Most physicians succeed in substance abuse programs, study says

Surgeons battling substance abuse have similar rates of success as other doctors in completing treatment and monitoring programs, a study says.

Researchers analyzed data on 780 physicians and found that 63% of 144 surgeons and 65% of 636 nonsurgeons successfully completed monitoring programs within five years. The two groups also had equal rates of relapse and reports to medical licensing boards for failing to comply with monitoring agreements, says the November Archives of Surgery study.

"Overall, the prognosis for recovery is really good," said Krista L. Kaups, MD, program director of surgical critical care at Community Regional Medical Center in Fresno, Calif.

The results are positive compared with other populations, said Amanda Buhl, MPH, lead study author and research and communications coordinator with the Washington Physicians Health Program.

"No other group of individuals with substance use disorders has demonstrated similar outcomes over this length of time," Buhl said.

Researchers conducting the comparison hypothesized that success rates would be higher for surgeons, but that turned out not to be true.

However, surgeons were less likely than other physicians to return to practice following treatment and monitoring, the study said. Researchers looked at physicians who underwent substance abuse treatment and who were admitted to state physician health programs between September 1995 and September 2001.

Twenty-six percent of surgeons and 17% of nonsurgeons had not returned to medicine by the end of the study period. More research is needed to understand why, but Dr. Kaups and Buhl speculate that it's related to common characteristics of surgeons.

Surgeons work long hours under intense pressure and have high responsibility. They tend to be very focused, driven and meticulous individuals, said Dr. Kaups, a clinical surgery professor at University of California, San Francisco, Fresno.

"This is a busy profession where there are many stressors," she said. "We deal with life-and-death situations."

Many surgeons may be reluctant to admit they have lost control, Buhl said. The technical skill required for surgery also may make it more difficult for credentialing groups to feel confident assessing a surgeon's ability to return to practice and safely operate on patients, she said.

"The stigmatization, scrutiny and expectation of perfection may not only discourage surgeons from seeking help, but may also contribute to a greater reluctance to return to practice," Buhl said.

A responsibility to get help

An estimated 10% to 12% of physicians will be impaired because of alcoholism or drug dependency during their careers, the study said. Those rates are similar to the public.

But physicians with substance abuse or other mental or physical impairments have an added responsibility to seek help, because their actions affect patients, said Luis Sanchez, MD, a psychiatrist and director of Physician Health Services Inc., a subsidiary of the Massachusetts Medical Society.

"As physicians we are obligated to get ourselves diagnosed and treated because ultimately this is all about patient safety," he said. "To be a good doctor we need to be a good patient."

The study found that alcohol was the most abused substance for both surgeons and nonsurgeons, but surgeons were more likely to have issues with alcohol (62% compared with 47% of nonsurgeons). Meanwhile, nonsurgeons were more likely to battle opioid addiction at 37% compared with 23% for surgeons.

About 20% of participants were reported to state licensing boards for failing to comply with monitoring contracts.

Physician health programs are typically affiliated with state medical societies, medical licensing boards, or both, said Dr. Sanchez, immediate past present of the Federation of State Physician Health Programs.

Physicians come to the programs voluntarily or are referred by hospitals or licensing boards. The programs help physicians assess their problem and direct them to confidential treatment programs. Once a physician has completed treatment, the physician health program provides monitoring that typically lasts three to five years. Physicians being monitored must abstain from all addictive substances and submit to random drug tests.

"The success rate is extraordinarily high," Dr. Sanchez said. "It's really an opportunity for doctors to improve their lives."