Richard Payerchin

One out of seven physicians admitted consuming alcohol or controlled substances while working to cope with occupational stresses, according to a new survey.

The finding was derived from the study “State of Mental Health: American Healthcare Workers Report,” which was commissioned by Edwards, Colorado-based All Points North (APN), a recovery and rehabilitation center that specializes in treating health care workers. The survey of 1000 health care workers found that 21% of physicians—more than 1 in 5—consumed alcohol or controlled substances multiple times a day and 17% reported using at least once a day.

The results indicate “high levels of substance abuse, an acute mental health crisis, and stigma within the healthcare industry,” APN founder and CEO Noah Nordheimer said in the report.

The survey, which was conducted in July 2022, found 1 in 5 (20%) respondents had checked into a rehab or detox facility in the prior 3 months, but 14% said they did not want to admit they had a problem. Reasons for not seeking help included being overworked and not having the time (32%), concern that colleagues or family would judge them (23%), fear of getting their license revoked (23%); and not knowing where to begin and thinking the system is too difficult to navigate (20%).

The study found a difference between men and women, with 58% of male health care workers reporting they were at their breaking point or were looking for a new job because of stress, burnout, and trauma, compared with 45% of women. Male health care workers reported struggling with substance misuse more than their female counterparts. Men were more likely to use their positions in health care to acquire controlled substances than women (21% versus 4%).

Men also were more likely to consume alcohol or controlled substances while at work (18% versus 4% of women) and men were more likely to consume alcohol or controlled substances up to 12 hours before their shifts (44% versus 17% of women).

Health care experts generally agreed workers were facing dangerous levels of burnout before COVID-19 spread, but the pandemic made things worse. As such, 40% of workers said they felt anxiety or dread about going to work, 49% said they were at their breaking point or looking for new work because of job stress and trauma, and 64% said the US Supreme Court decision overturning the Roe v Wade abortion rights case increased their stress levels or caused them to feel betrayed.

“The wellbeing and mental health of health care workers has been dramatically impacted by the pandemic, with many of them seeing more pain and death than ever before,” Nordheimer said in a news release. “This frequency and intensity of exposure is causing an unprecedented amount of trauma and stress, leading to high levels of burnout. The behavioral health care industry has been slow to innovate to meet the growing need for mental health care, oftentimes treating it as an accessory to health care. We must put mental health on par with physical health and make it a basic human right, an indicator of overall health, and an industry standard.”

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"We must put mental health on par with physical health and make it a basic human right, an indicator of overall health, and an industry standard.”

Survey Finds 1 in 7 Physicians Uses Alcohol or Drugs on the Job to Cope With Stress

locations and vulnerable communities across the United States could lead to disruptions in care for patients in times of disaster, according to a new study.

 The research is a result of collaboration across the 

Healthy Regions & Policies Lab at the Center for Spatial Data Science

 and natural disasters, such as tornados, hurricanes, and wildfires, could disrupt access to buprenorphine, methadone, and extended-release naltrexone—all medications for opioid use disorder (MOUDs), lead study author Paul Joudrey, MD, MPH, said in a press release.

 Joudrey is assistant professor of medicine and a Yale Drug Use, Addiction, and HIV Research scholar at Yale School of Medicine in New Haven, Connecticut.

“In plain terms, we are not placing enough services in communities that are more vulnerable to disasters and pandemics,” Joudrey further explained. “If a disaster disrupts medication services, people living within these communities are less likely to receive treatment.”

This mismatch between community vulnerability during disaster and the availability of services was the worst for vulnerable suburban communities—a particularly unique finding, Joudrey added. “We also found that in rural communities, because the availability of services was just bad all around, there was no association between vulnerability and access to medications.”

The study compared treatment facility locations with residents’ social vulnerability across 32,434 zip codes in the United States. The social vulnerability index measured 4 issues: socioeconomic status, household composition and disabilities, racial and ethnic minority status and language, and housing type and transportation.

The investigators found that “zip codes with greater

did not have greater geographic access to each of the 3 MOUDs, showing the degree to which the United States falls short of ensuring equitable access to all MOUDs, especially during natural disasters.”

In addition, almost 25% of the US continental population lives without access to the medications within a 30-minute drive. The study authors put it in perspective: “Drive times were significantly longer for methadone and extended-release naltrexone relative to dialysis centers, despite the prevalence of OUD being greater than that of ESKD [end-stage kidney disease],” the authors wrote, noting their results were consistent with the emerging literature on these “opioid treatment deserts.”

Sadly, the study findings confirm what has been reported in recent natural disasters.

, Hurricane Sandy, and Hurricane Maria showed that part of the deaths that occur following disasters such as those are because people’s health services were disrupted,” noted coauthor Emily Wang, MD, professor of medicine and of public health and director of the SEICHE Center for Health and Justice. “Our results show that preparedness has too long been only a practice for the middle and upper class. We need to think more deliberately about how preparedness for hurricanes and for COVID-19 includes those placed at highest risk.”

The authors called for MOUD policy and delivery innovations “to address urban-rural inequities and better match the location of services to communities with greater social vulnerability to prevent inequities in opioid overdose deaths during future disasters.”

1. Joudrey PJ, Kolak M, Lin Q, Paykin S, Anguiano V Jr, Wang EA. 

Assessment of community-level vulnerability and access to medications for opioid use disorder

2. Parry J. Disasters could disrupt care for opioid use disorder in most vulnerable communities. News release. Yale School of Medicine. April 19, 2022. Accessed April 27, 2022. 

https://medicine.yale.edu/news-article/disasters-could-disrupt-care-for-opioid-use-disorder-in-most-vulnerable-communities/

Treatment deserts are adding fuel to the fire of the opioid crisis.

Opioid Treatment “Mismatch” Threatens Vulnerable Communities 

According to the Physicians Foundation’s 2022 Survey of America’s Physicians, 8 in 10 physicians believe the United States cannot improve health outcomes or reduce health care costs without addressing social factors that affect patient health. Furthermore, although they are interested in addressing social drivers of health (SDOH) for patients, 61% of the 1502 surveyed physicians said they do not have the time or ability to do so effectively. The February 2022 survey examined the current impact of SDOH on physician practice, physician well-being, and their patients, as well as possible solutions needed to address the social factors.

“Over the course of the COVID-19 pandemic, there is no question that physicians and patients have all been impacted, some worse than others. Part of what drives the scale of that impact is SDOH,” Physicians Foundation CEO Robert Seligson said in a news release. “The desire from physicians to properly address the SDOH is there. We need take the initiative to make changes, like screening patients to identify social needs and creating financial incentives to support physicians in addressing their patients’ unique needs.”

Also known as social determinants of health, SDOH include factors such socioeconomic status, education, neighborhood and physical environment, employment, nutrition and food security, health care access, and social support networks.

The survey highlighted the resulting frustration of not being able to address SDOH for their patients. “[It] isn’t for lack of trying or effort—physicians face many barriers when addressing SDOH,” the Physicians Foundation report said. For instance, along with limited time, 84% of physicians said they have an insufficient workforce to navigate patients to community SDOH resources. Similarly, although there are some helpful resources to navigate SDOH factors, 77% of physicians reported community resources were not available, inadequate, or difficult to access, and 77% said there is inadequate information on how to access community resources.

The impact of SDOH challenges is very real, and not just for patients. More than half the physicians reported the challenges cause them stress on a daily or weekly basis. They cited factors such as existing payer reporting requirements taking time away from discussing patients SDOH (63%) and lack of reimbursement for screening or addressing SDOH (57%).

To make addressing SDOH easier for clinicians, the survey identified multiple policy steps that could improve patient health outcomes while ensuring high-quality, cost-efficient care. The top strategies were reimbursing physician-directed efforts to address SDOH (86%), incentivizing payers to invest in availability and quality of community resources to address patients’ SDOH (84%), and providing greater flexibility for Medicare Advantage to reimburse for addressing SDOH (81%).

“In 2021, The Physicians Foundation submitted the first-ever SDOH measures to Centers for Medicare and Medicaid Services (CMS), which are currently under consideration to be included in federal payment programs,” Seligson said in the news release. “If adopted, these measures might potentially impact reimbursements for physicians, as well as address SDOH in how our country pays for and delivers care to improve patient health.” ❒

8 in 10 physicians believe the United States cannot improve health outcomes or reduce health care costs without addressing social factors that affect patient health. 

Richard Payerchin

Articles

Survey Finds 1 in 7 Physicians Uses Alcohol or Drugs on the Job to Cope With Stress

Opioid Treatment “Mismatch” Threatens Vulnerable Communities

Physicians Point to SDOH as Area of Improvement for Health Care