Am I good to go? Okay. Hi, everybody. I'm Amy Harrington. I'm the Vice Chair for Ambulatory Psychiatry at UMass, and in a previous life, I was an Associate Director for the Massachusetts Physician Health Program. I left but stayed on the Clinical Advisory Committee and kind of have participated a few times in the Federation of State Physician Health Programs annual meeting and done a couple of workshops, and the last time I had been at that meeting is, I want to say it was 2019, and definitely when I was at that meeting, it was like, you know, here's a lecture on like five different drug tests to catch doctors that are doing drugs that they shouldn't be doing, and it was very focused on sort of identifying physicians that may be putting patient safety at risk, and then I went this past spring, and it was almost like some huge societal transition had happened, and the whole tone of the conference was so much different. It was much more, you know, looking at physicians as people who experience burnout and challenges. It was much more sort of focused on how these are people that have dedicated their lives, financial costs, you know, like sacrificing things in their lives to get the training to be doctors. We don't have an endless supply of doctors. We really need to make sure that we're helping people and helping them through difficult times, and it was a very positive sort of vibe, and so Rebecca Payne, who many of you may know, you're the vice president of AAAP and medical director for the South Carolina PHP, and then Mark and Paul, we said, let's put something together for AAAP and try to keep this enthusiasm moving forward. Unfortunately, Paul and Mark were both unable to be here, but we're gonna keep going, and we're gonna talk a bit about, this is sort of like a Physician Health Programs 101 with a little bit of how the emphasis on physician burnout and wellness has trickled into the physician health sphere. So none of us have any financial disclosures, and so as I said, today we wanted to talk about sort of how burnout has been a huge topic in healthcare professionals, both before and then after the COVID-19 pandemic. We wanna talk a little bit about physician health programs, the history of it, and how they're structured today. We wanna talk a little bit about how physicians as a group are unique as a patient population, and thinking about if a physician walked into your office as an addiction psychiatrist, what might you be thinking about in terms of how you would evaluate them and how you would determine the treatment, and also thinking about some of the regulatory issues that are specific to treating a physician with a substance use or mental health condition. So as we're going through this workshop, we're gonna be coming back to this case. So I just wanted to take a minute to introduce this case to you. So this is Mary Smith. She's a 43-year-old widowed female with three young children. She is coming into you with a chief complaint of depressed mood. She's been depressed since her husband passed away from cancer about 18 months ago. In terms of her psychiatric and substance use history, she has a history of obsessive-compulsive personality traits, has done a brief course of cognitive behavioral therapy in 2013, but otherwise no other treatment, no medications, has a history of migraines, fibromyalgia, and a motor vehicle accident in 2021 where she was prescribed opioid pain management for some orthopedic problems. The medications were continued by her primary care up until about three months ago when the medications were stopped. Has a family history of alcohol use disorder and a paternal grandfather. And in terms of her social history, she is working as a locum tenens anesthesiologist. So this is a case that we pulled together. It's sort of an amalgam of many cases, but is not representative of one specific case and we're not describing any one specific doctor in this. So, you know, just sort of thinking about where we are, you know, it's been sort of a perfect storm. So there was already a mental health crisis and a mental health access crisis that was going on in the United States before COVID-19 started. And I sort of love when, you know, when I'm meeting with my CEO, for example, I refer to it as like the mental health epidemic that followed the respiratory epidemic of COVID-19. I truly try to hit home that this is an epidemic. Then, you know, COVID-19 came in and it made everything worse. And it was a very much a collective traumatizing experience, especially for physicians. And then you sort of look at what's going on in our country right now, where we're dealing with social, political, and economic unrest that we haven't seen in over a hundred years. It's a very challenging time, challenging patients, challenging for everybody. And so we know that with the COVID-19 pandemic, the demands that were put on healthcare providers exacerbated an already preexisting burnout issue. In 2022, the U.S. Surgeon General put out this advisory on building a thriving health workforce, highlighting the burnout issues. Excuse me. And in some ways it was a precursor to the next slide I'm gonna talk about, but it was really focused on healthcare professionals. And I think what I sort of took away from this is this concept that we have to shift thinking about burnout from being a me problem to a we problem. So I think with physician burnout, many people, the intervention is, oh, you're burnt out. Here's a list of resources, go out and get that taken care of and then come back, as opposed to what I'd like to think that my organization is doing, which is thinking about how do we make our institution less burnoutogenic in the first place? Like how do we as an institution make it so that we're eliminating administrative burden or creating an environment where we aren't supporting physicians throwing things across the OR or that kind of behavior is just unacceptable. And really, I think we were sort of reflecting on this yesterday at the BU. We all went out to dinner and we were saying like, how lovely it is to just be connected and be around other people and how much we lost that. And we know that during COVID, healthcare workers experienced high rates of stress, anxiety, frustration, exhaustion, and isolation. Like I was even struck by, I had a family member who wanted to limit contact with me because I was a healthcare provider. And I'm like, I'm a psychiatrist. I literally am in a locked room with my door closed and I'm on Zoom, but just the fact that I was a healthcare provider, that person was like, well, I wanna be safe. So, it exacerbated those feelings of isolation. And then going from being highly valued to then feeling undervalued. Sleep loss, we know that there was increased rates of substance use that was going on during the pandemic and suicidal ideation. And then in 2023, the Surgeon General came out with the advisory about loneliness and isolation and just the effects that the isolation can have on health. And this was a quote, over four decades of research has produced robust evidence that lacking social connection, and in particular, scoring high on measures of social isolation is associated with significantly increased risk for early death from all causes. And that lacking social connection is worse than smoking 15 cigarettes a day or drinking six alcoholic drinks a day. It can be that devastating to your health. And I was thinking, I actually in May of 2020 got shingles and I remember going to my urgent care and the urgent care doc being like, you're like the fourth woman under the age of 50 with young kids, who's just the stress has made them immunocompromised. And the impact of the pandemic on our overall health and the is pretty profound. And so, sort of taking that as context, now we wanna jump into talking about the impact on physicians. And so I'm going to back up and I wanna get into the case. Sure, and so as you as the addiction psychiatrist, I'm here, I got some pens here. I know, I'm all over it. What are some things about this case that you either wanna know more about or that are jumping out at you as like things that you're noticing? Questions that you have? Yeah. I think that's a good question. And so, yeah, as we are talking with patients with her, I mentioned that her husband had passed away from cancer and had been prescribed opioid pain medications. And when her doctor stopped prescribing the pain medications, she did begin taking the pills that were left over in the house and has purchased some from some friends of hers. And yeah, is now that you mentioned it a little bit concerned about that. It was about 18 months ago. What if the doctor stopped prescribing the medication? Yeah, I sort of think that maybe he would have stopped even sooner knowing that, but was a bit, here's this poor woman whose husband just passed. She's got three young kids. She's got so much going on. The last thing I wanna do is make her life worse by taking away this medication that's helping her chronic pain. Eventually, yes, yeah. And now she's having some signs of tolerance and withdrawal and is struggling a bit and is trying to seek that out. Yeah, yeah. In this, we wanted to highlight that she's, has some family support but is in locum tenens and so is going from place to place. And so maybe she's, first of all, hasn't built up that social network that you might get if you were in one location. Also, maybe isn't in any one place long enough for people to start picking up on the fact that she's making mistakes or coming in late or, I don't think we've necessarily had a pill count go awry in this case, but certainly something that is a bit concerning. It was a taper, but it was a, you've been on this long enough, and she had been sort of asking to continue it over and over, and finally the PCP said, maybe the PCP has some oversight where their charts get audited, and if they have people on for too long, they have to justify why they're on so long. But it was tapered in a safe way, but the patient still is actively seeking it out. So, yeah. Yeah, so in this, she's denying other substance use, but, yeah, Lily. Yeah, you know, that's, I mean, and I think everybody here kinda knows that, you know, anesthesiologists are particularly at risk, very high risk, yes, and in terms of like, you know, I remember when I was in med school, and I was doing my anesthesia rotation, and the anesthesiologist gave the fentanyl, and there was still like a little bit left in the bottle, and he made a joke like, hey, you can take that if you want. It was a joke, like, I mean, you know, but it was like, it would have been very easy, like that was not part of the count, that was just like residual stuff that was in the thing, so, yeah. Yeah. I think there's a lot about this that would worry me about her ability to sustain this long-term. And yet, now here she is with three young kids, and she's the sole breadwinner. I think it's incredibly important that she be able to stay in her job and need supports that are going to help her to be successful and stay in her career. Yeah. Well, you know, I think she's got daycare. But yeah, it could be a problem if she had to go somewhere overnight. Well, let's say she lives in like Massachusetts where she can pop out to Springfield and do a locum's position there, no problems. Massachusetts is fairly small, like all the populations in Boston, but you know, you can get out to Springfield pretty easily. So. So, any other, any other things that are jumping out or questions that you have? I think, you know, sort of over the course of our evaluation, we are pretty certain that she's developing a problematic relationship with opioids, and we're concerned about that there might be an opioid use disorder, and it's on our differential. Yeah, I mean, some people might look at it as like she is feeling so bad that she took the potential risk to her career of seeking treatment for a mental health disorder, which in many states now she would have to disclose as having sought treatment for mental health problems. And the fact that you were the Ph.D. position, that... Why I'm in this as an addiction, like she walks into your office, yeah, yeah. We're not at Ph.D. quite yet, yeah. Maybe we won't get there. I don't know. We'll take the advice of the crowd. What's her insight? Did she come in really saying, I'm depressed, or is she worried about... The chief complaint was depression. That is why she is seeking treatment with you, but I'd like to think maybe she Googled and saw you were board certified in addictions, because maybe she was a little bit worried about that. So, yeah. Yeah, I was going to say, but she's like, no, no, no, no, no, no, no, no, no, no, no, Yeah. I mean, I have to imagine as an anesthesiologist, she has a pretty strong belief in the ability of medications to do very powerful things, so, yeah. Yeah, so in this, she does meet criteria for a major depressive disorder. Yeah. Well, it's, I guess, we haven't really, we didn't really decide if it was ruled out or not, but she does meet criteria for a major depressive episode right now, and certainly on digging, we believe she meets criteria for a substance use disorder. Yeah. Yeah, so she was in medical school at the time and was having some difficulty with acclimating and went to her student counseling service and, you know, got referred to CBT and said, well, okay, well, it's, you know, this isn't mental health treatment. This is just, you know, learning some skills to cope with the stresses of medical school, and that's how she kind of rationalized it. Is that where she picked up the history of depression? Yeah, you know, a lot of doctors are pretty perfectionistic. You know, we got high standards, and if we fall below them, we can feel pretty bad about ourselves and not tolerate that, so, yeah. Yeah, in fact. Yeah, this is one of those cases where I would say duloxetine's a great, it's, that's for pain, like, oh, it might also help your depression, but that might be one of those ones that she might be willing to try. But in this case, no other psych meds, but yeah, there are certainly untapped non-opioid strategies for pain management that she hasn't explored yet, so. All right. So what did you feel that was important? Well, I think that is something we're gonna need to explore in therapy. I don't think she was expecting to have to be working to support three kids, that her husband was also a physician and was making more money than her, which allowed her some flexibility, and now she's in this position where she now has full responsibility and wasn't expecting that. So what about working conditions? Working conditions, like in terms of hours. Working conditions, did she get gratified by her work? Did she get gratified by her work? Did she, like, what did she do wrong? What did her experience look like? Yeah. We didn't really come up with that, but that is a good question for us to explore. Yeah. Does she like her job? Yeah. All right, we'll do one more, and then we'll move on, so yeah. Yeah. Yeah, yeah, it seems like a major stressor, a major trigger for seeking treatment was the opioid being stopped and sort of the withdrawal and the dysthymia that she's having, and so now she's seeking treatment and sort of felt like that was the main catalyst, so. All right, I will turn things over to Rebecca. And actually, Amy, can I take the advancer? Thank you so much. Can you hear me okay with this? Okay, good. And usually I can just project and make it happen, but so as I was writing this, first of all, I was a little scared. Oh, yes, thank you. I was a little scared it was gonna bleed through, and I didn't want to damage the hotel, and then I also realized that my chicken scratch is probably not something you can see from where you're sitting, so that's a good thing for me. Hi, everyone, my name is Rebecca Payne. I am currently the medical director at the South Carolina Recovering Professional Program, and I do think as we're talking about PHPs and the intersection of addiction psychiatry, kind of thinking about how one might enter into this field, and I'll tell you a little bit about my story. So I graduated from Addiction Psychiatry Fellowship. I went to the VA for a couple years on the inpatient unit, and then went over to an academic institution, and while I was there, in the mornings, I would round on the detox units, and then in the afternoons, hustle across town to a partial hospitalization program, an intensive outpatient program, and all along, we had learners, students, residents, all that, and sitting in my office in that capacity from time to time, a healthcare provider would walk in, and I'd go, hmm, what do I do with this person? Oh, you're a nurse, hmm, okay, all right, and it really sort of would catch me aback, if you will, because I'd go, well, what do I do with this person? I knew what my reporting requirements were for my state, and then that was where it ended, right? That was it, and then, lo and behold, you get voluntold to get involved in certain things, and I thought Dr. Petrakos' talk this morning was very, I loved it because it sort of, I think, demonstrates most people's paths as people ask you, hey, you wanna do this? And you go, sure, and then you find yourself in that area, so similarly, I got voluntold to begin to evaluate some of our healthcare employees in our academic institution when some sort of issue happened. In our division, we had a wellness department, and if there was ever a sniff of a substance disorder, it was, well, call Dr. Payne, okay, and so I became involved in those, and I started doing those more and more, and began to collaborate with my forensic colleagues there, and it really gave me an appreciation for some of the nuances in managing and helping healthcare professionals, and evaluating healthcare professionals, I should say. I ended up doing a forensic fellowship and then landed here, so it's sort of my way of bringing all of these things together, but what I hope to convey to you today as we're talking about this is that physician health, addiction psychiatrists are very well-suited to help healthcare professionals and have significant roles in PHPs, so what is a PHP? You can read the definition there, and I'm gonna actually unpack each of those in some of the information in the slides as we move forward, but the confidential resources for professionals that have an impairing condition, or a potentially impairing condition. In this concept, and we actually just had an interest group and we were starting to talk about some of the history and the impetus, if you will, behind physician health programs, and that it really has its basis to some degree in 12-step work, but people began to recognize the need for physician health programs in a documented way in the 1970s, and the AMA was really the institution that said, hey, let's take a look at this. We have these doctors that are trained, some type of issue comes up, and what's happening to these folks, and what was happening is the boards didn't know what to do, right? So one of a frequent response to that, to the concern, was shut their license down, and then we'll figure it out, right? So really the idea of a physician health program, or a PHP, is as an alternate pathway. So let's find out what's actually going on, and see if this is something that we can treat or remediate in some way, and keep that person working, keep their profession. So they've been around for about 40 years. They are fairly structured, and there is typically a fast response in the event that some type of recurrence of illness or drug use is detected. And there's been a lot of developments over time. This is somewhat of an intimidating conversation for me to have, as I have Dr. Gendell sitting in the audience, who could give this presentation five times over, but there's been a lot, there have been developments over time. You know, any time you do something for decades, you're going to learn from that, right? The more experience that you have. I joke with my staff sometimes, because, you know, you get to the point where you kind of feel like you're in a rhythm, you have a handle on what's happening, and then this one particular case comes in, and you look at each other and you go, ha, what are we gonna do with that? So it's a very individualized approach, and we learn from those individuals. Every day, I could say. Also, too, the scope of PHPs has changed over time. You know, when these were conceptualized, it was addressing substance use. I think it's, you know, scopes have expanded to include mental health conditions as well, and some other conditions. And then there's conflicts. I put the word conflicts up there. There's some controversy surrounding physician help programs. Sometimes when I give this talk, I actually have a slide that just sort of directly addresses some of the controversies that exist surrounding PHPs, and you can do a quick Google search and find them all, right? So a concern about, you know, the level of care that might be recommended, a concern about conflict with evaluator or treatment facilities, and, you know, monetary involvement and relationships. And also, too, you know, Amy talked about how COVID-19 has really sort of changed, I would say, it helped us to recognize that our healthcare providers were suffering. We already knew, the story is, healthcare professionals were not well. Then COVID happened, and they became even more unwell, right? Increase in substance use, increase in mental health disorders. And so we're learning, even after the COVID-19 pandemic, how do we help our healthcare workers? Interestingly enough, as obviously, as mental health problems and substance use increase in response to, you know, either the direct or indirect effects of COVID, you would anticipate that referrals to PHPs would, what, go up or down? Up, that would be the expected response. Well, and we have some other folks here in the audience that do this work as well. You know, nationwide, the trend is actually referrals are down. And you kind of scratch your head, and you go, hmm, what's that about? Referrals are down, and I think across the board, people would agree that complexity is up. We could talk, you know, I think people have some ideas about why that took place. I would like to think on the optimistic, glass-half-full side of things, that COVID, at least in some silver-lining way, created a dialogue about seeking mental health treatment, whether that's in the general population or among healthcare providers. So maybe, perhaps, why these referrals are down is that it became more okay, less stigmatized, for a healthcare provider to go and get treatment or help before the development of an impairment. And I'm gonna talk about illness and impairment in just a moment, but maybe that's part of the reason. You know, probably, chances are, it's multifactorial. I think there's probably other reasons that aren't so positive, right? I can tell you, I came into this position in July of 2020, so I'd never had the experience of working in this group prior to COVID, but interestingly enough, when someone would be asked to refrain from work for some type of issue, we would get calls, angry calls, from human resource departments. When is this person coming back to work, okay? Why, when is this gonna happen, what do you mean? And they were desperate, because what was happening during COVID? People were leaving healthcare, right? You saw these reports every month, 3.1%, this percent, people were just leaving, and droves, and facilities were desperate to fill those, keep those slots filled. So my guess is, why are referrals down? It probably is very multifactorial, and I do know that there are some individuals that are looking into that in a more sort of systematized way, doing some research, specifically in the nursing population, about reasons for that, but that is something that we have seen. So I touched base on, oh, sorry, we'll talk about illness and impairment in a moment. Just some, I think of these as foundational building blocks for what PHPs are, and what they do. And there's several building blocks, but these are some of the most important. So we're dealing with a population that is safety-sensitive, right? This seems very obvious, but I do think that it plays into how we evaluate and how we move forward with treatment with our healthcare providers. So safety-sensitive simply means that you are responsible for the safety of yourself and other people, right? And you can consider a couple of different factors when you think about the degree of safety sensitivity of somebody's profession. So how many people they impact, or could potentially impact, depth of damage to one particular individual, and then also how much trust does the public put into that profession? So you see a couple, well, or you don't, it's a pretty small picture. So you see a couple of professions here, some are very clear. Pilots, if they're flying 300 people, that's fairly safety sensitive position, right? And they are also a highly regulated group. A nuclear engineer, I think somebody mentioned, Dr. Westreich mentioned nuclear engineers earlier this morning. They also have the potential for reaching numerous people. And even within healthcare, there's degrees of safety sensitivity. So our Dr. Smith is an anesthesiologist. That is one of the more safety sensitive positions that we have within healthcare. I'll use myself as an example. As a psychiatrist, E prescribing some medications, that's a different degree of safety sensitivity than a neurosurgeon creating a burr hole or drilling a burr hole in my cranium to relieve pressure or what have you. And we can make that same sort of extrapolation to the nursing professionals, etc. Another building block foundation for PHP, so we're dealing with individuals that have a safety sensitive profession. And these are also individuals that have an impairment, not simply an illness. There's a couple of definitions. So illness is, we know, the presence of a disease. And then the impairment is really as that illness has progressed, it has impacted your ability to do something. And we're talking about our profession here. So usually, too, if you think about how impairment develops, again, it's your illness progresses over time. There's an old statistic that I didn't put up here because I think it's from the 1990s. But it looked at the onset of problems from substances that physicians experience in the lapse of time until treatment. And the average for that was somewhere between six to seven years. And that's just the average. So obviously, some were shorter, and then some were certainly longer. And it's interesting, and some of the folks that have experience working with healthcare professionals might have some antidotes on this as well. But physicians in particular really seem to, I use the word bubble wrap. I don't know if that's an appropriate term. But they really seem to protect or bubble wrap their profession, if you will. So the life might be falling apart for their family, their finances, et cetera, but they'll draw very clear lines. And then they'll tell you about how those lines got to be blurred. For instance, since we're dealing with an anesthesiologist, they may tell you, well, early in my drinking or whatever the problem might be, I never drank on call, not once. If I was on call, I didn't drink. And then you might hear them say something to the effect of, okay, well, and then a couple years later, I started having that first drink an hour after I'm about to go off call. And then I started drinking the night before I went on to call. And so you hear that progression, that loss of control, you know, those efforts to control and inability to do so creep in. So building blocks are we're dealing with individuals that have an impairing condition and they are safety sensitive. The AMA defines impairment. You can read it there. You'll hear that phrase reasonable skill and safety quite often. And I love this list because it pretty much just throws everything, you know, at the wall and it sticks. So any type of illness can become impairing. And they actually estimate that a third of physicians, so one out of every three, if we go one, two, three, one, two, three, will have some type of impairment over the course of their career. They didn't get more specific than that. They didn't say from what. But I think that's a pretty staggering statistic or estimate rather. Okay. So there's lots of etiologies of impairment. I appreciate coming to a group like this. I don't have to convince you that comorbidities are the rule rather than the exception. Right? So this is an easy concept for this group. Sorry. The green and the green are the same color. But yeah. So I mean you can see here really any sort of etiology and often it's multifactorial. Right? That's absolute. That seems to be the most common presentation is multiple. And then we can certainly get into chicken or egg questions. I think somebody posed the depression or the opiates first. Right? And I think it's different for different people. But so oftentimes very multifactorial and very complicated. All right. So and Amy alluded to this. You know, healthcare professionals come to the table as a unique group in some way. Right? They have some factors that make them a unique population. Much as we would talk about adolescents, much as we would talk about the LGBTQ population, there are certain factors that contribute or make their development of illness and impairment perhaps a little bit different from someone else. So you can see here the development of mental health and substance use. Pre-existing personality constructs. We talked about this a little bit already. Right? So Mary has some or Dr. Smith. Sorry. Dr. Smith has a history of obsessive compulsive personality traits. Right? I'm going to pick on myself. You know, I have always considered myself somewhat of a structured organized person. Some might say I'm rigid. Right? So there's some personality characteristics that we bring to the table and we're self-selecting into healthcare profession. Right? That is also a factor. But we self-select into this and some of those traits are very helpful. You know, it kept me organized. I could create a study schedule and actually stick to it. And then some of them are not so helpful. Right? So when I get behind an hour in clinic and I'm, you know, stressing out the entire day because I'm an hour behind and my rigidity gets in the way, that's, you know, the line has been crossed. It's now not helpful. Okay? Disruption in training and work. So you think about these, I call them adult developmental milestones. Right? Becoming financially independent and I don't mean like, you know, excessively wealthy. I just mean independent. Financially, partnering with a significant other, whether you choose to parent, those issues are impacted by the fact that people have self-selected into healthcare. Right? Things are delayed often, maybe not always, but and then even after graduation and out of the training environment, the demands are still there. The long hours, the strange hours, what have you. Also too, healthcare professionals have internal and external pressure here. More than anything that I see and I'm sure people could kind of comment on this is the pressure that healthcare professionals and physicians put on themselves is excessive. It's not from outside. It seems to be primarily internally driven. Access to medication and prescribing is also a unique factor for this group. Prescribing capabilities, whether that's, you know, to oneself or for family members or individuals with, you know, with whom you do not have a doctor-patient relationship. Those factors are there. There's familiarity with medications. A lot of time people have this idea, you know, hey, I prescribe this to my patients all the time. This may be appropriate for myself. That familiarity can also sort of translate to others. I'll give you one example. There was a surgical subspecialist that came into our program and this individual was in a group of four and essentially what had been happening over years is that the individual had approached some of his partners and said, hey, I have ADHD. I took this quiz online. See, I need you to prescribe my Adderall. And they did. And it went okay until it didn't. And they, you know, started scratching their head and becoming concerned when, you know, a couple of them talked to each other and said, well, how often are you writing it? And how often are you writing it? And those types of things. So familiarity can lead to a lot of problems. I mean, we could also spend another hour on boundaries as well, but. And then there's this culture of silence, right? And by that I mean a couple of things. So obviously there's stigma still around seeking treatment. Hopefully that's diminishing for lots of different reasons. There's also this idea that doctors don't want to be wrong. So if I approach my colleague and I express a concern and I'm off base, uh-oh, did I offend that person? I don't want to be wrong. And then there's either a conscious, unconscious, or subconscious idea that, hey, if this person goes and needs treatment for several weeks and is working part-time because they need to be in an intensive outpatient program or what have you, who does that work burden fall to? Right? The group. So there's several factors that make them a unique group. And then there's all the general stuff too, right? Our hereditary exposure to adverse childhood events. All of those things play a role. Okay. So, and we're going to actually talk about this, yep, in just a minute here, but all of these factors that make these individual, these characteristics and make these individuals more unique also play into how we evaluate them, right? So asking questions about their prescribing, you know, do you prescribe for family? Do you prescribe without a doctor-patient relationship? You know, talking about their, you know, how they typically approach situations. What characteristics have been helpful to or not helpful? So there's, some of these factors play into how we both evaluate and also treatment, right? So oftentimes with healthcare providers, they might have limited insight. I put denial in quotations because we're trying to kind of shift away from those types of, that type of language, but there may not be a recognition that there's a problem. How do we support their families during this time? They're scared. The healthcare provider is scared. The families are scared, not just for finances, but what is happening down the road. How do we help you navigate if in fact your board is involved? Okay. Not every person, not every physician has a board involvement. We're going to talk about that and that pathway. What I see the most is really just this shame is so great. And how do we help people through that? How do we surround them with some support to help address that? And then also, you know, dealing with any ethical violations that may have occurred at the time of the, or around the time of the impairment. So with those things being said, we have an exercise. Let's see. How are we doing on time, Amy? Are we okay? 43 minutes. 43 minutes. Super. All right. So what we're going to ask you guys to do is look across a couple of chairs to your neighbor, maybe groups of two or three. Okay. And we want you to think about some of these questions. So what do we need to consider in this evaluation? And you guys already did some of that as we were talking about her case and what other information we would like, but also too, how do, what do we need to think about as it pertains to her profession? Is this someone you would refer to a PHP and are you mandated to report to the, to the medical board? Well, how, how, how does that articulate? So we're going to talk about it for a few minutes, five or six, and then we'll have some people sort of offer some answers up and, and then we're going to talk about PHPs in South Carolina and Massachusetts.

physician health programs

burnout

well-being

substance use

COVID-19 pandemic

mental health

supportive environment

professional stress

case study