Panel Grapples With Substance Abuse, Mental Health Concerns Among Physicians

A state licensing board continues to grapple with how best to address mental-health issues and substance abuse among medical students and physicians across Florida. 

A Florida Board of Medicine subcommittee last week agreed to reduce a look-back period for mental health and substance abuse on a licensure application from five years to two years. But a day later, the full Board of Medicine raised concerns that it could put the public’s health at risk.

“The main concern I have is this undermines the direction that we have to protect the citizens of Florida,” said Zachariah Zachariah, a South Florida cardiologist who will become Board of Medicine chairman next year.

The changes would apply to medical-school students and interns, which has support among many of the board members, including Zachariah.

But the changes also would apply to practicing physicians who participate in the state’s impaired-practitioner program, which worried many of the board members.

While he was sympathetic to the medical students, Zachariah said the proposal went too far when it came to practicing physicians.

“I understand the residents and interns … that has nothing to do with the doctors practicing in other jurisdictions that come to Florida,” he said. “They are comingling this to pass this rapidly. I think it’s the wrong thing to do. And I think the board should look at the issues and not pass this just because the (Florida Medical Association) wants this to happen.”

Board member Magdalena Averhoff, agreed. She worried that the changes could result in a flood of impaired practitioners heading to Florida.

“It causes me great trepidation because we will miss picking up applicants who are impaired or who need some intervention,” said Averhoff, who practices in Coral Gables. “We don’t want physicians in another state to come to Florida because they got in trouble in another state for whatever reason --- for discipline or dependence --- and then all of a sudden they end up in Florida.”

Currently, the state medical licensure application has six broadly worded questions about mental health and substance abuse.

The questions ask applicants whether they have been treated for any alcohol or drug abuse or mental health disorder or have been hospitalized for either condition in the last five years. Applicants are also asked if they have been enrolled in, required to enter into or participated in any drug or alcohol recovery program or impaired practitioner program in the last five years.

But there is concern that the broad questions can actually deter physicians from seeking treatment they need.

According to 2015 study published in the journal JAMA Psychiatry, between 300 and 400 physicians commit suicide each year. The suicide rate among men who are physicians is 1.41 times higher than for the general population of men, the study found. The risk is even higher for female physicians --- 2.27 times greater than for the general population of women.

The Florida Medical Association, which represents physicians across the state, and the Council of Florida Medical School Deans, analyzed the issue in 2014, conducting a survey of 862 medical students. Slightly more than 70 percent of the respondents indicated feeling they would benefit from psychological resources, but 60.2 percent admitted they had never utilized any services.

Moreover, the survey showed that 63 percent of those surveyed said their physical health had worsened since beginning medical school, and 60.6 percent reported their psychological health had worsened.

Under the leadership of Board of Medicine Chairman Steven Rosenberg, a West Palm Beach dermatologist, the board has been wrestling with the issue and proposed changes.

The proposal discussed last week at a meeting in Altamonte Springs would replace the six broadly written questions about treatment for substance abuse and mental-health disorders over a five-year period with three questions that cover a two-year period.

Also, medical students, residents or fellows, as well as applicants who have completed participation in the state’s impaired practitioner program could answer “no” even if they did seek treatment for those conditions over the last two years.

The proposal was approved Thursday by the Board of Medicine’s Rules and Legislative Subcommittee by a one-vote margin, allowing it to move to the full board for consideration the following day. The board agreed to approve the changes but with the stipulation that they would be revisited next year.

Mary Thomas, assistant general counsel for the Florida Medical Association, told members of the subcommittee that she recently talked to Florida State University medical school students about the state’s regulatory requirements and the operations of the Florida Board of Medicine.

“I was bombarded with questions both during my lecture and afterwards,” she said. “This is really something that they know about, are scared about. And it’s preventing them from getting help.”

Joan Younger Meek is a regional campus dean for the Florida State University College of Medicine in Orlando and associate dean for graduate medical education. She told subcommittee members that the changes would assuage the fears of medical students who need treatment for stress and anxiety but fear the stigma of that treatment.

“We are really all about prevention with these medical students and with the residents. We want them to seek services. We want them to get help,” she said, adding that the Orlando campus has three licensed clinical psychologists who work with medical students who may be suffering from anxiety or depression.

“We invest a lot of money into their training, and we want them to be successful. We want them to be able to practice. We obviously want them to be able to practice safely. What we’re really trying to prevent are those more serious mental illnesses,” Meek said.

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