Addicted Docs: Failure Is not an Option

Editor’s Note: Opioid addiction is just one form of substance abuse among physicians. In the second part of this interview with MD Magazine contributor Megan Daily, Joseph Garbely, DO, medical director of Caron Treatment Centers, in Wernersville, PA discusses addiction treatment for doctors. Part one is here.

Q: How often do physicians treated for addiction relapse?

I would say that the data on physician success is excellent. Studies of Physician Health Programs based on data from the National Physician Health Program Blueprint Study have been done. I think they found success rates around 88% to 92% at the five- and 10- year marks so we are talking sustainable recovery.

Q: Are physicians good candidates for treatment?

There are some factors that are unique to this population that you cannot export to other populations. One is the investment in one’s career. The average medical school debt right now is about a half a million dollars. You're not going to be able to earn the kind of money you need to earn to pay back your student loans if you leave the profession.

Q: Are there other motivations besides financial?

There’s also an over-identification with one's profession as a physician. Physicians over-define ourselves by what we do. If you're impaired you cannot take care of patients, there's all kinds of agencies that will get involved to stop you from doing that. So you either access recovery and verify and demonstrate it-- or you don't go back into medicine. That is leverage that is very difficult to replicate.

Q: Are Physician Health Programs easy to find?

There are only a handful of programs acceptable for the regulatory agencies and advocacy agencies in each state and ours are thankfully on that very short list.

Q: How long is treatment?

It really lasts five years if you include aftercare treatment. The “dosage” just slowly decreases over time. For us we have three phases of treatment. Each phase has it’s own set of very measurable milestones that have to be touched before you move to the next phase. It’s all designed to move someone through treatment into a place of stable recovery.

Q: When doctors try to go back to practice after treatment, what happens from a regulatory standpoint, is there a period of probation for instance?

Physician Health Programs in different states and they are either connected with a state’s medical board or not. In Pennsylvania they're part of the state’s Medical Society, so they're an advocacy agency. What they all do is create a contract that involves continued treatment and verification of one's recovery through random toxicology screening.

Q: What else is involved in determining whether a physician is in control of the addiction?

The boards ask folks who are treating these patients to give updates on progress, how they appear when they're in group or individual therapy; are there any signs of relapse. Also they ask for workplace monitors to opine about appearance, comportment, any telltale signs of relapse they need to report. Plus there are peer physicians who have sustainable recovery who also report on the physician to the Physician Health Program.

Q: All PHP’s work this way?

What I described is pretty much the blueprint for every PHP. The difference between states is the relationship to the Medical Board. In some the medical board is involved, and might even fund the Physician Health Program. In other states, like Pennsylvania, the Medical Board gets involved only when a physician is not doing well in monitoring. The job of Medical Boards and licensure agencies is to protect the public, so they come at from a different angle and vantage point

Q: What stops physicians from getting help—the stigma associated with addiction?

Absolutely. There's a great fear, and the truth is the real problem is that doctors don't get a lot of education on addiction as a disease. I have taught addiction as a disease in multiple medical schools over my career, and oftentimes I get a two-hour block. That’s woefully inadequate.

Q: What would adequate addiction training be?

We offer an addiction medicine fellowship, a whole year of addiction medicine training. That's really ultimately where we need to go, but all doctors should get more didactic training, classroom training, and practical/clinical rotation training in addiction medicine. That is starting to change and become part of the medical school curriculum. We're starting to get this right. It's a really exciting time in addiction medicine. We are recognizing addiction as a disease and showing how to deliver good treatment.

For further information:

Federation of State Physician Health Programs

http:/fshp.org/state-programs

Caron Treatment Center

http://http:/fshp.org/state-programs

National Physician Health Program Blueprint Study

http://icotp.org/national-physician-health-program-blueprint-study/