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
© Colorado Physician Health Program 2008 All Rights ReservedPlease do not reproduce or use without written permission of CPHP
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
© Colorado Physician Health Program 2008 All Rights ReservedPlease do not reproduce or use without written permission of CPHP
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.
© Colorado Physician Health Program 2008 All Rights ReservedPlease do not reproduce or use without written permission of CPHP
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
© Colorado Physician Health Program 2008 All Rights ReservedPlease do not reproduce or use without written permission of CPHP
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)
© Colorado Physician Health Program 2008 All Rights ReservedPlease do not reproduce or use without written permission of CPHP
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
© Colorado Physician Health Program 2008 All Rights ReservedPlease do not reproduce or use without written permission of CPHP
Loss of Function HierarchyLoss of Function Hierarchyfor Ill Physiciansfor Ill Physicians
CommunitySpiritual lifeRecreation and avocationFriendsPeersFamilyWork
© Colorado Physician Health Program 2008 All Rights ReservedPlease do not reproduce or use without written permission of CPHP
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
© Colorado Physician Health Program 2008 All Rights ReservedPlease do not reproduce or use without written permission of CPHP
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
© Colorado Physician Health Program 2008 All Rights ReservedPlease do not reproduce or use without written permission of CPHP
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
© Colorado Physician Health Program 2008 All Rights ReservedPlease do not reproduce or use without written permission of CPHP
Residents’ Problems Accessing Residents’ Problems Accessing CPHP and Treatment ServicesCPHP and Treatment Services
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
© Colorado Physician Health Program 2008 All Rights ReservedPlease do not reproduce or use without written permission of CPHP
Residents’ Problems Accessing Residents’ Problems Accessing CPHP and Treatment ServicesCPHP and Treatment Services
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
© Colorado Physician Health Program 2008 All Rights ReservedPlease do not reproduce or use without written permission of CPHP
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.
© Colorado Physician Health Program 2008 All Rights ReservedPlease do not reproduce or use without written permission of CPHP
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
© Colorado Physician Health Program 2008 All Rights ReservedPlease do not reproduce or use without written permission of CPHP
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%)
© Colorado Physician Health Program 2008 All Rights ReservedPlease do not reproduce or use without written permission of CPHP
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
© Colorado Physician Health Program 2008 All Rights ReservedPlease do not reproduce or use without written permission of CPHP
CPHP Residents New Referrals CPHP Residents New Referrals Primary Presenting ProblemPrimary Presenting Problem
July 2007 – June 2008 July 2007 – June 2008
N=39
Legal5%
Emotional5%
Physical/Medical
8%Substance
Abuse3%
Stress13%
DUI/DWAI8%
Family5%
Behavorial15%
Psychiatric28%
Career5%
Work Stress5%
© Colorado Physician Health Program 2008 All Rights ReservedPlease do not reproduce or use without written permission of CPHP
CPHP Resident New Referrals CPHP Resident New Referrals SpecialtySpecialty
July 2007 – June 2008 July 2007 – June 2008
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%
© Colorado Physician Health Program 2008 All Rights ReservedPlease do not reproduce or use without written permission of CPHP
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
© Colorado Physician Health Program 2008 All Rights ReservedPlease do not reproduce or use without written permission of CPHP