Physician impairment: When should you report?
Table 4
Options for reporting impaired colleagues
| Impairment in hospital-based physicians may be reported to the hospital’s in-house impairment program, the hospital’s chief of staff, or another appropriate supervisor (eg, a chief resident) |
| Impairment in physicians with office-based practices may be reported to hospitals where they have privileges or to the state’s physician health program |
| Colleagues who continue to practice despite offers of assistance and referrals for treatment or for whom the above options are not available should be reported to the state licensing board |
| Source: References 2,12 |
Overcoming emotional factors
Doctors facing the need to report an impaired colleague often experience emotional conflicts because the impaired is a mentor, supervisor, trainee, friend, or practice partner. Denial, stigmatization, concerns about practice coverage, and fear of retaliation also can contribute to non-reporting. Although we know a colleague’s substance misuse represents a threat to his patients’ welfare and safety,13 reporting a colleague forces us to overcome our allegiance to a fellow practitioner.
Medical professionals should remember, however, that it is always better to identify and treat illnesses early in their course. When early referrals are not made, doctors afflicted by illness often remain without treatment until more severe impairment causes workplace errors. Withholding information about an impaired colleague from supervisors or state medical boards does a disservice to patients and to the colleague. The colleague’s drug or alcohol problems may worsen, and recovery or acquisition of future licenses might become more difficult or impossible. Initial application for medical licensure in 47 states and the District of Columbia inquire about physicians’ recent history of mental health and substance abuse problems, as well as their functional impairment.14 Even renewal of state medical licensure examines applicants’ mental health, physical health, and substance abuse histories.15
Recovery resources
Many institutions and medical board committees have instituted written policies for dealing with workplace addiction.13 An awareness of and sensitivity to physician vulnerability and early detection and prevention of impairment are important.2
At least 39 states have “sick doctor statutes” that permit licensure suspension for physicians who cannot practice medicine safely because of illness or substance use disorders.16 Several states have forms of “immunity”—license protection and preservation—for physicians who seek treatment voluntarily, and some states have legislative provisions that require impaired physicians to get treatment and be monitored so they can keep their licenses.17 In almost every state, medical societies have established physicians’ health committees and treatment programs (Table 5).18
Table 5
Examples of state physician health programs
| State | Organization | Contact |
|---|---|---|
| Colorado | Colorado Physician Health Program | (303) 860-0122 www.cphp.org |
| Florida | Professional Resources Network | (800) 888-8776 www.flprn.org |
| Illinois | Illinois Professional Health Program | (800) 323-8622 www.advocatehealth.com/IPHP |
| Massachusetts | Physician Health Services, Inc. | (781) 434-7404 www.massmed.org |
| Minnesota | Health Professionals Services Program | (651) 643-2120 www.hpsp.state.mn.us |
| Nevada | Nevada Professionals Assistance Program | (702) 521-1398 www.medboard.nv.gov |
| New York | Committee for Physician Health, Medical Society of the State of New York | (518) 436-4723 www.cphny.org |
| Ohio | Ohio Physicians Health Program | (614) 841-9690 www.ophp.org |
| Oregon | Oregon Health Professionals Program | (503) 620-9117 www.oregon.gov/OHA/addiction/health-professionals.shtml |
| Tennessee | Physicians Health Program, Tennessee Medical Foundation | (615) 467-6411 www.e-tmf.org |
| Texas | Committee on Physician Health and Rehabilitation, Texas Medical Association | (512) 370-1342 www.texmed.org |
| Source: Reference 18 | ||
Physicians often recover
Physician treatment is unique for several reasons. First, it is rarely voluntary, and because treatment is coerced in some way, physicians are sicker when they enter treatment. They have more social dysfunction, more medical consequences, and simply are more complicated to treat. Still, most treatment programs for impaired professionals report better rates of long-term recovery than those of the general public, perhaps because physicians are monitored intensively and have the strong motivation of not wanting to lose their medical licenses. For example, in a study of 100 alcoholic U.S. doctors followed for 21 years, 73% had recovered. This study and others show a strong relationship between recovery and attending meetings of self-help groups.19
What should Dr. Z do?
Dr. Z is a member of a professional community that has an ethical obligation to police itself and to report observations that suggest impairment. His colleague’s suspected substance use disorder could interfere with his ability to function and pose a risk to patient welfare and safety.
Although reporting a colleague is unpleasant, impaired physicians often recover, and the data support optimism about returning to clinical practice for physicians who get appropriate treatment. In this case, Dr. Z’s reporting of his concerns about impairment would help uphold the integrity of the medical profession and would offer his colleague the potential benefits of treatment and recovery programs.
