Essential components of physician health program monitoring for substance use disorder: A survey of participants 5 years post successful program completion

Abstract

Background and Objectives: Physician health programs (PHPs) have demonstrated efficacy, but their mechanism of influence is unclear. This study sought to identify essential components of PHP care management for substance use disorder (SUD), and to assess whether positive outcomes are sustained over time.Methods: Physicians with DSM-IV diagnoses of Substance Dependence and/or Substance Abuse who had successfully completed a PHP monitoring agreement at least 5 years before the study (N = 343) were identified as eligible. Of the 143 (42%) that could be reached by phone, 93% (n = 133; 86% male) completed the anonymous online survey.Results: Virtually all PHP program components were rated as being at least "somewhat helpful" in promoting recovery, with the plurality of respondents rating almost all components as "extremely helpful." The top-rated components were: signing a PHP monitoring agreement, participation in the PHP, formal SUD treatment, and attending 12-step meetings, with each receiving a mean rating of at least 6.2 out of 7. Notably, 88% of respondents endorsed continued participation in 12-step fellowships. Despite the significant financial burden of PHP participation, 85% of respondents reported they believed the total financial cost of PHP participation was "money well spent."Discussion and Conclusions: Components of PHP monitoring were viewed as acceptable and helpful to physicians who completed the program, and outcomes were generally sustained over 5 years. More studies are needed to confirm these preliminary findings.Scientific Significance: This study documents the perceived cost-benefit of participation in a PHP among a small sample of program completers.

For the Physician, By the Physician: The Management of Addiction in Medicine

“…A recent study that examined participants over 5 years following treatment completion at a PHP found that two-thirds of physicians rated their treatment as "extremely helpful," with another 17% rating it as "moderately helpful." 13 Additionally, 89% of physicians reported no recurrence during the 5-year monitoring period, while 97% of physicians identified as "in recovery" following treatment. Of note, PHPs provide more concerted and comprehensive care for physicians compared with the members of the general population receiving standard of care and demonstrate better outcomes.…”

Barriers to recovery for medical professionals: Assessing financial support through a survey of Physician Health Programs

“…This allows PHPs to provide verifying documentation of a participant's compliance with treatment and/or continuing care recommendations. Studies evaluating the long‐term PHP care model for substance use disorders confirm physician recovery rates that are markedly higher than the general population 10,11 . Also, malpractice risk for physicians who successfully complete PHP monitoring is lower than for physicians who have been suspected of impairment but have not yet benefited from PHP intervention 12 …”

“…Expenses incurred reflect multiple components of continuing care: independent medical evaluations with providers specializing in assessment of healthcare professionals, intensive treatment, ongoing therapy, and long‐term monitoring including frequent drug testing using expanded panels to detect substances commonly‐used by healthcare professionals. These may vary widely for individual physicians based on the severity of their condition, level of support from their employer/practice partners, and quality of health insurance coverage 11 . Psychosocial sequelae of illness, including financial hardship, combined with unique rehabilitative needs of healthcare professionals, can put the necessary services out of reach, leaving many demoralized.…”

“…Studies evaluating the long-term PHP care model for substance use disorders confirm physician recovery rates that are markedly higher than the general population. 10,11 Also, malpractice risk for physicians who successfully complete PHP monitoring is lower than for physicians who have been suspected of impairment but have not yet benefited from PHP intervention. 12 Unfortunately, physicians who are ill may also face serious financial hardship due to inability to work, restriction of their medical license, financial consequences of addictive behavior, legal problems, and/or high unreimbursed treatment costs.…”

“…These may vary widely for individual physicians based on the severity of their condition, level of support from their employer/practice partners, and quality of health insurance coverage. 11 Psychosocial sequelae of illness, including financial hardship, combined with unique rehabilitative needs of healthcare professionals, can put the necessary services out of reach, leaving many demoralized. Due to higher-than-average salaries compared to the general population, few envision physicians to have unmet financial needs, so little is known regarding funding resources available to restore a physician to practice.…”