Addiction – A Tale of Two SurvivorsMichael Sprintz, DO

Mark Baskerville, MD

Anesthesiology and Perioperative MedicineJuly 21, 2014

Circa 1998

JAMA – December 2013

1 in 80will develop a

Substance Use Disorder

Incidence

Occupational Mortality Rateper 100,000 worker years

Commercial Fisherman 21.2

Police Officers 18.6

Truck Drivers 13.3

Firefighters 2.5

Healthcare Workers 0.7

15.76 times Fire Fighters

22 times Healthcare Workers

1. Monitor Your Own Pulse

2. Leave Control in the OR

3. Respect Boundaries

4. Learn to Ask for Help

I care about your health

Low-tech Audience Response!

• Do you know of someone in anesthesia found to be diverting controlled medications?

• Do you know of someone who has died of a drug overdose who is in a healthcare related field?

Prevalence of Burnout in Residents and Physicians in Practice

• Burnout rates of 30 to 76% seen across 15 studies of residents: multiple years, types of programs, US and International teaching hospitals represented (Thomas, 2004)

• Similar burnout rates among physicians in practice (Chopra et al., 2004)– 46-80% moderate to high EE– 22-93% moderate to high DP– 16-79% moderate to low PA

• Lower rates of burnout among academic physicians (Tait, 2003)– 37-47% burnout in academic physicians vs. 60% burnout in physicians in private practice

Physicians in Training and Practice vs. General

Population

• Higher rates of burnout, stress• Similar to higher rates of depression• Similar rates of substance abuse• Higher rates of suicides—especially for

women

• 300 to 400 physician suicides(Center et al., 2003; Shanafelt et al., 2012)

OHSU Resident & FacultyAll OHSU and

Legacy residents and fellows

All OHSU SOM faculty (0.5 , >FTE)

Left to right: Sydney Ey, Ph.D., Dan Helfet-Hilliker, M.D., Mary Moffit, Ph.D., Mark Kinzie, M.D.

OHSU Resident and Faculty Wellness Program

How to Reach RFWP Clinicians

To schedule an appointment or get consultation re: trainee/faculty concern:

Directly email or page any of the providers listed at www.ohsu.edu/rfwp

Urgent consultation: RFWP pager 1-0975

Resident and Faculty Wellness Program

• Confidential, free coaching, counseling and medication management– Limits to Confidentiality: risk to patient safety or

danger to self or others• Private, on-site location • EMR: but not in EPIC and you can opt-out of EMR• Meeting w RFWP is not reportable to medical

board“Impairment is reportable, treatment is not”

• Schedule directly by emailing any of 3 providers • Hours: Mon-Thurs 9-7, Fri 9-5

Positive Outcomes (Ey, Moffit, Kinzie, Choi & Girard, 2013)

• 88% of OHSU residents, fellows (N = 448; 71%) knew about our program

• 87% OHSU residents, fellows “somewhat to very willing” to seek counseling

• Utilization rate (new cases per yr) from 5% to 17% in 8 yrs

• 93.9% of clients “very or mostly satisfied”

• PDs satisfied w/ referral process/consult

Barriers Still Exist (Ey, Moffit, Kinzie, Choi & Girard, 2013)

“Reaching Out” Research Aims

• IRB approved study, funded by GME• Suicide prevention among medical

residents, fellows, and SOM faculty by:– Reducing risk factors of untreated depression

and substance use, hopelessness and isolation

– Increasing protective factors of greater self-awareness, strong coping skills, increased connection, and access to effective MH treatment if needed

Stress and Depression Survey

• We invite all OHSU residents, fellows and School of Medicine faculty to participate in this important new physician wellness initiative. Please take the OHSU Stress and Depression Survey. Click on this link: https://www.ohsuwellness.org/welcome.cfm

Invitation to Take Stress and Depression Survey

User can take the Stress & Depression Survey by creating a self-assigned User ID and Password (encrypted)

The User ID is the only way user is known to our clinicians

Only aggregate data reported

Our Clinician Response &Dialogue

• User may provide an email address to be notified when our team’s response is posted or sign back on to the ISP site

• User’s email address is encrypted to protect identity, not known to anyone, including our clinical team

• Our clinician responds with feedback, resources, offer to meet in person if appropriate

Pilot with OHSU SOM Trainees/FacultyApril-June 2014

• Response rate: 23% (N=91)• 78% of OHSU users reviewed clinician response• 16% of OHSU users dialogued with clinician

• High distress: 15% • Suicidal ideation in past 2 weeks: 6%• Due to survey, sought treatment at RFWP:

12%– “realized that I needed to take better care of

myself”– “survey made it easier to come in”

Strategy to keep our team members safe

• Encourage balanced approach to life• Readily available counseling within

department and OHSU• More stringent monitoring of pharmacy

transactions and returned medications• More realistic guidelines for testing for

drug use.