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Anesthesiologists with Substance Use Disorders: A 5-Year Outcome Study from 16 State Physician Health Programs

Section Editor(s): Dexter, FranklinSkipper, Gregory E. MD*; Campbell, Michael D. PhD; DuPont, Robert L. MD

doi: 10.1213/ane.0b013e3181adc39d
Economics, Education, and Policy: Research Reports

BACKGROUND: Anesthesiologists have a higher rate of substance use disorders than other physicians, and their prognoses and advisability to return to anesthesiology practice after treatment remain controversial. Over the past 25 yr, physician health programs (PHPs), created under authority of state medical regulatory boards, have become primary resources for management and monitoring of physicians with substance abuse and other mental health disorders.

METHODS: We conducted a 5-yr, longitudinal, cohort study involving 904 physicians consecutively admitted to 1 of 16 state PHPs between 1995 and 2001. This report analyzed a subset of the data involving the 102 anesthesiologists among the subjects and compared them with other physicians. The main outcome measures included relapse (defined as any unauthorized addictive substance use, including alcohol), return to anesthesiology practice, disciplinary actions, physician death, and patient harm.

RESULTS: Anesthesiologists were significantly less likely to enroll in a PHP because of alcohol abuse (odds ratio [OR] 0.4 [confidence interval {CI}: 0.2–0.6], P < 0.001) and much more likely to enroll because of opioid abuse (OR 2.8 [CI: 1.7–4.4], P < 0.001). Anesthesiologists had a higher rate of IV drug use, 41% vs 10% (OR 6.3 [CI: 3.8–10.7], P < 0.001). During similar periods of monitoring, anesthesiologists received more drug tests, 101 vs 82 (mean difference = 19 [CI: 3–35], P = 0.02); however, anesthesiologists were less likely to fail at least one drug test during monitoring, 11% vs 23% (OR 0.4 [CI: 0.2–0.9], P = 0.02). There was no statistical difference among rates of program completion, disciplinary actions, return to practice, or deaths, and there was no report of significant patient harm from relapse in any record.

CONCLUSIONS: Anesthesiologists in our sample treated and monitored for substance disorders under supervision of PHPs had excellent outcomes similar to other physicians, with no higher mortality, relapse rate, or disciplinary rate and no evidence in their records of patient harm. It is postulated that differences of study design account for contradictory conclusions from other reports.

From the *Departments of Medicine and Psychiatry, University of Alabama School of Medicine, Montgomery, Alabama; and †Institute for Behavior and Health, Rockville, Maryland.

Supported by the Robert Woods Johnson Foundation.

All authors participated in study design, implementation, and writing and editing the article. Skipper had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Skipper and DuPont were paid as Co-Principal Investigators and Campbell was paid by the Institute for Behavior and Health to assist in study design, statistical analysis, and review. Skipper is the medical director of the Alabama Physician Health Program. Neither DuPont nor Campbell have any affiliation with Physician treatment or Physician Health Programs. A. Thomas McLellon, PhD, was the recipient of the grant and contributed significantly to development and implementation of the larger study. A steering committee of the Federation of State Physician Health Programs oversaw the larger study design, implementation, and interpretation and reviewed this article for comment.

Address correspondence and reprint requests to Gregory E. Skipper, MD, 19 S Jackson St., Montgomery, AL 36117. Address e-mail to

© 2009 International Anesthesia Research Society