1. Addiction – A Tale of Two Survivors Michael Sprintz, DO Mark Baskerville, MD Anesthesiology and Perioperative Medicine July 21, 2014

2. Circa 1998

3. JAMA – December 2013

4. Substance Use Disorder
Incidence
1 in 80
will develop a
Substance Use Disorder

5. Occupational Mortality Rate
per 100,000 worker years
Commercial Fisherman 21.2
Police Officers 18.6
Truck Drivers 13.3
Firefighters 2.5
Healthcare Workers 0.7

6. 15.7
6 times Fire Fighters
22 times Healthcare Workers

7. Monitor Your Own Pulse
Leave Control in the OR
Respect Boundaries
4. Learn to Ask for Help

8. I care about your health

9. 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?

10. 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

11. 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)

12. OHSU Resident & Faculty
OHSU Resident and Faculty Wellness Program
OHSU Resident & Faculty
All OHSU and Legacy residents and fellows
All OHSU SOM faculty (0.5 , >FTE)
Started in 2004
Left to right: Sydney Ey, Ph.D., Dan Helfet-Hilliker, M.D., Mary Moffit, Ph.D., Mark Kinzie, M.D.

13. How to Reach RFWP Clinicians
To schedule an appointment or get consultation re: trainee/faculty concern: Directly or page any of the providers listed at Urgent consultation: RFWP pager

14. 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 ing any of 3 providers
Hours: Mon-Thurs 9-7, Fri 9-5
Briefly mention that we are trying to lower known barriers to physicians’ seeking help—stigma, time, confidentiality, reportability, helpfulness of counseling

15. 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

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

17. “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

18. 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:

19. 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

20. Our Clinician Response & Dialogue
User may provide an address to be notified when our team’s response is posted or sign back on to the ISP site
User’s 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

21. Pilot with OHSU SOM Trainees/Faculty April-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”

22. 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.