Colorado Physician Health Program (CPHP) and Physician Health Issues Presentation to UCHSC Residency Directors December 10, 2008 Michael H. Gendel MD –

Colorado Physician Health Colorado Physician Health ProgramProgram

(CPHP) and Physician Health (CPHP) and Physician Health IssuesIssues

Presentation to UCHSC Residency DirectorsPresentation to UCHSC Residency DirectorsDecember 10, 2008December 10, 2008

Michael H. Gendel MD – Medical Director

Sarah R. Early PsyD – Executive Director

© Colorado Physician Health Program 2008 All Rights ReservedPlease do not reproduce or use without written permission of CPHP

Program ServicesProgram Services

Client Services: Assessment Treatment referral Monitoring and support Family support Documentation

Workplace and Referral Source Services: Consultation on identifying physicians who need assistance Consultation on making effective referrals Workplace consultations Educational presentations


Program Services Cont.Program Services Cont. Medical Community Services:

Promote physician health awareness Educational presentations Partnership with organizations to meet special needs Develop meaningful research on physician health

Presentation Topics: Colorado Physician Health Program services Work stress Substance abuse, addiction Women in medicine Physicians in relationships and families Professional boundaries Self-care and physician health issues Disruptive behavior management


CPHP ServicesCPHP Services

• CPHP’s direct services are free to Colorado licensed physicians and physician assistants.

• CPHP has contracts to serve Colorado residents, medical students and physician assistant students.

• Participants are responsible for costs of any additional evaluations and treatment if those services are necessary.


Relationship To The Colorado Board Relationship To The Colorado Board of Medical Examiners (BME)of Medical Examiners (BME)

• BME Makes Referrals to CPHP • Applications for licensure• Renewal applications• Complaints

• CPHP Provides “Treatment Monitoring” for individuals with license stipulations

• “Safe Haven” on applications and re-applications

• 22% of CPHP cases are known to the BME© Colorado Physician Health Program 2008 All Rights ReservedPlease do not reproduce or use without written permission of CPHP

ConfidentialityConfidentiality

State and Federal Laws

CPHP Policies and Procedures

ConsentForms


Clinical Assessment Clinical Assessment

• Assessment• Review of documentation• Self-reported history (health, lifestyle, family and

work)• Face-to-face interview• Collateral interviews• Laboratory tests and/or urine drug screen• Review by clinical team• External evaluation (i.e., psychological testing,

neurological exam)


Annual Number of New ReferralsAnnual Number of New Referrals Program History 1986 - Present Program History 1986 - Present

* = BME License Renewal Years

0

50

100

150

200

250

300

350


Loss of Function HierarchyLoss of Function Hierarchyfor Ill Physiciansfor Ill Physicians

CommunitySpiritual lifeRecreation and avocationFriendsPeersFamilyWork


Warning SignsWarning Signs

• Decline in job performance • Absenteeism• Attitude and/or mood• Troubled professional/interpersonal

relationships• Professional boundary issues• Physical symptoms or illness• Decline in physician appearance• Other problem areas


What You Can Expect From CPHP What You Can Expect From CPHP Following a ReferralFollowing a Referral

• With signed consent:• You will be notified that the referred individual came for

evaluation and what the plan is• CPHP will discuss with you arrangements regarding work if

necessary• CPHP will furnish status reports as necessary

• Without signed consent:• You will not receive any information

• If you want information about a mandatory referral, require a signed consent in the referral documentation


Residents’ Problems Accessing Residents’ Problems Accessing CPHP and Treatment ServicesCPHP and Treatment Services

Perception that department would not be supportive in terms of time away from work

Guilt about having other’s provide coverage or not doing their share

Perceived dissonance between supportiveness of residency director/chair and attendings/chief resident



Belief that having an illness/diagnosis, requiring treatment, or being a CPHP client will affect negatively impact their career

Denial (including age-related factors) that they could be seriously ill

Stigma about psychiatric or substance related conditions



Tradition of excessive work demands of residency (which entails ignoring important aspects of self-care and relationships) cannot be challenged or modified even to prevent or ameliorate illness Problem may be enhanced for women of childbearing

age (increased role conflict)

Reality: Lack of reasonable balance in residency years predicts lack of balance in subsequent professional activity


Referral is not enoughReferral is not enough

If a resident has a problem that needs ongoing assistance, the referring party needs to problem-solve with the resident how he or she will address the above concerns – time away, managing others (attendings, chief residents), coverage, guilt, balance, stigma, denial, career fears, etc.


UCHSC ResidentsUCHSC ResidentsUSCHS Residents:

A total of 37 UCHSC resident new referral were served during Fiscal Year 2007-08.

Presentations/Exhibits Provided:

Date Department Topic

07/02/07 UCHSC Resident Orientation CPHP/Physician Health07/16/07 UCHSC Graduate Medical Education Collaboration 08/02/07 UCHSC Graduate Medical Education Collaboration08/18/07 UCHSC Residency Directors CPHP/Physician Health08/20/07 Anesthesiology Residents CPHP/Physician Health08/23/07 Board of Medical Examiners/GME Collaboration 10/02/07 Pediatrics Residents Stress Management10/16/07 UCHSC Graduate Medical Education Collaboration 10/16/07 Family Medicine Residents CPHP/Physician Health11/05/07 Internal Medicine Residents CPHP/Physician Health 11/13/07 UCHSC Graduate Medical Education Training Program Collaboration 12/14/07 Surgery Residents CPHP/Physician Health02/13/08 UCHSC Residency Directors Professional Boundaries03/25/08 Pediatrics Residents CPHP/Physician Health06/20/08 UCHSC Resident Orientation CPHP/Physician Health


CPHP Resident New ReferralsCPHP Resident New ReferralsReferral SourceReferral Source

July 2007 – June 2008 July 2007 – June 2008

N=50 Proactive6%

Res Program

48%

Self38%

BME8%

• Voluntary (58%)

• Mandatory (42%)


CPHP Fiscal Year 2007- 2008 CPHP Fiscal Year 2007- 2008 Client Primary Presenting Client Primary Presenting

ProblemsProblems

Other1%

Work Stress8%

Family3%Psychiatric

26%

Psyc/Sub5%

Physical/ Medical

5%

Prof Bound3%

Substance Abuse

8%

Legal7%

DUI/DWAI5%

Career6%

Behavioral13%

Emotional2%Stress

7%

Domestic Violence

1%

N=190Other= Credentialing Matter


CPHP Residents New Referrals CPHP Residents New Referrals Primary Presenting ProblemPrimary Presenting Problem


N=39

Legal5%

Emotional5%

Physical/Medical

8%Substance

Abuse3%

Stress13%

DUI/DWAI8%

Family5%

Behavorial15%

Psychiatric28%

Career5%

Work Stress5%


CPHP Resident New Referrals CPHP Resident New Referrals SpecialtySpecialty


N=39

Physical

Medicine/ Rehab

3%

Surgery

10%

Pediatrics

17%

OB/ GYN

3%

Pathology

3%

Otolaryngology

5%

Anesthesiology

3%

Psychiatry

8%

Family Practice

20%

Internal

Medicine

17%

Opthalmology

8%

Neurological

Surgery

3%


Contacting CPHPContacting CPHP

• CPHP may be reached at:• 303-860-0122 or 800-927-0122

• Office Hours: • 8:30 a.m.- 4:30 p.m. • Monday – Friday

• After Hours Clinical Emergencies: • Pager: 303-437-2138

• For additional information visit the CPHP website: • www.CPHP.org


Documents

Colorado Physician Health Program (CPHP) and Physician Health Issues Presentation to UCHSC Residency Directors December 10, 2008 Michael H. Gendel MD –