By John Mac Ghlionn
The United States is grappling with the pervasive issue of addiction.
In 2022, the most recent year for which data are available, as many as 48.7 million Americans over the age of 12—or 17.3 percent of people in the age group—were diagnosed with a substance use disorder, according to the National Survey on Drug Use and Health.
Doctors are not immune to this deathly grip of addiction. Up to 10 percent of all physicians and about 15 percent of surgeons, specifically, are estimated to battle drug or alcohol dependency. This means that for every seven doctors, at least one struggles with addiction.
A recent report by American Addiction Centers, which provides addiction and mental health care at locations across the country, sheds light on the various substances used by doctors. Different medical disciplines are associated with different types of substance abuse.
Substance Abuse Among Physicians
In 2022, All Points North (APN), a chain of mind-body health treatments that specialize in mental well-being, addiction treatment, trauma therapy, and improving one’s physical health, published a rather sobering report.
Approximately 14 percent of doctors admit to consuming alcohol or a controlled substance while on duty. Of the physicians surveyed, around 21 percent revealed that they have used drugs or alcohol multiple times per day, with 17 percent acknowledging that this behavior occurs on a daily basis.
Anesthesiologists
Take anesthesiologists, for example. Many who are addicted are typically addicted to potent intravenous opioids like fentanyl and sufentanil. These drugs are often taken from the workplace, sometimes from their patients’ supplies.
Several factors contribute to the high prevalence of drug abuse among anesthesiologists, including their proximity to highly addictive substances in the operating room, the ease of diverting these drugs for personal consumption, and the stressful work environment in which they operate.
There is also evidence suggesting that exposure to aerosolized intravenous anesthetics in the workplace can sensitize the brain’s reward pathways and lead to subsequent opioid abuse among anesthesiologists, according to American Addictions Centers.
Surgeons
Except for alcohol and tobacco use, surgeons generally have lower rates of substance abuse. However, addicted surgeons, particularly female surgeons, primarily turn to alcohol for support. As the report notes, 25.6 percent of female surgeons experience alcohol abuse or dependence issues compared to 13.9 percent of male surgeons.
These rates significantly surpass the 11.2 percent prevalenceof alcohol use disorder among the general adult American population.
ER Doctors
Although they make up only 3 percent of physicians, emergency medicine physicians constitute a significant portion of physicians enrolled in Physician Health Programs for substance abuse management, ranging from 7 percent to 18 percent. Compared to other specialties, emergency medicine physicians were found to have a higher prevalence of illicit drug use, particularly cannabis use.
Given their position at the forefront of providing care, emergency medicine physicians constantly face demanding and unpredictable situations. Consequently, their profession is associated with high levels of stress. In fact, emergency medicine physicians have the highest burnout rates among all physician specialties, with 60 percent admitting to feeling burned out.
Why Is This Happening?
My intention here is not to criticize doctors, who provide an invaluable service to society. Rather, I aim to highlight that many doctors are suffering and need support.
Burnout on the Rise
Like millions of other American workers—41 percent of the working population, to be exact—doctors are experiencing burnout, according to a new MyBioSource survey of over 1,000 employed Americans.
As a recent report by The Century Foundation (TCF) warns, physician burnout will impact us all. Between 2011 and 2021, physician burnout rose by 17 percentage points. This issue, as the report’s authors note, extends beyond just the medical professionals themselves, impacting patient care and safety.
Nearly half of physicians leaving the workforce attribute burnout as a major factor. Notably, female physicians experience a burnout rate of 63 percent, higher than their male counterparts at 46 percent. This has implications for specialties like primary care and obstetrics, predominantly female positions with already high burnout rates.
Money Goals Are a Factor
Physician burnout is a complex issue influenced by various factors that negatively impact patient care. Financial pressures, corporate influence, and the trend of consolidation in health care are squeezing physicians, hindering their ability to prioritize patients, establish trust, and form relationships.
Today, the authors of the TCF report wrote, most hospitals are owned by large national chains, a stark contrast to the 1980s when only 12 percent were. Around 70 percent of physicians are employed by these corporate entities, further exacerbating the challenges faced by health care professionals.
Health care professionals now face greater pressure to meet financial targets and produce results. There is also a growing realization that corporate leaders may opt to replace physicians with other staff members to cut costs, according to TCF.
Doctors often find themselves stressed due to the amount of time they spend on electronic health records (EHRs). EHR systems can be difficult to navigate, leading to potential patient harm, and payers require extensive documentation. Although the exact amount of time physicians spend on EHRs varies, many primary care physicians dedicate approximately 16 minutes per patient visit to EHRs, according to research.
This significant time investment in EHRs adds to the stress physicians experience, especially considering the health care system’s emphasis on productivity. In fact, a survey of over 200 doctors revealed that 75 percent attributed burnout to EHRs. After all, doctors are trained to work with humans, not to spend an inordinate amount of time engaged in administrative duties.
Burnout’s Toll
Physician burnout not only affects the well-being of physicians but also directly impacts patient care and outcomes. Research suggests that physicians facing burnout are more than twice as likely to be involved in patient safety incidents as those who are not.
Burnout often leads to physicians leaving the profession early, resulting in a significant care access issue. The shortage of primary care physicians (PCPs) can result in a decrease in primary care visits and an increase in urgent care, emergency department, and specialty care visits.
Also, areas with more PCPs per capita have been associated with higher life expectancy. For instance, one study found an increase of 10 primary care physicians per 100,000 people resulted in a 51.5-day increase in life expectancy.
Last but not least, burnout contributes to higher health care costs, with physician turnover due to burnout costing the system over $260 million annually, according to TCF.
What Can Be Done?
Policymakers must intervene to disrupt the pattern of concentrated power and profit-oriented motivations that fuel physician burnout, escalating costs, and subpar results, according to TCF. Redirecting financial incentives toward promoting reliable, dignified, and respectful patient care is imperative.
One way to achieve this is by mandating transparency and accountability from every health care institution to enhance health and equity and to clarify financial arrangements supporting health care organizations. This will aid in understanding the system dynamics that exacerbate these overarching issues.
