Physician Health, Physician Health Programs & the AMA

1. Physician Health, Physician Health Programs & the AMA Organization of State Medical Association Presidents June 9, 2017

2. P. Bradley Hall, M.D.DABAM, DFASAM, MROCC President Federation of State Physician Health Programs Executive Medical Director WV Medical Professionals Health Program

3. CONFLICT OF INTEREST DISCLOSURES

4. OBJECTIVES FSPHP / PHPs Historical Overview PHP Role / Interface Health and Wellbeing Continuum Potential Impairment Referrals & Outcomes Safety Sensitive Occupations

5. Historical Perspective 1953 – FSMB calls for model physician assistance programs 1973 – “The Sick Physician: Impairment by Psychiatric Disorders, Including Alcoholism and Drug Dependence” by AMA Council on Mental Health 1975 & 77’ – AMA held Physician Health Conferences 1980 – Almost all state medical societies had authorized or implemented a state PHP and PHPs were communicating. 1985 – AMA Model Physician Health Policy 1990 – Several state Physician Health Program’s organized the Federation of State Physician Health Programs

6. Historical Perspective (con’t) • 1995 – FSMB adopted policy “Report of the Ad Hoc Committee on • Physician Impairment” • 2001 – Joint Commission Standard on Physician Health • 2005 – Federation of State Physician Health Programs (FSPHP) • Guidelines http://www.fsphp.org/sites/default/files/pdfs/2005_fsphp_guidelines-master_0.pdf • 2008 – How are Addicted Physicians Treated? A National Survey of • Physician Health Programs (DuPont, et al); • Setting the Standard for Recovery: Physician Health Programs • (DuPont, et al) • Five year outcomes in a cohort study of physicians treated • for substance use disorders in the United States (BMJ) (DuPont, et • al)

7. Historical Perspective (con’t) • 2011 – American Society of Addiction Medicine 11 Policies on Licensed Professionals • with Addictive Illness • http://www.asam.org/advocacy/find-a-policy-statement/-in-Category/Categories/policy-statements/licensed-professionals-with-addictive-illness • 2011 – Joint Commission Standard “Licensed Independent Practitioner Health” MS.11.01.01 http://www.jointcommission.org/assets/1/18/MS_01_01_01.pdf • 2011 –FSMB updated “Policy on Physician Impairment” • http://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/grpol_policy-on-physician-impairment.pdf • 2013 – FSMB adopted “Report of the Special Committee on Reentry for the Ill Physician” http://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/special_committee_reentry.pdf • 2013 & beyond

8. Potentially Impaired Physician

9. FSPHP Mission To support physician health programs in improving the health of medical professionals, thereby contributing to quality patient care.

10. FSPHP Vision & Principals in Development: A society of highly effective PHP’s advancing the health of the medical community and the patients they serve. Membership:  FSPHP is dedicated to enhancing the value of membership and upholding an environment of fellowship and networking. Advocacy:  FSPHP strengthens PHPs by promoting best practices and providing guidelines, advocacy, and other resources that enhance their effectiveness.  FSPHP encourages partnership between physician health programs, regulatory boards and other appropriate components of organized medicine. Collaboration:  FSPHP fosters collaboration and engagement with other national and international medical organizations. Equality:FSPHP opposes discrimination against physicians and the medical community solely based on the presence of a particular diagnosis and/or other discriminatory factors and supports the use of PHP services in lieu of disciplinary action whenever possible.  Education: FSPHP supports education and research designed to establish best practices for the prevention, treatment and monitoring of physicians experiencing substance use disorders, mental illness, physical illness, and other potentially impairing conditions. 

11. AMA Mission To promote the art and science of medicine and the betterment of public health. Vision To enhance the delivery of care and enable physicians and health teams to partner with patients to achieve better health.

12. FSPHP Strategic Plan To address emerging trends facing Physician Health Programs, requiring more accountability, consistency and excellence, along with which comes a need for increased education programs, and research, FSPHP held a strategic retreat in 2015 outlining a 3-5 year plan of action. FSPHP increased funding is a key factor in the success of these goals.

13. FSPHP Strategic Development Areas Funding Development Accountability, Consistency & Excellence Education & Research Organizational Infrastructure

14. FSPHP Activities 2016 – FSPHP Performance Enhancement Review Guidelines 2016 – World Medical Association, Physician Wellbeing Policy 2016– AMA Model Physician Health Program Act (1985 policy revision) 2016 – FSPHP Guidelines Update (in process) 2016 – ACGME – Symposium on Physician Wellbeing 2016 – FSPHP organizational independence

15. FSPHP Collaboratives • Federation of State Medical Board & Federation of State Physician Health Program Conferences • American Society of Addiction Medicine’s Drug Testing Appropriateness Document • Federation of State Medical Board’s Burnout Task Force • Federation of State Medical Board’s Ethics and Professionalism Committee • Coalition for Physician Enhancement, CPE • American Osteopathic Association, AOA • Coalition of Physician Education, COPE • American Medical Association, AMA • ASAM Text (6th Edition) Chapter on PHPs & Physician Addiction (Paul Earley, M.D.) • Physician Mental Health and Well-Being: Research and Practice Textbook (28 authors) • FSPHP Guidelines update • California Legislation SB1177– Physician Health Program enabling legislation • The Council on Medical Education Report 1-I-16, Access to Confidential Health Services for Medical Students and Physicians, was adopted as amended at I-16 and the final recommendations are now official AMA policy (H-295.858)

16. Medical Students & Resident ACGME – Symposium on Physician Wellbeing World Medical Association, Physician Wellbeing Policy The AMA Council on Medical Education Report 1-I-16, Access to Confidential Health Services for Medical Students and Physicians, was adopted as amended at I-16 and the final recommendations are now official AMA policy (H-295.858) * Cultural change

17. AMA Physicians Health Program Act Dual Purpose Early Detection Mitigate Barriers Confidentiality / Public Safety / Discrimination Funding PHP Model Endorsement Principles of Accountability, Communication, Collaboration & Transparency

19. 2017 FSPHP Annual MeetingApril 19-22, 2017 - Worthington Renaissance Fort Worth Hotel Fort Worth, TexasPHPs Restoring Physician Satisfaction and Wellness in an Era of Burnout, Mental Illness, Addiction & Suicide • FMA – CME Provider • Objectives: • Burnout Prevention & Satisfaction in Medicine • Mental Health & Suicide Prevention • PHP Best Practices • PHP Funding Strategies • The Aging Physician Population • Guest Speakers Pending • Kurt Mosley, Vice President of Strategic Alliances for Merritt Hawkins, Staff Care, companies of AMN Healthcare, the innovator in healthcare workforce solutions. • Christine Moutier, MD, Chief Medical Officer, American Foundation for Suicide Prevention • Art Hengerer M.D., FSMB • Suzie Brown, MD, “My Life as a Guitarologist” (Cardiologist, singer songwriter) 2018 FSPHP Annual Meeting - April 24 - 28

20. OBJECTIVES FSPHP / PHPs Historical Overview PHP Role / Interface

21. What is a Physicians Health Program?and What it is NOT

22. What the WVMPHP is NOT...

23. What’s next? Refer medical professional to the WV Medical Professionals Health Program A comprehensive evaluation including collateral information will be done. A treatment plan is constructed based on the evaluation and treatment recommendations of treatment professionals. An agreement with the WVMPHP is signed. The individual is monitored throughout the agreement and provided support and documentation of compliance.

24. PHP and Board Balance SMA SMA SMA SMA PHP Licensing Board Confidentiality Public protection Illness Impairment Treatment Sanctions

25. Developing a Partnership – PHPs, Boards & SMAs Public Protection Healthy Physicians Patient Care

26. OVERLAPPING MISSIONS(Medical Boards, Physician Health Programs & State Medical Associations)

27. OBJECTIVES FSPHP / PHPs Historical Overview PHP Role / Interface Health and Wellbeing Continuum

28. Prevention **Cultural shift through education • Primary Prevention - avoid the development of disease ** • Secondary Prevention- diagnose and treat an existing disease in its early stages before significant morbidity and patient harm • Tertiary Prevention - treatments aim to reduce the negative impact of established disease by restoring function and reducing disease-related complications

29. Health and Wellbeing Issues * Professionalism/Boundaries Life / Work Balance Satisfaction Lack of joy / unhappiness Stress Distress Burnout Behavioral Health (interpersonal) Mental Health Physical Health Substance Use / Addiction Suicide

30. Individual Wellness: Key Targets Awareness Self-Care Resilience Engagement

31. Physician Wellness Shanafelt TD, Sloan JA, Haberman TM. The well being of physicians. Am Med J 2003; 114: 513–17. “Wellness goes beyond merely the absence of distress and includes being challenged, thriving, and achieving success in various aspects of personal and professional life.”

32. BurnoutAMA / Mayo Clinic – 6,880 physicians surveyed 2011 & 2014 At least one symptom of burnout increased 2011-2014 (45.5-54.4%) Work / Life balance satisfaction declined 2011-2014 (48.5-40.9%) Burnout rates higher for all specialties in 2014 Nearly a dozen specialties increased greater than 10% More prevalent when compared to the general US working population even when adjusted for age, sex, hours and educational level

33. Burnout Emotional exhaustion Loss of meaning in work Feelings of ineffectiveness Depersonalization - viewing people as objects rather than human beings Burnout impacts the quality of care physicians provide and physician turnover.

34. Courtesy: Christine Sinsky, MD

35. Burnout: Demands, Resources, Control Resources Demands Control Personal wellness interventions Workplace interventions

36. Healthy Physicians Give Better Care! Decreased medical errors Increased patient satisfaction Better treatment recommendations Increased treatment adherence Lower malpractice risk Better attitudes toward work Higher team functioning Lower turnover

37. Individual Drivers of Physician Burnout Perfectionism High achievement orientation Difficulty setting boundaries Intellectualization Delay of gratification Compartmentalization Materialism

38. Environmental Drivers of Physician Burnout Workload and time constraints Inefficiencies/frustration (EHR) Lack of autonomy/control Ineffective leadership Mission/values mismatch (loss of meaning) Culture of incivility Perception of fairness and respect Diminished rewards

39. Building Wellness into the Practice Environment Professional Practice Environment Tension Workplace Wellness Wellness System Redesign

40. Resilience The ability of an individual to respond to stress in a healthy, adaptive way such that personal goals are achieved at minimal psychological and physical costs….. the “Bounce-Back”.

41. How Do You Prevent Burnout? Accept shared responsibility for burnout Elevate personal wellness to a core professional value, starting in medical school Make wellness and satisfaction a quality outcome and incentivize it accordingly Muster the will to address burnout generators and ask for help Create opportunities for peer support and decrease isolation Nurture the brain through meditation and application of mindful practice to clinical work

42. Suicide 400 physicians

43. Suicide Protective Factors MITIGATED BY PHYSICIAN HEALTH PROGRAMS Effectiveclinical care for mental, physical, and substance abuse disorders Easyaccessto a variety of clinical interventions and support for help seeking Family and community support Support from ongoingmedical and mental health care relationships Skills in problem solving, conflict resolution, and nonviolent handling of disputes Cultural and religious beliefs that discourage suicide and support self-preservation instincts

44. An example of unhealthy cycle that healthcare professionals may experience PHPs can intervene and help at any point!

45. Stigma Illness resistant God complex Knowledge is not protective Training how and who to ask for help *Education is the key

46. Other Collaboratives National Academy of Medicine, July 14, 2017 AMA Conference on Physician Health, Oct 12-13, 2017 Coalition on Physician Education COPE

47. OBJECTIVES FSPHP / PHPs Historical Overview PHP Role / Interface Health and Wellbeing Continuum Potential Impairment Referrals & Outcomes

48. Barriers to Help Conspiracy of Silence

49. DEADLY SILENCE DENIAL – personal, family, peers, community FEAR – ill HCP, observer IGNORANCE – dz, progression, intervention, tx, legal, ethical, PHPs = solution AMBIVALENCE – “ostrichitis”, hassle, stigma MYTHS – bottom, willingness