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Continuing Medical Education College of Medicine
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Current Issues in the Evaluation/Treatment and Monitoring of Healthcare Professionals

activity
post test

Presented by:
Dr. Scott Teitelbaum, MD, DFSAM
Pottash Professor in Psychiatry & Neuroscience
Vice Chair, Department of Psychiatry
Chief, Division of Addiction Medicine
Medical Director, UF Health Florida Recovery Center
University of Florida, College of Medicine

Faculty Disclosure:

Dr. Teitelbaum has disclosed that he has no relevant financial relationships. No one else in a position to control content has any financial relationships to disclose.

Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/. All relevant financial relationships have been mitigated.

Release Date: October 15, 2022
Expiration Date:  October 14, 2025

Target Audience: All physicians

Learning Objectives:

As a result of participation in this activity, participants should be able to:

  1. Discuss the history of development of safety-sensitive professional monitoring programs.
  2. List 3 critical factors in the effectiveness of monitoring programs.
  3. List and discuss at least 3 current issues/controversies in the monitoring of individuals in safety-sensitive professions.

Requirements for successful completion: Certificates are awarded upon successful completion (80% proficiency) of the post-test.

Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Resource(s) for further study:

  1.  The Sick Physician: Impairment by Psychiatric Disorders, Including Alcoholism and Drug Dependence. JAMA. 1973;223(6):684-687. Doi:10.1001/jama.1973.03220060058020 https://jamanetwork.com/journals/jama/article-abstract/346882
  2. Merenes D. Protect Your Patients from Nurse Addicts. Nursing Life. 1981;1:70-73.
  3. AMA Code of Medical Ethics’ Opinions on Physicians’ Health and Conduct, Opinion 9.0305 – Physician Health and Wellness. AMA Journal of Ethics. https://journalofethics.ama-assn.org/article/ama-code-medical-ethics-opinions-physicians-health-and-conduct/2011-10
  4. Baldisseri MR. Impaired healthcare professional. Crit Care Med. 2007 Feb;35(2 Suppl):S106-16. Doi:10.1097/01.CCM.0000252918.87746.96. https://pubmed.ncbi.nlm.nih.gov/17242598/
  5. 2019 Florida Statutes Title XXXII Regulation of Professionals and Occupations Chapter 456, Health Professionals and Occupations: General Provisions. 456.076 Impaired practitioner programs. http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0456/0456.html
  6. Nutt DJ, King LA, Phillips LD. Drug harms in the UK: A Multicriteria Decision Analysis. The Lancet. 2010; 376:1558-1565. https://www.sciencedirect.com/science/article/pii/S0140673610614626
  7. Murthy P, Narasimha VL. Effects of the COVID-19 Pandemic and Lockdown on Alcohol Use Disorders and Complications. Curr Opin Psychiatry 2021;34(4):376-385. Doi: 10.1097/YCO.0000000000000720 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8183243/
  8. Boisaubin EV, Levine RE. Identifying and assisting the impaired physician. Am J Med Sci. 2001 Jul;322(1):31-6. Doi: 10.1097/00000441-200107000-00006. https://pubmed.ncbi.nlm.nih.gov/11465244/
  9. DesRoches CM, Sowmya RR, Fromson JA, et al. Physicians’ Perceptions, Preparedness for Reporting, and Experiences Related to Impaired and Incompetent Colleagues. JAMA. 2010;304(2):187-193. Doi:10.1001/jama.2010.921. https://jamanetwork.com/journals/jama/article-abstract/186214
  10. Humphreys K. How to Deliver a More Persuasive Message Regarding Addiction as a Medical Disorder. J Addict Med. 2017 May/Jun;11(3):174-175. Doi:10.1097/ADM.0000000000000306. https://pubmed.ncbi.nlm.nih.gov/28557959/
  11. Gastfriend DR. Physician Substance Abuse and Recovery: What does it mean for physicians – and everyone else? JAMA 2005. 293(12):1513-1515. https://pubmed.ncbi.nlm.nih.gov/15784877/
  12. Brooke D. Why Do Some Doctors Become Addicted? Addiction 1996. 91(3):317-319.
  13. Hughes PH, et al. Physician Substance Use by Medical Specialty. J Add Dis 1999. 19(2):23-37.
  14. Lloyd G. One Hundred Alcoholic Doctors: A 21-Year Follow-up. Alcohol & Alcoholism. 2002. 37(4):370-374.
  15. Schuckit MA. New Findings in the Genetics of Alcoholism. JAMA 1999. 281(20):1875-1876.
  16. Kenna & Wood. Alcohol Use by Healthcare Professionals. Drug Alcohol Dependence 2004 Jul15;75(1):107-16.
  17. Federation of State Physician Health Programs. FSPHP Performance Enhancement and Effectiveness Review (PEER) Program Criteria and Metrics. March 2022. https://www.fsphp.org/fsphp-guidelines–policies–position-statements
  18. Federation of State Physician Health Programs. The FSPHP Evaluation and Treatment Accreditation (FSPHP-ETA) Standards for Accreditation. March 2022. https://www.fsphp.org/fsphp-guidelines–policies–position-statements
  19. Brooks E, Gendel MH, Gundersen DC, Early SR, Schirrmacher R, et al. Physician Health Programmes and Malpractice Claims: Reducing risk through monitoring. Occupational Medicine, 2013; 63(4):274-280. https://doi.org/10.1093/occmed/kqt036 https://academic.oup.com/occmed/article/63/4/274/1430067
  20. DuPont RL, McLellan AT, Carr G, Gendel M, Skipper GE. How are Addicted Physicians Treated? A National Survey of Physician Health Programs. J Subst Abuse Treat 2009; 37(1):1-7. Doi:10.1016/j.jsat.2009.03.010. https://pubmed.ncbi.nlm.nih.gov/19482236/
  21. DuPont RL & Merlo LJ. Physician Health Programs: A model for treating substance use disorders. The Judges’ Journal 2018; 57(1) https://ncphp.org/wp-content/uploads/2018/03/PHPs-A-Model.pdf
  22. Skipper GE, Campbell MD, DuPont RL. Anesthesiologists with Substance Use Disorders: A 5-Year Outcome Study from 16 State Physician Health Programs. Anesth Analg 2009; 109(3):891-896. Doi:10.1213/ane.0b013e3181adc39d
  23. Yellowlees PM, Campbell MD, Rose JS, Parish MB, Ferrer D, Scher LM, Skipper GE, DuPont RL. Psychiatrists with Substance Use Disorders: Positive Treatment Outcomes from Physician Health Programs. Psychiatric Services 2014; 12(65):1492-1495. Doi:10.1176/appi.ps.201300472.
  24. Rose JS, Campbell M, & Skipper G. Prognosis for Emergency Physician with Substance Abuse Recovery: 5-Year Outcome Study. Western Journal of Emergency Medicine 2014; 15(1):20-25. Doi:10.5811/westjem.2013.7.17871.
  25. Merlo, Cummings, Cottler. 2010. College on Problems of Drug Dependence Annual Meeting.
  26. Merlo, Klingman, Conwell, & Rivenbark. 2012. American Psychological Association Annual Meeting. Orlando, FL.
  27. Anderson P. Physician Health Programs: More Harm Than Good? Medscape. 2015.
  28. Boyd JW. A Call for National Standards and Oversight of State Physician Health Programs. J Addict Med 2015;9(6):431-2. Doi:10.1097/ADM.0000000000000174. https://pubmed.ncbi.nlm.nih.gov/26517323/
  29. Wible PL. Do Physician Health Programs Increase Physician Suicides? Medscape. 2015.
  30. Dyrbye LN, West CP, Sinsky CA, Goeders LE, Satele DV, Shanafelt TD. Medical Licensure Questions and Physician Reluctance to Seek Care for Mental Health Conditions. Mayo Clin Proc 2017;92(10):1486-1493. Doi:10.1016/j.mayocp.2017.06.020
  31. Saddawi-Konefka D, Brown A, Eisenhart I, Hicks K, Barrett E, Gold JA. Consistency Between State Medical License Applications and Recommendations Regarding Physician Mental Health. JAMA. 2021;325(19):2017-2018. Doi:10.1001/jama.2021.2275
  32. ARC Issue Brief: Confidential Care to Support Physician Health and Wellness. American Medical Association July 2022. https://www.ama-assn.org/system/files/issue-brief-physician-health-wellness.pdf
  33. Beletsky L, Wakeman SE, Fiscella K. Practicing What We Preach – Ending Physician Health Program Bans on Opiod-Agonist Therapy. N Engl J Med. 2019;381(9):796-798. Doi:10.1056/NEJMp1907875. https://pubmed.ncbi.nlm.nih.gov/31461593/
  34. Polles AG, Williams MK, Phalin BR, Teitelbaum S, Merlo LJ. Neuropsychological Impairment Associated with Substance Use by Physicians. J Neurol Sci. 2020;411:116714. Doi:10.1016/j.jns.2020.116714. https://pubmed.ncbi.nlm.nih.gov/32036159/
  35. U.S. Department of Justice. Civil Rights Division. The Americans with Disabilities Act and the Opioid Crisis: Combating Discrimination Against People in Treatment or Recovery. April 2022. https://www.ada.gov/opioid_guidance.pdf
  36. 4.WPHPreport.pdf (wa.gov)
  37. Merlo, Campbell, Skipper, Shea, DuPont. J Subst Abuse Treat. 2016;64:47-54.

If you have any questions please feel free to contact Nancy Boyd at (352) 594-4298 or at nancy.boyd@ufl.edu