Fewer Substance Use Disciplinary Actions Against Docs May Reflect Less Stigma

Disciplinary actions against U.S. physicians related to substance use have steadily declined over the last 17 years, but are still higher than those for psychological and physical impairments, a cross-sectional study found.

Of 5,032 actions against licenses from 2004 through 2020, 76.3% were primarily related to substance use, 11.5% were related to psychological impairment, and 12.2% to physical impairment, reported Lisa Rotenstein, MD, MBA, of Brigham and Women’s Hospital in Boston, and colleagues.

License actions based on substance use had the most dramatic decrease, from 5.6 in 2004 to 1.6 in 2020 per 10,000 physicians. Actions based on psychological and physical impairments had only slight decreases (from 0.8 to 0.2 actions and 0.7 to 0.2 actions per 10,000 physicians, respectively), they noted in a research letter in JAMA Health Forum.

Of note, doctors with license actions related to substance use and psychological impairment were more likely than those with physical impairment to have “indefinite” penalties versus “permanent” penalties (69.2% and 80.6% vs 58.1%), to have an emergency action taken against their license (12.0% and 20.6% vs 8.0%), and to have a greater mean number of lifetime license actions (4.5 and 3.5 vs 2.5; all P<0.001).

Though the data only show trends in license actions, “hopefully [the decrease in actions] means that we have reduced stigma to some extent and given physicians the resources they need to stay healthy and to stay in practice,” Rotenstein told MedPage Today.

Disciplinary actions for substance use often occur when a physician is impaired at work, while physical health problems that yield disciplinary actions stem from diseases that hinder a physician’s practice, such as cancer, dementia, and Parkinson’s disease. Common psychological impairments that result in disciplinary actions include depression, psychotic disorders, and any other mental health conditions that get in the way of doctors’ duties.

Even before the COVID-19 pandemic, physicians and medical students reported high rates of burnout, depression, and substance use, prompting efforts from hospitals and healthcare systems to support them. But it’s been unclear how mental health challenges are reflected in disciplinary measures.

Rotenstein and colleagues have studied depressive symptoms in medical students and burnout in attending physicians. “There has been, luckily, increased attention to physician mental health,” Rotenstein noted, citing more access to care and reduced stigma. “We wanted to understand how this ended up playing out in the most severe cases.”

Hospitals and health systems, she added, “have an important role to play in providing mental health resources,” and ensuring that providers can find the time to access them. Resources include the confidential Physician Health Programs, offered by state boards, organizations, or health institutions, which can evaluate, treat, and coordinate care and monitoring for medical professionals with mental health or substance use issues.

Licensing questions for physicians are increasingly being reworded to decrease stigma around seeking help, Rotenstein said. They might ask if a physician has ever experienced a mental health issue that impaired their ability to practice, instead of any mental health issue at all.

She noted that the decline in license actions for substance use could be a sign that physicians are getting support before a situation serious enough to warrant discipline. “I am hopeful that that means that physicians are getting treatment and attention sooner than they have in the past, and hopefully that means that they’re getting the help that they need before any of these issues need to come to the attention of state boards.”

For this study, the researchers looked at all physicians with actions against their licenses from 2004 through 2020 reported in the National Practitioner Databank (NPDB), focusing specifically on actions related to substance use, psychological health impairments, and physical health impairments. They determined the number of license actions in each category per year, and compared characteristics of doctors with license actions with those of the overall licensed U.S. physician population.

Actions that make it into the NPDB, which gathers adverse action reports and malpractice payments from state licensing or medical boards and medical malpractice payers, aren’t necessarily license suspensions or revocations, Rotenstein explained. They could also be probation periods, or conditions a medical board imposes on a physician to continue practicing, like treatment for their condition.