Prognosis for Emergency Physician with substance abuse recovery: 5-year outcome study.
BACKGROUND
Emergency physicians (EPs) are reported to have a higher rate of substance use disorder (SUD) than most specialties, although little is known about their prognosis. We examined the outcomes of emergency physician compared to other physicians in the treatment of substance use disorders in Physician Health Programs (PHP).


METHODS
This study used the dataset from a 5-year, longitudinal, cohort study involving 904 physicians with diagnoses of SUD consecutively admitted to one of 16 state PHPs between 1995 and 2001. We compared 56 EPs to 724 other physicians. Main outcome variables were rates of relapse, successful completion of monitoring, and return to clinical practice.


RESULTS
EPs had a higher than expected rate of SUD (odds ratio [OR] 2.7 confidence interval [CI]: 2.1-3.5, p<0.001). Half of each group (49% of EPs and 50% of the others) enrolled in a PHP due to alcohol-related problems. Over a third of each group (38% of EPs and 34% of the others) enrolled due to opioid use. During monitoring by the PHPs, 13% of EPs had at least one positive drug test compared to 22% of the other physicians; however, this difference was not significant (p=0.13). At the end of the 5-year follow-up period, 71% of EPs and 64% of other physicians had completed their contracts and were no longer required to be monitored (OR 1.4 [CI: 0.8-2.6], p = 0.31). The study found that the proportion of EPs (84%) continuing their medical practice was generally as high as that of other physicians (72%) (OR 2.0 [CI: 1.0-4.1], p = 0.06).


CONCLUSIONS
In the study EPs did very well in the PHPs with an 84% success rate in completion and return to clinical practice at 5 years. Of the 3 outcome variables measured, rates of relapse, successful completion of monitoring, and return to clinical practice, EPs had a high rate of success on all variables compared to the other physician cohort. These data support the conclusion that EM physicians do well following treatment of SUD with monitoring in PHPs and generally return to the practice of emergency medicine.
University of California Davis School of Medicine, Department of Emergency Medicine, Sacramento, California.
John S
JS
Rose
Institute for Behavior and Health, Inc., Rockville, Maryland.
Michael
M
Campbell
Promises Treatment Centers, Professionals Health Services, Santa Monica, California.
Gregory
G
Skipper
D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000175:diagnosis / Q000534:rehabilitation / Q000628:therapy; D004635:Emergency Medicine / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000534:rehabilitation / Q000628:therapy; D010815:Physician Impairment / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data; D012008:Recurrence; D015813:Substance Abuse Detection; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000534:rehabilitation / Q000628:therapy; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology