Impaired residents re-entering residency

[PublicHealthGal]

Hi,

I'm a public health student in Illinois trying to gather information about anesthesia, EM, and psych residency programs that have a protocol in place for how they re-enter impaired residents post-rehab into clinical practice. Impairment can be a result of alcohol use, opiate use, prescription medicine abuse, psychological issues.

So far I've only been able to find one program that has something in place for anesthesia (Mt.Sinai), however if anyone can help me out with info on other anesthesia programs as well as EM and Psych programs in the country that have a re-introduction phase that would be great! I figured asking attendings and residents for help would yield more info than cold-calling over 300 programs!

Thanks in advance!

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[wolfvgang22]

Real doctors don't get ill or make mistakes.

 

[HarryMTieboutMD]

Most states have physician health programs that coordinate intervention, evaluation, treatment, and monitoring. I don't think most programs have protocols, but once the evaluating physician determines that the resident can practice medicine with reasonable skill and safety, he or she will make recommendations in his or her evaluation for return to work. Every case is different, so there cannot be a protocol. Generally, some time off is recommended. Impaired doctors are required to attend regular monitoring meetings with random drug testing. They might also be subjected to evaluations of performance in residency that will go to the PHP. In terms of actual, clinical work, again, it depends on the case. Some anesthesia residents may require being supervised initially if they were using IV opioids. I know in Florida the recommend naltrexone for all anesthesiologists going back to work. Again, this is generally a negotiation between the program director, the PHP, and the evaluating physician.

 

[witzelsucht]

I know in Florida the recommend naltrexone for all anesthesiologists going back to work.

Wow that's interesting. Is that just for opiates or alcoholics as well?

 

[HarryMTieboutMD]

Wow that's interesting. Is that just for opiates or alcoholics as well?

Just opioids. This comes from work Mark Gold did showing a higher concentration of aerosolized fentanyl in the OR at highest concentrations near the head of the bed (where the anesthaesiologists are stationed) possibly contributory to high rates of addiction and relapse: http://www.ncbi.nlm.nih.gov/pubmed/16597569. Also, a small case control study showed that this is reasonably effective: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3223377/#R9