Colorado Physician Health ProgramAnnual Report

July 2004 - June 2005

Executive Director: Sarah R. Early, PsyD

Medical Director: Michael H. Gendel, MD

The mission of Colorado Physician Health Program is to assist physicians, residents, medical students,

physician assistants and physician assistant students who may have health problems which if left untreated, could adversely effect their ability to practice medicine safely.

Page 2

Table of ContentsAnnual Report

July 2004 - June 2005

• Referral Summary Page 3• Number of New Referrals - Program History Page 4• Source of New Referrals - Year-to-Date Page 5• Primary Presenting Problem -Year-to-Date Page 6• Specialty of New Referrals - Year-to-Date Page 7• License Status of New Referrals - Year-to-Date Page 8• New Referrals – Geographical Area - Year-to-Date Page 9• Referrals & Reactivations 1993 - 2004 Page 10• Reactivations - Year-to-Date Page 11• Inactivations (Reasons/Outcome) - Year-to-Date Page 12• Participants Documentation Requests Page 13• Program Highlights Pages 14-

15• Community Outreach Page 16• Services Provided by CPHP Page 17• CPHP Board of Directors and Staff Page 18

APPENDIX• Definition of Terms Page 19

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Referral Summary July 2004 - June 2005

• New Referrals: CPHP continued to receive steady New Referrals throughout Fiscal Year 2004-05 with 216 New Referrals, representing the highest number of New Referrals for a medical license Non-Renewal Year. When compared to Fiscal Year 2002-03 (the last fiscal year that was not a BME license renewal year), CPHP experienced an actual growth of 12 cases, an increase of 6%. When compared to Fiscal Year 2003-04, CPHP experienced an actual reduction of 6 cases, a decrease of 3%. Fiscal year 2004-05 represents the second highest number of New Referrals in CPHP history!

• Caseload: The average active caseload at any given period during Fiscal Year 2004-05 was 373 clients. This represents an increase of 2% compared to Fiscal Year 2003-04 (365 active client caseload).

• Overview: Significantly, 47% of New Referrals came to CPHP voluntarily. 53% were mandatory referrals. This is a slight decrease (6%) of voluntary New Referrals when compared to Fiscal Year 2003-04 (with 53% voluntary New Referrals). Of the total New Referrals this year, 63% had an active Colorado license, 16% had a Colorado Training License, 12% were Applicants and 6% did not have a license, which included medical students, physician assistant students and out-of-state clients. CPHP served New Referral clients from 22 counties of residence throughout Colorado during Fiscal Year 2004-05.

• Referral Source: The highest single source of New Referrals was Self referrals, representing 39% of New Referrals. The second highest source of New Referrals was the BME (24%). Administration (13%) was the third highest category of referral source.

• Primary Presenting Problem of New Referrals: The three most common primary presenting problems among the New Referrals were: Substance Abuse and Psychiatric each at 21%, followed by Behavioral (20%).

• Specialty of New Referrals: Family Practice (21%) is the most frequent specialty of New Referrals, followed by Anesthesiology (15%) and Internal Medicine (14%). This representation is similar to Fiscal Year 2003-04 with the same three most frequent specialties of Internal Medicine (22%), Family Practice (17%) and Anesthesiology (13%). However, when compared to last fiscal year, this fiscal year CPHP had an increase of Family Practice physicians by 5%, an increase of Anesthesiologists by 2% and a decrease of Internal Medicine physicians by 8%.

• Reactivations: Of the 216 New Referrals, 46 were Reactivations. This represents 21% of the total New Referrals. The percentage of Reactivations continues to increase in recent years at CPHP when compared to Fiscal Year 2003-04 Reactivations (17%) and Fiscal Year 2002-03 Reactivations (14%).

• Outcome: For Fiscal Year 2004-05, CPHP inactivated 189 participants and opened 216 new cases, resulting in a net gain of 27 cases. Of 189 inactivations, 29 (27%) Declined Evaluation, 2 Relocated, 3 were Referred in Error and 3 unfortunately died; therefore, 152 clients were evaluated. Of the 152 evaluated, 143 (94%) were inactivated with an outcome considered successful and/or satisfactory.

• Total Referrals in CPHP History: Since the inception of the program in 1986, CPHP has received 2,649 referrals and has served 2,250 participants. Of 2,649 referrals, approximately 15% were referred more than once.

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Annual Number of New Referrals Program History 1986 - Present

0

50

100

150

200

250

85*-86

86-87

87*-88

88-89

89*-90

90-91

91*-92

92-93

93*-94

94-95

95*-96

96-97

97*-98

98-99

99*-00

00-01

01*-02

02-03

03*-04

04-05

• This graph shows the continued overall growth of New Referrals in the history of the program. CPHP continued to receive steady New Referrals throughout Fiscal Year 2004-05 with 216 New Referrals, representing the highest number of New Referrals for a medical license Non-Renewal Year. When compared to Fiscal Year 2002-03 (the last fiscal year that was not a BME license renewal year), CPHP experienced an actual growth of 12 cases, an increase of 6%. When compared to Fiscal Year 2003-04, CPHP experienced an actual reduction of 6 cases, a decrease of 3%. Fiscal year 2004-05 represents the second highest number of New Referrals in CPHP history! The average active caseload at any given period during Fiscal Year 2004-05 was 373 clients. This represents an increase of 2% compared to Fiscal Year 2003-04 (365 active client caseload).

* = BME License Renewal Years

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Source of New Referrals July 2004 - June 2005

Continued High Self & Voluntary Referrals

Admin13%

Peer2%

Res Prog8%

Malprac2%

BME24%

Attorney1%

Other3%

Hospital7%

Self39%

Med Sch1%

• During Fiscal Year 2004-05, the highest single source of New Referrals was Self referrals, representing 39% of New Referrals. This is a slight increase (1%) when compared to last year (38%). CPHP continues to be proud of the number of Self Referrals to the program demonstrating trust and confidence in CPHP.

• Significantly, 47% of New Referrals came to CPHP voluntarily. 53% were mandatory referrals. This is a slight decrease (6%) of voluntary New Referrals when compared to Fiscal Year 2003-04 (with 53% voluntary New Referrals). Despite this slight decrease in voluntary referrals, CPHP is proud of the high percentage of referrals that are voluntary, as this reflects the respect for the program among physicians within the state and medical community. CPHP attributes this high level of voluntary referrals to the relationship building efforts made in the community, the positive and caring approach of CPHP’s staff and provision of educational materials that normalizes physician experiences and illness. The increase in mandatory referrals appears to correlate with an increase (10%) in BME referrals from last fiscal year of 14% to this fiscal year of 24%.

• The second highest source of New Referrals was the BME (24%). Administration (13%) was the third highest category of referral source. CPHP appreciates the referrals received from the BME to assist physicians in evaluating potential health issues that may effect their ability to practice medicine safely.

• For definitions of referral source categories, see page 19.

• The pie chart on the right reflects the medical profession of CPHP clients. The majority of clients are Physicians without a resident status (67%). Residents (17%) comprise the second largest group served and Osteopathic Physicians (7%) comprise the third largest group.

Other = CPEP, Family, Friend, Tx Prov, Spouse PCP

N=216

MD67%

Other1%

DO7%

Med Stud2%

Res17%

PA 5%

PA Stud1%

Client Medical Profession

Other = DPM, DDS

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Primary Presenting Problem of New Referrals

July 2004 - June 2005

Work Stress9%

Other2%

Psychiatric21%

Psyc/Sub5%

PhysMed6%

Prof Bound2%

Sub Abuse21%

Legal7%

Career4%

Behavioral20%

Stress3%

• In an effort to better understand the relevancy of the primary presenting problem data, CPHP has removed cases that are “in process” or have not yet been assigned a primary presenting problem. Of the 216 New Referrals received during Fiscal Year 2004-05, 52 were in process at the time of this report, thus 164 were assigned a primary presenting problem.

• A primary presenting problem area which best represents the participant is identified by the clinical team following the completion of the initial intake interview. This does not mean that other problem areas are not present or being addressed with the participant at CPHP. Rather, the primary presenting problem is identified for data collection and reporting purposes.

• The three most common primary presenting problems among the 164 New Referrals were: Substance Abuse and Psychiatric each at 21%, followed by Behavioral (20%).

• Using the same methodology of data collection, this representation is similar to Fiscal Year 2003-04 with the same top three categories of Psychiatric (18%), Behavioral (16%) and Substance Abuse (12%). Noteworthy is the primary presenting problem of Substance Abuse increasing from 12% last fiscal year to 21% this fiscal year. This may be attributed to an increase of education and awareness of substance abuse issues within the medical community.

N=164

Other= Emotional, Family, License Status

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Specialty of New Referrals July 2004 – June 2005

• In an effort to reflect the true representation of specialties served, CPHP is reporting on cases where specialty information has been collected. The data on specialty is collected at the time of intake. Of the 216 New Referrals received during Fiscal Year 2004-05, 52 had not completed an initial intake session at the time of this report, thus for 164 New Referrals, specialty information had been collected.

• For Fiscal Year 2004-05 Family Practice (21%) is the most frequent specialty of New Referrals, followed by Anesthesiology (15%) and Internal Medicine (14%).

• This representation is similar to Fiscal Year 2003-04 with the same three most frequent specialties of Internal Medicine (22%), Family Practice (17%) and Anesthesiology (13%). However, when compared to last fiscal year, this fiscal year CPHP had an increase of Family Practice physicians by 5%, an increase of Anesthesiologists by 2% and a decrease of Internal Medicine physicians by 8%.

• The specialty statistics among CPHP participants are only meaningful if there is a deviation from the specialty populations of practicing physicians in Colorado. CPHP does not posses current information to determine the significance of this data.

Other = Dermatology, Gastroenterology, Neurology, Occupational Med, Otolaryngology, Pain Mgmt, Pathology, Preventive Med, Pulmonary Disease, Urology

N/A = Student

N=164

FP21%

Emergency Med1%

Ortho Surg7%

Psyc5%

Anes15%Peds

7%

Ophthal1%

OB/Gyn6%

Rad2%

N/A6%

PM&R2%

Surgery7%

Other6%

IM14%

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License Status of New Referrals July 2004 - June 2005

Active63%

None6%

Training16%

Inactive/ lapsed

2%

Other1%

Applicant12%

• This pie chart shows the medical license status of each New Referral to CPHP at the time of referral.

• Of the total New Referrals this year, 63% had an active Colorado license, 16% had a Colorado Training License, 12% were Applicants and 6% did not have a license, which included medical students, physician assistant students and out-of-state clients.

N=216

Other = Active with pract limit, Probation, Suspended

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Region Number Percent

Adams 2 1.0

Alamosa 1 .5

Arapahoe 23 14.0

Boulder 10 6.0

Broomfield+ 1 .5

Denver 50 30.5

Douglas 9 6.0

Eagle 2 1.0

Colorado Counties Served by CPHP July 2004 - June 2005

• CPHP served New Referral clients from 22 counties of residence throughout Colorado during Fiscal Year 2004-05. CPHP is pleased with the efforts to assist clients throughout the state. These results illustrate the effective promotion and utilization of CPHP services state-wide.

• The most frequent county of residence among New Referrals was Denver County at 30.5%, followed by Arapahoe County at 14% and Jefferson County at 9%.

= County Served

N

= OtherOther includes counties that contain less than 10 physicians, based on a BME listing (obtained in September 2004) of Colorado licensed physicians. These counties are grouped into one category (Other) to protect the confidentiality of clients residing in those counties. Counties in this category include: Baca, Cheyenne, Crowley, Custer, Dolores, Hinsdale, Jackson, Kiowa, Mineral, Phillips, Saguache, San Juan and Sedgwick.

Region Number Percent

El Paso 11 7.0

Grand 1 .5

Jefferson 15 9.0

La Plata 1 .5

Lake 1 .5

Larimer 4 3.0

Las Animas 1 .5

Logan 1 .5

Region Number Percent

Mesa 3 2.0

Moffat 1 .5

Montezuma 1 .5

Montrose 1 .5

Pueblo 5 3.0

Summit 1 .5

Out-of-State 19 12.0

YR 2004-05 164 100

In Process 52 -+ = Broomfield County is not indicated on this map due to recent designation as a county.

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Referrals & Reactivations1993 - 2005

110 137 143 119 130 112153 132

187 175 184 17018

21 2422 18

16

4732

29 38 4645

0

50

100

150

200

250

1993-1994

1994-1995

1995-1996

1996-1997

1997-1998

1998-1999

1999-2000

2000-2001

2001-2002

2002-2003

2003-2004

2004-2005

Referrals Reactivations

• Of the 216 New Referrals, 46 were Reactivations. This represents 21% of the total New Referrals. The percentage of Reactivations continues to increase in recent years at CPHP when compared to Fiscal Year 2003-04 Reactivations (17%) and Fiscal Year 2002-03 Reactivations (14%).

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Reactivations July 2004 - June 2005

Admin17%

Attorney4%

BME30%

Peer2%

Hospital9%

Self34%

Res Prog4%

• “Reactivation” refers to when a participant returns to CPHP after having been inactivated.

• Referral sources of reactivated clients are depicted on the left pie chart. Of 46 participants who were reactivated, 34% Self Referred. This represents a decrease when compared to Fiscal Year 2003-04 when 42% of Reactivations Self Referred.

• The second most frequent referral source among reactivated clients was the BME (30%). This is an increase of 14% when compared to last fiscal year in which BME Referrals comprised 16% of the Reactivation Sample.

• 37% of Reactivations voluntarily returned to CPHP during Fiscal Year 2004-05. There is a decrease of voluntary referral Reactivations when compared to Fiscal Year 2003-04 which had 55% voluntary Reactivations. The decrease in voluntary Reactivations appears to correlate with an increase in BME Referrals, which are mandatory.

• Primary presenting problems of reactivated clients are illustrated on the right pie chart. These statistics reflect that Reactivations most commonly present with Behavioral problems (28%), followed by Psychiatric (21%) and Legal (15%) issues. This distribution varies from Annual New Referrals (three largest categories: Psychiatric, Substance Abuse and Behavioral). The primary presenting problem of Behavioral was 8% higher for Reactivations (28%) compared to Annual New Referrals (20%). The percentage was the same (21%) for the primary presenting problem of Substance Abuse for both Reactivations and Annual New Referrals. Interestingly, the primary presenting problem of Substance Abuse was 12% less for Reactivations (9%) compared to Annual New Referrals (21%). Legal was 8% higher in Reactivations (15%) when compared to Annual New Referrals (7%).

N=46

Primary Presenting ProblemReferral Source

Sub Abuse9%

Psychiatric21%

Work Stress6%

Legal15%

Psychiatric/Sub Abuse

6%

Physical/ Medical

9%

Behavioral28%

Career6%

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228 Participants Inactivated (Reasons/Outcome)

July 2004 - June 2005

Eval Declined

15%

Relocated1%

Eval Comp35%

Referred in Error

2%

Tx Comp39%

License Status Change

4%

Deceased2%

Non-Compliance

2%

• “Inactivation” refers to when a case is closed at CPHP. Definitions of inactivation reasons are on page 19.

• For Fiscal Year 2004-05, CPHP inactivated 189 participants and opened 216 new cases, resulting in a net gain of 27 cases.

• Of 189 inactivations, 29 (15%) Declined Evaluation, 2 Relocated, 3 were Referred in Error and 3 unfortunately died; therefore, 152 clients were evaluated. Of the 152 evaluated, 143 (94%) were inactivated with an outcome considered successful and/or satisfactory. CPHP improved its high success rate in comparison to Fiscal Year 2003-04 (which was 90%). CPHP is pleased with our continued high rate of satisfactory outcomes!

• Length of Active Status at CPHP is depicted on the right pie chart. The majority of participants (61%) completed the necessary involvement with CPHP in one year or less. During Fiscal Year 2003-04, 56% of participants completed the necessary involvement with CPHP in one year or less.

N=189

0-3 Mos13%

4-6 Mos13%

7-9 Mos20%

10-12 Mos15%

1-2 Yrs19%

2-5 Yrs13%

5+ Yrs7%

Length of Active Status at CPHP

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Participants Documentation Requests July 2004 - June 2005

BME Interim/ Addendum

8%

BME Qrtly28%

Standing Status

2%Credentialing27%

One-Time Status

Request25%

BME Evaluation

10%

• CPHP processed 939 report requests during Fiscal Year 2004-05. This is consistent with Fiscal Year 2003-04 at 933 report requests.

N= 939

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Program HighlightsJuly 2004 - June 2005

• Expansion of CPHP Team: – CPHP Welcomes New CPHP Board Directors: At the May 17, 2005 Board of Directors meeting,

CPHP welcomed four new Board Directors beginning their three year term. • Stephen Dilts, MD is a retired psychiatrist, one of CPHP’s founders, and CPHP Medical

Director Emeritus. • Warren Johnson, MD serves as a family practice physician in private practice in Brighton.• Dennis O’Malley is the President of Craig Hospital in Englewood.• Larry Varner, DO works as an orthopedic surgeon through his private practice in the metro

Denver area. We are proud of the caliber of experience and talent that is represented by the newest

additions to the CPHP team. Welcome!

– CPHP hires two Associate Medical Directors: CPHP is pleased to announce Jay H. Shore, MD, and Mary Ellen Caiati, MD, as the newest Associate Medical Directors.

• Dr. Shore received his bachelor’s degree in anthropology from Macalester College and his medical and public health degrees (MD, MPH) from Tulane University School of Medicine and Public Health.  He completed an internship in psychiatry at State University of New York at Buffalo and received his general training in Psychiatry at the University of Colorado Health Sciences Center, where he currently serves as an Assistant Professor in the Department of Psychiatry.  Dr. Shore has a long-standing interest in addiction and the health issues of indigenous peoples.  He is Board Certified in Psychiatry.

• Dr. Caiati received her bachelor’s degrees in English and mechanical engineering from the University of Notre Dame. She received her medical degree from the University of Washington School of Medicine and completed an internship in community medicine and a residency in Psychiatry at the University of Colorado Health Sciences Center. Dr. Caiati serves as Staff Psychiatrist at Boulder Mental Health Center and maintains a private practice in general Psychiatry. She is Board Certified in Psychiatry.

– CPHP promotes Cae Allison, LCSW, to Director of Clinical Services: Ms. Allison joined the CPHP staff in February 2000 as a Clinician, responsible for clinical support functions in consultation with the clinical team and was promoted to Director of Clinical Services in August 2004. Ms. Allison’s recent professional experiences prior to joining CPHP were as a case manager on the Adult Protection Unit at the Jefferson County, Colorado Social Services Department and prior to that, she served for three years as the Director of Social Services at a local residential Hospice. Ms. Allison received her Master of Social Work degree from the University of Denver, and completed a Certificate in Gerontology at the University of Denver. She is licensed as a clinical social worker (LCSW) by the Colorado Board of Social Work Examiners.

• CPHP Newsletter Distributed: The Summer 2005 edition of CPHP News was mailed to all active Colorado licensed physicians and physicians assistants and various other medical entities throughout the state.  CPHP is proud of this initiative in an effort to provide the Colorado medical community with informative physician health articles and to promote CPHP’s mission and services.  Given the importance of this educational and outreach venture, we have committed to publishing CPHP News annually.  CPHP News is also available for download from our website at www.cphp.org.

• Availability of Services: In addition to CPHP providing services to Colorado licensed physicians and physician assistants, contracts exist to provide services for University of Colorado Health Sciences Center Residency Program, Medical School, and Physician Assistant Program, St. Joseph’s Residency Training Program, St. Anthony’s Residency Training Program and Red Rocks Community College Physician Assistant Program. CPHP was excited to also begin providing services to Southern Colorado Family Residency Training Program for the 2004-05 academic year. CPHP welcomed the opportunity to expand our services to serve this Pueblo-based training program.

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Program Highlights continued July 2004 - June 2005

• Federation of State Physician Health Programs (FSPHP): CPHP continued active national involvement with the FSPHP during Fiscal Year 2004-05 with CPHP Medical Director, Michael H. Gendel, MD, serving as President of this organization. As always, CPHP welcomes FSPHP meetings as a forum for education and exchange of information among state physician health programs.

– Western Region of the Federation of State Physician Health Programs (FSPHP) Annual Meeting: CPHP Medical Director, Executive Director, Director of Clinical Services and Associate Medical Director attended the Western Region of the FSPHP Annual Meeting in Albuquerque, New Mexico October 1-2, 2004. Doris C. Gundersen, MD, Associate Medical Director, and Sarah R. Early, PsyD, Executive Director, presented on the topic Women in Medicine to highlight the context and culture of gender issues in medicine, various differences and similarities between male and female physicians, and the most effective ways physician health programs can successfully work with physicians of both genders.

– International Meeting of the Federation of State Physician Health Programs (FSPHP): CPHP Board of Directors Chair, Medical Director, Executive Director, and Associate Medical Directors attended the International Meeting of the FSPHP in Chicago, Illinois October 14-16, 2004. Michael H. Gendel, M.D., Medical Director, presented on two topics: Fitness to Practice Medicine: The Roles of the Evaluating Physician and Do Data Obtained from Admissions Interviews and Resident Evaluation Predict Later Personal and Practice Problems?

– Federation of State Physician Health Programs (FSPHP) Annual Meeting: CPHP Medical Director, Executive Director and Associate Medical Directors attended the FSPHP Annual Meeting in Dallas, Texas May 9-11, 2005. Michael H. Gendel, MD and Doris C. Gundersen, MD presented Assessing the Ability to Work. Elizabeth “Libby” Stuyt, MD presented Recent Advances in the Neurobiology of Addictions with a Focus on Nicotine Research. Dr. Gendel completed his two-year term as FSPHP President at the conclusion of this meeting. Appreciation was expressed for his role as a leader in the FSPHP and the field of physician health in addition to his ambitious goals during his tenure and ultimately the maturity of the FSPHP under his leadership. Dr. Gendel concluded his term by stating his hope that the Federation will continue to grow as a diverse, scientific and professional organization which others view as a credible source of information about assisting and monitoring physicians with health problems. Susan McCall, MD, Oregon Physician Health Program Medical Director, will succeed Dr. Gendel. He will continue to serve the FSPHP as Immediate Past President. Congratulations Dr. Gendel on a successful term.

• Spirit of Medicine Fundraising Campaign: CPHP completed the annual Spirit of Medicine fundraising campaign with successful results! CPHP utilizes fundraising efforts to supplement expenses that exceed the Peer Assistance Budget. CPHP Board of Directors along with the Development Specialist and Staff work together to cultivate and extend fundraising efforts throughout the Colorado medical community. This year, CPHP hosted our first Spirit of Medicine Donors Tribute breakfast and awards presentation. CPHP hopes to continue the tradition of success for Fiscal Year 2005-06. We are thrilled with the show of support for CPHP and we plan to utilize the funds raised for continued improvement of client services and community outreach.

• Finance and Peer Assistance Budget: CPHP finished the Fiscal Year ending June 30, 2005 with a program operations Year-to-Date Net Loss of $30,078.91. Revenues, which continued to be higher than anticipated, were largely due to Fee-For-Service revenue which is comprised of evaluation fees for out-of-state-clients. Year-to-Date expenses were largely on target with Year-to-Date budget with the exception of increased expense in physician hours and purchase of unbudgeted office and computer equipment. The Net Loss was supplemented with cash reserves from the annual Spirit of Medicine fundraising campaign.

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Community Outreach Highlights July 2004 - June 2005

• CPHP Responds to Medical Community Tragedies: • On November 11, 2004, Michael H. Gendel, MD, Medical Director and Sarah R. Early, PsyD,

Executive Director visited Penrose/St. Francis Health Services in response to recent physician deaths in the Colorado Springs area. Dr. Gendel presented Depression in Times of Stress in an effort to normalize mental health issues in physicians, identification of warning signs in colleagues and utilization of CPHP as a resource. CPHP was pleased to have the opportunity to provide education to the Colorado Springs medical community in an effort to prevent future untimely physician deaths.

• On December 1, 2004, Michael S. Sturges, MD, Associate Medical Director; Sarah R. Early, PsyD, Executive Director; and Lynne Klaus, LCSW, CACIII, Clinician met with the UCHSC Neurology Residents following a recent death of a resident. The CPHP team allowed time for debriefing and processing this tragic event in addition to providing information on prevention and CPHP services. CPHP is honored to have been able to respond to the needs of this select group of residents.

• Physician Stress and Stress Management Seminars: CPHP and Copic successfully completed the third series of Physician Stress Seminars to educate physicians about the importance of stress management to attain good health. These seminars were met with overwhelming success throughout Colorado. Locations of the third series of presentations included: Canon City, Colorado Springs, Denver, Greeley, Longmont, Thornton, Vail and Wheat Ridge. CPHP and COPIC have again partnered to continue a fourth series of educational presentations for Colorado physicians. Due to the success of the Physician Stress and Stress Management Seminars, CPHP will continue to provide this informative presentation topic in addition to two other presentation topics: Professional Boundaries and Physicians in Relationships and Families. CPHP is delighted with the expansion of presentation topics to assist Colorado physicians in maintaining a healthy lifestyle.

• Unique Community Outreach Initiatives: • Women in Medicine: Colorado Permanente Medical Group representatives and CPHP

representatives, Sarah Early, Psy.D., Doris Gundersen, MD and Susan Swern collaborated to host a half day workshop addressing the issues faced by Women in Medicine. Doris C. Gundersen, MD, Associate Medical Director, presented on the History of Women in Medicine: Context and Culture. Issues such as effective communication, prioritization and balance were addressed with the overall workshop goal of presenting concrete, effective tools to utilize in everyday life. Feedback has been overwhelmingly positive and CPHP hopes to continue to provide education in this area to Colorado physicians.

• Resident Student Alliance Collaboration: CPHP was honored to be asked to participate in the Resident Student Alliance two-part series addressing the importance of a healthy marriage among physicians. Michael S. Sturges, MD, Associate Medical Director, presented Medical Marriages on March 16, 2005. On March 23rd, Sarah Early, PsyD, Executive Director and a CPHP representative participated in a panel discussion on the successes and pitfalls of medical marriages. CPHP was pleased to assist Colorado physicians early in their profession to achieve balance between family and career.

• Additional Community Presentations: In addition to the presentations on Physician Stress, CPHP conducted presentations and exhibits about CPHP and related physician health topics. Audiences included Residency Programs, Medical and Physician Assistant Programs, Medical and Professional Societies, Medical Staff Offices, Group Practices and Treatment Providers.

• Community Meetings: Referral source meetings were held with community entities including hospital administration and medical staff offices; medical and physician assistant training programs; residency programs; and affiliate organizations. Issues addressed included: how CPHP and the organization may work best together, building relationships with referral sources and improving CPHP services. Workplace consultation continues to be an important element of CPHP services. CPHP participants’ or participants’ potential workplaces seek assistance from CPHP on identifying problems, intervention strategies, how to make referrals, and documentation.

• Participant Monitoring Visits: CPHP Medical Director and Associate Medical Directors traveled to various areas in the state for client appointments outside of Metro Denver including Boulder, Fort Collins, Grand Junction and Pueblo.

Page 17

Services Provided by CPHP

• Client Services: Assessment Treatment referral Monitoring and support Family support Documentation

• Workplace and Referral Source Services: Consultation on identifying physicians who need

assistance Consultation on making referrals Workplace consultations Educational presentations

• Medical Community Services: Promote physician health awareness Educational presentations Partnership with organizations to meet special needs Develop meaningful research on physician health

• Presentation Topics: Colorado Physician Health Program services Physician stress and stress management Substance abuse, addiction Professional boundaries Self-care and physician health issues Disruptive physician management Women in medicine Physicians in relationships and families

Page 18

CPHP Board of Directors and Staff

Board of Directors Board of Directors- continued Medical Director andAssociate Medical Directors

Officers: Board Directors:

ChairBruce Wilson, MD George Dikeou, Esq Michael H. Gendel, MDMedical Director Executive Vice President Medical DirectorRocky Mountain Health Plans Copic CompaniesGrand Junction Denver Mary Ellen Caiati, MD

Associate Medical DirectorVice Chair Stephen Dilts, MD Theodore (Ted) Zerwin, MSW Retired Doris C. Gundersen, MDRetired, President CPHP Medical Director Emeritus Associate Medical DirectorArthritis Foundation, Rky Mtn Chptr DenverWestminster David A. Iverson, MD

Caroline Gellrick, MD Associate Medical DirectorSecretary Exempla Occupational Medicine Michael Michalek, MD Occupational Medicine Jay H. Shore, MDRetired Wheat Ridge Associate Medical DirectorDenver

Carol Goddard Michael S. Sturges, MDTreasurer Owner and CEO Associate Medical DirectorJames Borgstede, MD Goddard Associates Penrad Imaging Englewood Elizabeth “Libby” B. Stuyt, MDRadiology Associate Medical DirectorColorado Springs Warren Johnson, MD

Private Practice Professional and Administrative StaffDirector-at-Large Family PracticeMaureen Garrity, PhD BrightonAssociate Dean, Student Affairs Sarah R. Early, PsyDUniv. of Colo Health Science Ctr Debbie Lazarus Executive DirectorDenver Past -President

Colo. Medical Society Alliance Cae Allison, LCSWDirector-at-Large Greenwood Village Director of Clinical ServicesLarry Schafer, MD Private Practice Sandra Maloney Teresa Bajorek, CPCSOncology/Hematology Community Member Executive Assistant/Office AdministratorWheat Ridge Littleton

Karen Chipley, MBADennis O’Malley Director of FinancePresidentCraig Hospital Brian EllisEnglewood Receptionist/Program Assistant

Lawrence Varner, DO Lynne Klaus, LCSW Private Practice ClinicianOrthopedic SurgeryAurora Shari Lewinski, LPC

Clinician

Naomi Palumbo, MSWClinician

Jill Sample, BSClinical Coordinator

Natalie Van Note, LPCClinician

APPENDIX

Page 20

Definition of Terms

REFERRAL SOURCES:For the purpose of this report, the following definitions are applied:

Self: Voluntary referrals who request services on their own and there are not consequences with other entities or organizations if they do not follow through.

Board of Medical Examiners (BME): Any written referral made by the BME or required evaluations as part of the application or renewal process to Colorado

Administrative (Admin): Dept. Heads, Directors, Partners, Presidents, CEO’s (which are not part of a hospital system). For example, Vail Clinic, CFO of a Radiology group, managed care such as Kaiser Permanente

Hospital: MEC, Medical Staff Offices, Quality Management, Chief of Staff, Credentialing Committees

Resident Program (Res Prog) : Any referrals made by Residency Directors and personnel

Peer: Any MD, DO, or PA that does not fit into another category

Treatment Provider (Tx Prov): Professionals in community that provide treatment to CPHP participants

Malpractice: A malpractice company

Attorney: Referrals made by a physician’s attorney

Medical School: Any referrals made by the Medical School Faculty, administration and personnel

Physician Assistant Program: Any referrals made by a Physician Assistant School Faculty, administration and personnel

REASONS FOR INACTIVATION:Treatment Completed (Tx Comp): Client has completed the CPHP recommended treatment and/or monitoring

  Evaluation Completed (Eval Comp): Client referred for evaluation, no treatment or monitoring recommended. Used for most out of state referrals

Evaluation Declined (Eval Declined): Client referred for evaluation and refused or declined to have evaluation. Client self-referred and did not follow through with evaluation and/or cannot be located

Relocated: Client relocated, typically out of state

Client Request (Client Req): Client is self-referred or voluntarily referred for evaluation. Client does not follow through with treatment because the circumstances have changed and the client does not feel services are necessary

Declined Treatment (Declined Tx): Client declined the treatment recommendations. Typically used for self referrals who have an evaluation, treatment is recommended however client does not follow through

Other: Any reason that does not fit another category

License Denied: Client was involved with CPHP as license applicant and license was denied

Non-Compliance: Client inactivated by CPHP because client did not comply with CPHP treatment and/or monitoring recommendations. Typically used for voluntary referral with no concern for patient safety issues.

Admin Completed: Used historically for reactivations who are opened for documentation requests