Risk and Outcomes of Substance Use Disorder among Anesthesiology Residents: A Matched Cohort Analysis.
BACKGROUND
The goal of this work is to evaluate selected risk factors and outcomes for substance use disorder (SUD) in physicians enrolled in anesthesiology residencies approved by the Accreditation Council for Graduate Medical Education.


METHODS
For each of 384 individuals with evidence of SUD while in primary residency training in anesthesiology from 1975 to 2009, two controls (n = 768) who did not develop SUD were identified and matched for sex, age, primary residency program, and program start date. Risk factors evaluated included location of medical school training (United States vs. other) and anesthesia knowledge as assessed by In-Training Examination performance. Outcomes (assessed to December 31, 2013, with a median follow-up time of 12.2 and 15.1 yr for cases and controls, respectively) included mortality and profession-related outcomes.


RESULTS
Receiving medical education within the United States, but not performance on the first in-training examination, was associated with an increased risk of developing SUD as a resident. Cases demonstrated a marked increase in the risk of death after training (hazard ratio, 7.9; 95% CI, 3.1 to 20.5), adverse training outcomes including failure to complete residency (odds ratio, 14.9; 95% CI, 9.0 to 24.6) or become board certified (odds ratio, 10.4; 95% CI, 7.0 to 15.5), and adverse medical licensure actions subsequent to residency (hazard ratio, 6.8; 95% CI, 3.8 to 12.2). As of the end of follow-up, 54 cases (14.1%) were deceased compared with 10 controls (1.3%); 28 cases and no controls died during residency.


CONCLUSIONS
The attributable risk of SUD to several adverse outcomes during and after residency training, including death and adverse medical license actions, is substantial.
From the Departments of Anesthesiology (D.O.W., K.B.) and Health Sciences Research (A. Hanson, D.R.S.), Mayo Clinic, Rochester, Minnesota; and American Board of Anesthesiology, Raleigh, North Carolina (D.O.W., H.S., A. Harman).
David O
DO
Warner
Keith
K
Berge
Huaping
H
Sun
Ann
A
Harman
Andrew
A
Hanson
Darrell R
DR
Schroeder
D000328:Adult; D000776:Anesthesiology / Q000193:education* / Q000639:trends; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000639:trends; D008297:Male; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D016896:Treatment Outcome