Most docs return to work after addiction treatment

Surgeons and other types of doctors were equally likely to return to medical practice after being treated for drug or alcohol addiction, in a new study.

Surgeons were also no different from non-surgeons in the proportion who relapsed after treatment, or the number who had their medical licenses revoked.

Researchers wrote Monday in the Archives of Surgery that they had expected surgeons might make a stronger turn-around than other doctors, in part because of the expectation of “perfection” in everything they do.

“Being a safety-sensitive specialty, they receive greater scrutiny when returning to practice following chemical dependence treatment,” said Amanda Buhl from the Washington Physicians Health Program, who worked on the study. “We actually hypothesized that they would have more favorable outcomes following treatment.”

While that turned out not to be the case, the majority of surgeons and non-surgeons were able to return to practice within a few years of treatment.

The study included 144 surgeons and 636 other physicians, including family practice doctors and anesthesiologists, who were treated for a substance abuse disorder in 16 different state physician health programs from 1995 to 2001.

Physician health programs allow doctors to be treated for drug abuse and addiction without repercussions as long as they complete program contracts, including random testing, and recover before returning to practice.

The participating doctors, mostly men, and in their mid-40s, on average, were followed for five years after treatment to see how many of them fulfilled the contracts and if they went back to work.

Alcohol abuse was the most common reason for enrolling in the physician health programs, and was more prevalent in surgeons than non-surgeons. Other reasons for treatment included opioid, stimulant and sedative abuse.

About one in five surgeons and non-surgeons had a positive alcohol or drug test result after treatment, and the same number were reported to state licensing boards because of relapses or non-compliance with the programs.

Results Surgeons were significantly more likely than nonsurgeons to enroll in a physician health program because of alcohol-related problems (odds ratio, 1.9; 95% CI, 1.3-2.7; P = .001) and were less likely to enroll because of opioid use (odds ratio, 0.5; 95% CI, 0.3-0.8, P = .002). Surgeons were neither more nor less likely than nonsurgeons to have a positive drug test result, complete or fail to complete the monitoring contract, or extend the monitoring period beyond the original 5 years specified in their agreements. Fewer surgeons than nonsurgeons were licensed and practicing medicine at the conclusion of the monitoring period, although this difference was not statistically significant.

Conclusions Surgeons in this study had positive outcomes similar to those of nonsurgeons. However, further research is necessary to conclude whether surgeons are less likely than their nonsurgeon peers to successfully return to medical practice following chemical dependency treatment.

Still, after five years, 60 to 65 percent of all doctors had completed post-treatment monitoring contracts, and as many as 75 percent had their licenses restored and were practicing medicine again.

Slightly more surgeons than non-surgeons didn’t return to medicine for a variety of reasons, including having a license revoked, leaving voluntarily or dying.

The findings “certainly demonstrate favorable outcomes following successful treatment for a substance use disorder,” Buhl told Reuters Health.

Studies have estimated that about ten percent of doctors will abuse drugs or alcohol at some point during their careers - similar to figures in the general population.

But if they do get treatment, they tend to do better than the average non-doctor, possibly because they have a lot to lose, said Dr. Keith Berge, an anesthesiologist from the Mayo Clinic in Rochester, Minnesota, who has studied drug dependence in physicians.

Although physician health programs have helped address addiction by emphasizing treatment over punishment, there’s still a long way to go in terms of getting doctors the help they need in a timely fashion, added Berge, who wasn’t involved in the new research.

“There’s a huge barrier to physicians admitting to these problems, and often they’re pretty far gone in their addictive illness by the time they come to the attention of (other) physicians or state medical boards,” he told Reuters Health.

“The medical community - families, colleagues - need to remain vigilant to not only the signs and symptoms of substance use disorders, but to stress and burnout, those conditions that can lend themselves to drug and alcohol abuse,” Buhl agreed.

Berge said that the question of drug and alcohol addiction in doctors is increasingly being seen as an important patient safety issue - but the safest thing isn’t necessarily to remove doctors from the operating room or bedside for good.

“There is a scarcity of physicians, so the goal is not to basically take good physicians that can have a useful, safe career out of practice,” he said. “The goal is to have a valuable societal resource fixed and put back into place to provide safe, competent patient care.”

Amanda Buhl, MPH; Michael R. Oreskovich, MD; Charles W. Meredith, MD; Michael D. Campbell, PhD; Robert L. DuPont, MD

Arch Surg. 2011;146(11):1286-1291. doi:10.1001/archsurg.2011.271

SOURCE:  Archives of Surgery, online November 21, 2011.


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