Physicians Under the Influence Part I: Prevalence and Causes

Published Online: Wednesday, October 19, 2011

Over the last 30 years, medical professionals have increasingly grappled with the problem of impaired physicians, those who are unable to fulfill professional or personal responsibilities because of alcohol or drug dependency.

Identifying physicians who are impaired can be difficult since the manifestations are varied and physicians are notoriously suppressive and able to deny any suggestion of a problem. Identification is essential, however, because patient well-being may be at stake and untreated impairment may result in loss of license, health problems, and even death for the physician.

Our panel was moderated by Peter Salgo, MD, professor of anesthesiology and internal medicine at Columbia University in New York City, and included two leading authorities on the issue of impaired physicians: Ethan Bryson, MD, an associate professor of anesthesiology and psychiatry at Mount Sinai Medical Center in New York City, and Karen Miotto, MD, a clinical professor in the department of psychiatry and behavioral sciences at UCLA, where she is also chairman of the physicians’ wellness committee at the UCLA Medical Center. (Editor's Note: This transcript has been condensed and edited for clarity and length.)


Salgo: Dr. Bryson, how common a problem is substance impairment in physicians?

Bryson: Well, I think that the actual lifetime prevalence of substance use disorders in physicians is probably similar to the general population rate of about 10% to 12%. The difference is in what type of substances the physicians are abusing, and that’s a reflection of what they have access to.

Salgo: Well, first of all, I want to focus on that percent. It doesn’t sound like a lot until you think about it a little bit. That’s a large number of docs. I mean, two questions occur to me. First, as physicians, I think we all believe that we’re immune to this stuff. And, second, that, at least in our profession, we would have a lower rate than the population at large. And neither is true, is it?

Bryson: No. It’s actually surprising, I think, to anyone that thinks hard about it that the people who have more education than anyone else about the problems associated with substance abuse, misuse, and addiction are just as likely to become impaired by these substances as anyone without that education.

Salgo: I don’t want to use this word in a very clinical sense, but it just sounds crazy to me that, knowing what doctors know about these things, that they too would fall prey to this. What does that tell you about the nature of addiction in the human species?

Bryson: It’s reflective of the very real fact that this is a medical disease. Addiction is not a choice. There are certain people who may be predisposed to it. There are certain people who, when they’re exposed to these agents through whatever means, develop a dependence on them and become addicted at higher rates than other people. And physicians are just like everyone else. This sort of myth in our society that the person that becomes a physician is somehow different from anyone else is not borne out when you actually look at the numbers.

Salgo: It also implies that addiction is not subject to ratiocination.

Bryson: That is true.

Salgo: Dr. Miotto, is it more common in some specialties than others?

Miotto: Yes, it’s more common in anesthesiologists. When you look at the population of physicians with impairment, although anesthesiologists represent a small number of physicians across the country, they’re overrepresented in the population of opiate use disorders. We always talk about easy access, availability, and acceptability. And, certainly, anesthesiologists have the easiest access to narcotics.

Salgo: Well, what are the other specialties that have a problem? It can’t just be anesthesiologists.

Miotto: Oh, no. Other specialties certainly have higher rates of substance use. Psychiatric professionals tend to have higher use of benzodiazepines and opiates. Different practices have different profiles, but that may well be changing as we see more young physicians coming in, and many of them have had quite a bit of experimentation on drugs before they start their medical practice.

Bryson: I wanted to comment, if I may, about the issue of the increased prevalence in the subset of physicians, anesthesiologists. They’re definitely overrepresented in the treatment centers. But I think that one of the reasons is the agents which anesthesiologists become addicted to, like fentanyl, sufentanil, for example. They’re very potent, highly addictive narcotics with a very short half life. These are agents which grab a hold of you very tightly and very quickly, and bring you down. And, unlike someone who might have a decade’s worth of alcoholism before they end up in treatment, most people that become addicted to these drugs end up either in treatment or dead within a year.

Salgo: I heard something just while the two of you were talking which gave me pause, which is you say that there’s a younger group coming up which may, as a consequence of the society in which we live, have more experience with experimentation with drugs. Do you think this problem is more common than it was in years past? Do you think it’s going to get worse?

Bryson: I’d say absolutely. There’s a combination of factors, which are contributing to, one, an actual increased incidence of substance abuse, but also the recognition of substance abuse in general. This is a problem that many people in our society and also many physician leaders have swept under the rug for a long time. There’s not a lot of public recognition of the issue of substance abuse in the health care professional. I also wanted to address the statement that Dr. Miotto made about stress. I don’t think you’ll find anybody who says that anesthesia is not a stressful specialty. And the thing that may not be so obvious is that this is an environment that many people thrive in. In fact, there are many people who do well under stress and actually gravitate toward the fields of anesthesiology or emergency medicine not because the stress would cause them to use drugs or to self-medicate with alcohol or other agents, but because they actually thrive under those circumstances. I’ve spent the last year interviewing hundreds of people, physicians, and other health care professionals in recovery. And one of the common themes is that “Stress is not what caused me to become an addict.” And many said, “I would have become an addict had I not been an anesthesiologist or an emergency medicine physician,” and that, while it is a factor and it is associated, it’s not the primary reason why somebody becomes addicted.


This is the first part of a three-part expert discussion. To read the second part, click here.


Join the discussion on impaired physicians:

Have you encountered an impaired physician during your career?
How was the situation resolved?