Medicine has always been a high-reward, high-stress occupation. But with the currently challenging healthcare climate, physicians are placed under even greater burdens. From mounting fears of malpractice suits, and financial concerns—including pressure to treat more patients and the need to adapt to technological advances—physicians are under more stress than ever. This stress takes a tremendous toll on physicians’ well-being, while increasing their risk of psychiatric disorders, addiction, and stress-related medical illnesses. In addition, physicians are working longer hours, which only compounds these issues.
The American Medical Association (AMA) defines physician impairment as “any physical, mental or behavioral disorder that interferes with ability to engage safely in professional activities.” Recognition of the impaired physician began to emerge as a concern only in the 1970s, and led to the development of physician health programs (PHPs). For decades, these PHPs, such as those sponsored by state medical societies and others at the hospital level, have been vital in the identification, triage, treatment, and monitoring of physicians who may suffer from a number of maladies. Greater support and cooperation from licensing boards and hospital medical disciplinary entities have greatly assisted in this process, while a “tough love” approach that helps physicians but holds them accountable has brought these issues into the foreground where they can be openly addressed. Physicians and patients alike have been positively impacted by these efforts, as physicians’ professional engagement, the quality of care they provide, and their ability to prevent becoming overwhelmed depend, in large part, on the fulfillment they find in work.
In the past, these entities focused on the addiction itself. However, over the years the focus has expanded to providing comprehensive addiction programs specializing in treating physicians and other health care professionals in order to achieve higher abstinence rates and successful, responsible transition back to the workplace.
Unique Features of Physicians in General
The environmental factors that can impede physician well-being include the stress of high expectations; the need to make life-and-death decisions, sometimes with limited experience; and disruptive lifestyles due to demanding and inconsistent schedules.
Studies suggest that physicians tend to be compulsive perfectionists, a particular personality trait that has been shown to increase the risk for anxiety and depressive disorders, both of which are linked to addiction. Physicians also can have maladaptive tendencies that include difficulty engaging in leisure activities or taking vacations from work activities, a tendency to be satisfied with a low level of intimacy, such as the type between physician and patient, and a need to assume control of uncontrollable events.
Physicians also demonstrate a tendency to seek marital partners who are skilled at maintaining family relationships and household responsibilities, yet may have difficulty connecting on a deep emotional level with their partners because they are satisfied with the low level of intimacy they typically feel at the workplace.
With regard to the medical marriage, social status and financial stability are the rewards, but the bond often feels empty and delayed gratification is common. Future studies may explore the proposition that the combination of high levels of stress, without a commensurate level of emotional intimacy and connection, enhance the physician’s vulnerability to substance use. Moreover, it has been established that increased accessibility to drugs does increase the likelihood of abuse or addiction in physicians.
Physicians and Personality Styles
Knowledge of the common traits of professionals with addictive disorders helps to facilitate the clinician’s formulation of effective individualized treatment plans. In terms of healthcare professionals, as noted above, research studies suggest that physicians tend to be compulsive perfectionists. Maladaptive implications include difficulty engaging in leisure activities or taking vacations from work activities and problems allocating appropriate time for family functions. Difficulties in setting limits were also noted, along with guilty feelings relative to the pursuit of personal pleasure, which set up a lifestyle of “delayed gratification.” Participation in a competitive and high-profile profession may serve to mitigate long-term feelings of poor self-esteem and to please or impress an internalized parent; similarly, the “impostor phenomenon,” which occurs when high-achieving individuals question their abilities and fear that others will discover them to be frauds, also factors in the road to physicians’ addictions.
Certain specialties among healthcare professionals have demonstrated increased risk of addiction and drug of choice (see Angres, Healing the Healer, 2012). In addition to anesthesia, emergency medicine and psychiatry seem to have higher rates of drug abuse that may be impacted by the baseline personalities of these physicians.
There are any number of personality styles, features, traits and disorders in addicted professionals. Career choice, drug of choice, gender, age of addiction onset, trauma, and a host of other factors can influence personality. In addition to obsessive tendencies and the minimizing or indirect seeking of dependency needs in professional populations, one study published in the Journal of Affective Disorders suggests that physicians as well as lawyers have higher rates of dysthymic temperament and obsessive-compulsive personality traits when compared with the control group of outpatients in various other professions. Needless to say, the causes of practitioners’ distress are numerous, and range from a loss of control over their work spaces to unmanageable workloads and frequent experiences with human suffering and death.