should not be ignored or avoided. Addiction is a progressive illness—it gets worse with time, not better. By addressing the physician’s substance abuse directly and compassionately helping him or her get into effective addiction treatment, he or she may recover, resume work in their medical profession and often keep their family relations intact.
[1] DesRoches, Catharine M., et al. “Physicians’ perceptions, preparedness for reporting, and experiences related to impaired and incompetent colleagues.” JAMA. July 14, 2010.
[2] U.S. Dept. of Justice Drug Enforcement Administration. “Drug Addiction in Healthcare Professionals.”
[3] DesRoches, Catharine M., et al. “Physicians’ perceptions, preparedness for reporting, and experiences related to impaired and incompetent colleagues.” JAMA. July 14, 2010.
[4] Reading, EG. “Nine years’ experience with chemically dependent physicians: the New Jersey experience.” Md Med J. 1992;41:325-329.
