There’s a common misconception among the public that physicians should serve as examples of perfect physical and mental health. While medical professionals can help and inspire their patients by striving for optimal health, doctors are human beings who experience stress, illness and addiction like anyone else. The demands of the medical profession and the accessibility of psychotherapeutic drugs contribute to the prevalence of alcohol and drug abuse among doctors, physician’s assistants and other licensed health professionals.
Every now and then, a doctor needs to take the position of a patient. If you’re a medical professional who’s using illicit drugs, diverting prescription medications or abusing alcohol, your state’s medical board may offer a non-disciplinary diversion program that allows you to seek treatment anonymously. Physician rehabilitation and monitoring programs offer a compassionate, non-punitive solution to the problem of addiction.
*How Do Doctors Get Referred to Diversion Programs?
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State boards like the Texas Medical Board hope that by allowing physicians to report their substance abuse without fear of being punished or professionally stigmatized, they can encourage doctors to seek help. Physicians may receive confidential, non-disciplinary rehabilitation if they:
- Show signs of drug or alcohol addiction or habituation
- Self-report a problem with drugs or alcohol
- Are judged to be mentally unstable by a court as a result of their addiction
- Fail to pass a mental or physical exam to evaluate their impairment
Prevalence of Substance Abuse Among Doctors
The percentage of physicians who abuse drugs or alcohol is comparable to the rate of substance abuse in the general population, notes the journal Nursing and Healthcare Management and Policy. But research indicates that there are a number of key factors that make drug use among physicians especially dangerous:
- Physicians have specific patterns of drug and alcohol abuse that are different from the general public.
- Physicians are more likely to abuse, steal or self-prescribe prescription drugs.
- Physicians are more likely to abuse prescription meds in the workplace.
- Because of their medical authority, physicians under the influence of drugs are in a unique position to cause serious or life-threatening harm to the people under their care.
The pressures of a doctor’s lifestyle may make it tempting to turn to drugs or alcohol when you’re under stress. Physicians have to respond to the needs of multiple patients, often far more than they can effectively treat. The constant awareness of legal liability and the potential to cause harm can be a never-ending source of anxiety. On a personal level, many doctors feel that they don’t have enough time or energy to devote to spouses, children or romantic partners. And the need to provide care within the limits of an overburdened medical system has some doctors wondering whether they really want to practice medicine at all.
The Physician Diversion Process
For a lot of physicians, substance abuse remains hidden for years. Doctors know how to drink or use discreetly, concealing the effects of drugs or alcohol from their patients and staff members. It’s often not until a patient complains — or until a patient is harmed — that a doctor’s substance abuse is discovered. At that point, a physician may be given the option to complete a confidential diversion program, which includes rehabilitation and monitoring, or face disciplinary action.
Whether or not the rehabilitation order has a disciplinary element, physicians in diversion programs are scrupulously monitored. Monitoring may include random drug screening, verification of attendance at an approved treatment center and confirmation of participation in weekly self-help meetings. The terms of the rehab order can be modified to fit the nature of the doctor’s addiction, cooperation with the medical board and desire to get clean and sober.
The ACPInternist, a journal of the American College of Physicians, notes that the physician rehabilitation process typically includes several components and phases:
- Referral of a physician to the state medical board or a physician health program, either by a fellow doctor, a patient or a loved one
- Verification of the initial referral to make sure that the complaint of impairment is based in reality
- Notification of the impaired physician, who is given the opportunity to participate in non-disciplinary rehab and monitoring
- Evaluation of the physician and referral to an inpatient treatment facility or an intensive outpatient program
- Referral to a counselor who can provide therapy during and after the initial stage of recovery
- Aftercare to facilitate reentry into the medical community, including individual therapy, participation in a support group and monitoring through random drug screens and meetings with program representatives
Physicians who enter a diversion program usually sign a contract stating that they will stick to the terms of the rehabilitation order or risk facing disciplinary action.
Should Doctors Be Allowed to Practice While They’re in Rehab?
According to The Journal of the American Medical Association (JAMA), one out of four physicians who participated in the Washington Physicians Health Program relapsed when they were being monitored for drug or alcohol abuse. Considering how much these doctors had to lose — their licenses, their professional reputations and their livelihood — this relapse rate may serve as a testimony to the power of addiction.
Supporters of physician monitoring and rehabilitation believe that this is all the more reason why self-reporting of drug and alcohol addiction should be encouraged. Skeptics believe that state medical boards may not be doing everything in their power to monitor chemically dependent doctors.
The Washington Post reported that physicians who were in diversion programs were not adequately monitored and were not consistently disciplined when they relapsed. The report suggests that physicians should either be supervised more vigilantly while they’re in rehab, or that physicians should be temporarily removed from practice until they’ve confirmed that they can practice safely.
*What’s Being Done About Physicians Who Relapse?
In an investigation of physicians in diversion programs in the District of Columbia, Maryland and Virginia, the Washington Post found that:
- Seventy-four doctors were disciplined for substance abuse from 1999 to 2004.
- Out of these 74 doctors,10 were reprimanded and five were placed on probation.
- In five cases, medical boards were aware that doctors were using drugs or alcohol but did not take any action to prevent repeated substance abuse.
- In nine cases, doctors surrendered their licenses in order to avoid investigation of alcohol or drug abuse and possible punishment.
Giving the Medical Community a Second Chance
Monitoring and rehabilitation programs give doctors, nurses and other licensed health care providers a chance to lead safe, healthy, sober lives. Physicians are given the opportunity to get the treatment they need under confidential circumstances, without fear of losing their license to practice medicine. However, if a doctor doesn’t meet the conditions of a rehabilitation order, the state medical board may pursue disciplinary action, including suspension or revocation of the doctor’s license.
Doctors who are worried about exposing their substance abuse to their state medical board may have an alternative in the form of physician health programs (PHPs). These programs have been established in many states by private medical organizations to allow doctors to seek addiction treatment anonymously. In many cases, doctors who voluntarily report that they have a problem with drugs or alcohol can do so without the state medical board or the National Practitioner Data Bank being notified, according to JAMA.
Physician monitoring and rehabilitation programs may save not only the life of the doctor, but the lives of his or her patients. If you’re a health care practitioner who’s worried about a colleague’s drug addiction, you can contact your regional PHP or the state’s medical board to report signs of physician impairment. The Federation of State Physician Health Programs provides anonymous direction on how to get the care that you, a colleague or a loved one need to recover from drug or alcohol addiction.
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