As an aging population of physicians approaches a demographic cliff that may cause a shortage of medical doctors, there is renewed interest in prolonging and safeguarding the careers of those in the healing profession.
In that regard, William G. Buchta, MD, MPH, medical director of the Employee Occupational Health Service at Mayo Clinic in Rochester, MN, is involved in reaching out to physicians having health concerns whether they be physical, mental, or linked to substance abuse.
Some 40% of physicians are older than 55 and another 20% are over 65, he notes. All the while, the demand for healthcare is increasing. Thus the need for a “physician care model” developed by Buchta and colleagues at Mayo Clinic to address acute health needs, return-to-work issues, impairment, and recovery. It is a customized version of the kind of programs recommended by the Federation of State Physician Health Programs, which provide care for physicians with substance abuse issues as well as mental and physical illness. (For more information, visit: http://www.fsphp.org/.)
Before we delve more in-depth into these less tangible aspects, it should be noted that physicians typically suffer occupational injuries distinctly different from their nursing counterparts.
“Physicians are more inclined to have repetitive strain type of issues like neuropathies,” Buchta says. “I have [treated a] radiologist who works a computer mouse all day — 12 to 14 hours a day — and developed [a] compression syndrome. The surgeons that are doing hours-long procedures looking down a small deep hole tend to have more neck issues. It tends to be specific to the type of procedures they are doing, whereas the nurses are more likely to get neck, shoulder, and low-back strain from an acute exposure. You don’t see that much in physicians. It’s more the cumulative positioning issues that cause a new condition or aggravate an underlying condition.”
A member of the Hospital Employee Health editorial board, Buchta told us more about the physician care program at Mayo Clinic in the following interview.
HEH: We hear a lot about burnout in physicians and other caregivers. Are you seeing a lot of that issue in this program?
Buchta: It is the mid-career physicians who are having problems with burnout. They have too much on their plate — clinical responsibilities, research, education — and they can’t handle it all. So they go into a shell, become irritable — typical signs of burnout. Whereas with aging physicians, there are more problems with physical and cognitive decline. They are more susceptible to fatigue. It’s kind of a terminal manifestation that a career of 40 years is coming to an end. Burnout is not so much an aging issue as an over-commitment issue.
HEH: How did you become interested in developing this program?
Buchta: We were seeing a lot of own colleagues. We have 3,000 physicians in our institution and some of them were clearly struggling at one point or another. Working in occupational health, a lot of them would come to see me — sometimes on their own, but often they were directed by their administrator or colleagues saying, “Something’s wrong here. You should start taking action.” I realized that we were getting this pretty steady stream of these cases and figured that this wasn’t unique to our institution, so we decided to open it up to outside areas.
We advertised that we were available to make these types of evaluations, and we got some pretty interesting takers on that. Some of the situations are just unbelievably complex, emotionally charged. But I think we have been able to help them get their lives back together. We have discovered some underlying medical conditions that could explain why they were declining in their performance. We decided to formalize this program as an entry point for physicians or physician organizations to send people for confidential evaluation and a full report at the end with recommendations for their healthcare.
HEH: Does this present more as an issue of impairment — a patient safety issue — rather than strictly occupational health?
Buchta: Unfortunately, it has been primarily reactive — reacting to things gone wrong. It is kind of secondary prevention, and that’s not the best model for this. We would like to move to a primary prevention model if we can. That is what we are eventually advocating to have: to be the entry point for physicians who would then take care of themselves, to give them general preventive services before they start to decline, particularly focusing on the needs of their specialty and how that interacts with their own particular medical profile.
HEH: Are these physicians becoming aware of medical errors, say, an increase in infection rates for a surgeon?
Buchta: That’s one of the ways, yes. Usually it’s an event — something happens and somebody’s in trouble. So it is an emotionally charged emergency. Also, looking at data and seeing that [a physician’s] data doesn’t look as good as [colleagues’]. That’s a more objective, less emotionally charged way of doing it, but it takes work. It takes a system and somebody has to be looking at that. But I think we are moving in that direction more in reporting an individual’s statistics. I think that is probably a better model than the reactive: responding when something bad happens. We could offer this as a service to physicians, to enroll them to receive preventive services through this that would be over and above your general healthcare.
HEH: But you say healthcare reform legislation may not look favorably on this, as it may be viewed as a high-cost employer-sponsored health plan subject to the so-called “Cadillac tax?”
Buchta: That’s been kicked down the road to 2020, or otherwise we would be looking at that next year. This is one of those services that would be considered taxable by 40% and that could discourage a lot of people from participating and a lot of employers from offering a program like this. We are trying to collect the data to show that this really makes a difference and helps salvage lives and careers. We are looking at a healthcare shortage in the future, so we want to take advantage of the resources that we have and maximize those in addition to generating new [physicians].
HEH: What other kind of obstacles are you facing in treating these physicians?
Buchta: The initial problem is overcoming the barrier of self-recognition. So many physicians tend to isolate themselves as far as their personal problems. They don’t want to talk about them or think about them. It’s kind of like, no data, no problem. They have to come to the realization that they do have a problem. We have found that if they get past that barrier, they finally admit they need to address something, they become some of the best patients you ever met. It’s a complete 180. Suddenly, they realize this is an opportunity to get their act together and they become very compliant with our recommendations. It’s like you’re hitting this wall and suddenly the wall comes down. They get it, and this is particularly true with substance abuse. Most impaired physician programs are developed for substance abuse. But the recidivism rate is incredibly low in physicians because they get it. Once they acknowledge a problem and deal with it, they say, “Why would I let this get in the way of my career? It’s illogical.”
HEH: Do a lot of physicians come in with addiction problems?
Buchta: It’s no more common or less common than it is in the general population. We are a slice of the American population, and no different than anyone else. It is suggested that about 10% of all physicians have some type of chemical dependency issue. That doesn’t mean that they are all practicing it, but they need to admit that and deal with it. I think sometimes the public thinks that physicians are in a different category, they are superhuman. Physicians have to get past that [perception], too. We think we’re superhuman.”
HEH: Approximately how many physicians are you able to help a year?
Buchta: The program is pretty nascent — it is about 50-100 a year. That’s not huge by any means, and we know that there are a lot more cases out there that we could be helping. But it is a start.