When Doctors Become Addicts

Identifying physicians with problems

By Mike Byrne

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It is an incurable, chronic, progressive and fatal disease that potentially affects over 760 million people worldwide and 33 million people in the United States. Yet it is not recognized as a leading cause of death or even numbered among the top 10 diseases in the world according to web search engines.

Alcoholism and drug addiction were first recognized as disease in 1955 by the American Medical Association, yet even today, physicians and hospitals are often reluctant to treat such patients in their emergency rooms or hospitals, according to Erin Zerbo, M.D., who was an assistant professor of psychiatry at Rutgers New Jersey Medical School and an attending psychiatrist at University Hospital in Newark. She also helped train physicians in addiction medicine.

This disease affects 10-20 percent of the population without regard to race, socio-economic status or education.? The remainder of the population is unlikely to become substance abusers, Zerbo said.

Patients admitted for alcohol or drug-related illnesses may be as many as 50 percent of hospital admissions, she said.

The population of the United States is around 333 million, and there are nearly 7.6 billion people in the world.

Even physicians and other health care providers are not immune from addiction problems. In New Jersey, there are approximately 15-20,000 practicing physicians which means there are 1,500 to 2,000 medical doctors with alcohol and drug problems, said Louis Baxter, M.D., executive director of the Professional Assistance Program (PAP) of New Jersey, which oversees impaired physicians.

In 1982 New Jersey became the first state to institute a program to identify, monitor and counsel physicians with addiction. It was started by David Canavan, M.D., who became interested in alcoholism as a disease in 1952 while working at Bellevue Hospital in Manhattan.

Canavan knew Bill Wilson, one of the co-founders of Alcoholics Anonymous, which began in June, 1935. It is the oldest 12-step program in the world with several million members.

?Other physicians and psychiatrists in New York were aware of Wilson’s success in helping hopeless alcoholics recover, and Canavan became friendly with some of those physicians, Baxter said.

“He is the godfather of physician assistance programs,” Dr. Baxter said.

“All states now have Professional Assistance Programs, basically modeling theirs after ours in New Jersey,” Dr. Baxter said.

Baxter is an internist by training, certified in Addiction Medicine, and former President and Chairman of the Board of the Society for Addiction Medicine. He has served on the White House Council for National Drug and Alcohol Policy under Presidents William Clinton, George W. Bush and Barack Obama.

?Baxter personally oversees the recovery efforts of 700-plus physicians and health care professionals. Most impaired physicians are identified by professionals in hospitals or clinics where they work. Some have trouble with the police.

The law requires health care providers to report any professional they believe has a problem to the state licensing office or the Professional Assistance Program. Those individuals are then referred to Baxter’s office, headquartered in Princeton.

By actively cooperating with laboratory monitoring of urine samples, counseling, and by attending 12-step programs, like Alcoholics Anonymous and Narcotics Anonymous, impaired physicians can recover and become productive professionals again, Baxter said.

There are special 12-step meetings, called Caduceus meetings, that restrict attendance to physicians and health care professionals so members can speak freely and get the support they need, he said.

There are similar 12-step meetings for attorneys and even police officers.

Baxter also encourages impaired physicians to get psychiatric or other counseling when appropriate.

Some believe physicians are more prone to drug and alcohol problems because of high stress and also because of access to their own prescription pads.

“The health care professional incidence of impairment very closely mirrors the incidence in the general population,” Baxter said. The access provided by having a prescription pad is not an enticement.? Physicians become substance abusers the same way anyone does.

Unlike the general population, however, there are mechanisms to identify impaired physicians early on in their disease.

“All the hospitals and health agencies in the state and in the country, for that matter, have physician impairment committees. They were commissioned by the Joint Commission on Accreditation in 2001 to have programs to identify impaired physicians.

If physicians come into work with alcohol on their breath, or there is aberrant behavior, or there are problems with documentation of medications that are being used in hospitals, these committees learned cues to identify impaired physicians, and they make the referral to our program,” Dr. Baxter said.

In 1994, the state board of medical examiners established the Impaired Review Committee (IRC) that allows us to monitor impaired physicians.

“We will not allow a physician with an active impairment to resume practice until we can ascertain that that physician is in stable documented recovery and it is safe for them to resume practice,” he said.

If physicians with impairments cooperate with monitoring and counseling for a five year period, their license is not suspended, he said.

“That does a lot to protect the public’s safety and welfare,” he said. “Under no circumstances will the PAP protect physicians who are not deemed safe.”

?“We have a 96.3 percent success rate over a 5-year period. Only .6 percent of our enrollees get their licenses taken or have to be reported back to the (state licensing) board,” he said

“In general, physician-help programs do better” than other rehabilitation programs for nonprofessionals.? The secret to the high success rate is long-term monitoring, just like medical successes of other chronic diseases are correlated with long-term compliance of a treatment protocol. Physicians are also highly motivated to continue their livelihood, Baxter said.

Baxter makes recommendations to the state medical licensing board, hospital medical staffs, and malpractice insurance carriers on behalf of physicians who are in compliance.

As with any substance abuser, police arrests are not uncommon. A criminal record can hinder future credentialing efforts but with proven documented monitoring and recovery, denial of hospital privileges is unusual, Baxter said.

Baxter reviews the files of each one of the more than 700 impaired physicians his office handles, and while the staffs at PAP are “workaholics,” almost all are overworked. There are not enough funds available to hire more staff, he said.

It is an independent program. There are no taxpayer dollars as this office is not a government agency, he said.

Some funds come from the participants, some from medical malpractice insurance companies, hospital staff donations, and some from grateful alumni the program helped.

A revenue stream from a nominal surcharge on all medical licensing fees would be ideal, Baxter said.

Some states do just that.

More funds would ease the burden of the staff and allow for more outreach efforts to identify the almost equal number of unidentified impaired physicians who are putting the public at risk, he said.

“It’s scary to think of that,” he said.

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