Can Physician Health Programs (PHP) Help Doctors in Crisis?
Many physicians face heavier workloads and more stress than the average employee. Medical professionals have to juggle their personal lives with demanding schedules. At the same time, they are addressing various patient health challenges. All of this can take a toll on a physician’s mental and behavioral health.
To cope with the stressful nature of their jobs, some physicians will resort to substance or drug abuse as a solution. But this often only makes problems worse. Not only does it lower their ability to practice medicine effectively, but it also puts patients at risk. This is where physician health programs come into play. Physician assistance programs can help doctors manage their mental health and introduce them to effective coping strategies.
The Aim of Physician Health Programs
Physician health programs emerged in the 70s. This was a response to physician burnout and the associated depression, anxiety, addictions and even suicide. Experts understood that conducting interventions early on and encouraging treatment referrals could help protect both the physician and the public.
At the beginning, physician health programs only tackled addiction. Over time, the programs expanded their scope to include all mental illnesses. This is because mental health disorders often co-occur with addiction. The term for this is comorbidity or co-occurring disorders.
Why a Physician Health Program Is Sometimes Necessary
Doctors often have to deal with a lot of stress in their work. These stresses can include:
- Burgeoning patient consultations
- A busy medical procedure schedule
- Learning new medical software
- Dealing with insurance companies
- Running a medical practice
- Caring for patients who have complex cases, acute injuries or terminal illnesses
When combined, these stresses can create a perfect storm for mental health disorders. A doctor’s work commitments may result in less time spent at home and with family and friends. This can add further stress and lead to a reduction in quality of life. Chronic stress puts a doctor at risk of a range of issues. These include depression, anxiety, insomnia and drug abuse. A doctor’s worsening health may then affect a patient. A physician health program can help doctors recover from addiction and protect their careers and patients. Mental health issues and substance use disorders are clear signs that a doctor needs help.
Physicians and Substance Abuse
Health care professionals can become addicted to drugs and alcohol like anyone else. A physician’s genes or family history may put them at risk of addiction. High levels of stress, mental health issues and poor coping skills can also lead to substance abuse. This applies to people from all walks of life. Having said that, there are certain factors that put physicians at extra risk of substance abuse:
- Doctors often have easy access to addictive substances.
- Physicians are typically driven toward high-achievement and self-reliance. These traits make doctors good at their jobs, but it also places them under significant stress to be successful. Doctors are more likely to deny they have a problem or attempt to cope with it on their own.
- Physicians are in authority positions, so medical staff are less likely to confront them on any concerns they may have about their mental health.
- Health care professionals risk losing their medical license if someone discovers their addiction. They could also damage their reputation and livelihood in the process.
It can take a considerable amount of time before a physician’s substance abuse problem is discovered and treated. When a physician does ask for help, or someone notices a substance abuse problem, a supervisor will recommend an evaluation. The evaluation is an essential aspect of the intervention. Without it, a physician health program may prove to be ineffective.
A Professional Evaluation for a Struggling Doctor
Twenty years ago, doctors suspected of drug abuse problems underwent a formal intervention. They would then be referred to an addiction treatment center by their physician health program. Many medical professionals found this process to feel more like an ambush than help.
Rather than immediately referring a physician to rehab, an evaluation will be recommended. The doctor is told that behavioral concerns have been raised and the purpose of the evaluation is to make sure they are OK. The doctor is encouraged to “volunteer,” as this can help them resolve any issues and maintain their ability to practice. This approach helps to reduce confrontation and resistance. It is also helpful to conduct this initial conversation over the phone. This is less intrusive than having people from a physician health program or medical board show up at the doctor’s office.
During an evaluation, a multidisciplinary team examines all aspects of the “doctor-patient’s” life, including work, home and play. Evaluations often include assessments by:
- An addiction medicine specialist
- An addiction psychiatrist
- A psychologist trained in mental illness and addiction
After this part of the evaluation takes place, there is a “secondary intervention.” If the evaluation team determines a diagnosis of a mental health condition or substance use disorder, then they will make a formal recommendation to address these problems via a treatment referral. In the case of addicted physicians, the evaluation team may suggest that inpatient or outpatient rehab treatment is ideal. Most evaluation teams recommend that the doctor not return to work until they have received effective treatment.
How Physician Health Programs Can Help
A physician health program can refer doctors to many treatment options. To ensure ongoing commitment and increase the likelihood of a successful outcome, a few essential program elements should be included:
- A program led by professionals who have extensive expertise and history in treating physicians
- Peer group support, which can help reduce shame
- 12-step focus
- Intensive family involvement
- Assessment and treatment of dual diagnosis
- Support in addressing work/re-entry and legal issues
- Compulsory, long-term aftercare drug screening/monitoring (usually provided by the physician health program)
A crucial part of any effective physician assistance is adequate mental health treatment. This includes therapy, counseling and mental health education. These resources can help addicted health professionals figure out the underlying causes of their substance abuse. They can also teach healthy coping skills.
Addiction within the medical community engenders feelings of injured pride and deep shame. It’s important to incorporate strategies that help clients address and resolve these feelings as they heal.
Physician wellness programs can help doctors in crisis. These programs should be comprehensive in their evaluation and treatment approach. Programs should also provide personalized treatment. This makes it much more likely for the healthcare professional to fully recover.