Some California physicians are already calling the idea "naive," "worthless," and "another unfunded mandate." But if the president of the Medical Board of California has his way, all practicing physicians in the state as well as medical school students will enroll in certified wellness programs, perhaps as a condition of licensure.
"What I want is a policy, preferably a statute, that dictates there should be wellness education that starts in medical school, so it becomes part of our culture through all the years of practice," says Richard Fantozzi, MD, a San Diego head and neck surgeon. Such a program would be evidence based, perhaps run through hospital medical executive committees as a condition for staff privileges. It would be administered by the private sector, not the medical board.
Whatever form it takes, the program would help physicians recognize the first signs of depression or burnout, abusiveness, out-of-control anger, inappropriate behavior with patients, peers or staff, serious family issues, as well as problems with substance abuse and dependence.
"Usually," he says, "all of the things that doctors eventually get in trouble for with the medical board are consequences of these unrecognized stresses."
"We want to help physicians realize signs they are going through life changes, and not be afraid to get help." No other state in the nation has such a uniform program, he says.
An eight-person board committee is studying how the education program might work, and has initiated talks with medical malpractice insurance companies about the possibility of offering discounts for the first doctors who enroll. The programs would have no disciplinary functions.
Physician groups, such as the California Medical Association, are staunchly opposed, saying such education programs would do nothing to prevent physicians with behavior problems. They favor a return to a system now discontinued in which physicians with substance abuse problems enter a confidential monitoring program while they recover from their addictions.
Fantozzi says officials from other state medical boards are exploring the idea as well, possibly replacing programs they now run for doctors whose substance abuse problems harmed patients.
"The direction Dr. Fantozzi is heading in is the right one," says Raymond Pomm, MD, medical director of the Florida Physician Health Program.
Today, Pomm says, the way we deal with physician behavior is through coercion, "and that we know doesn't work. We need to empower physicians to take responsibility for their own health, and turn around their concept of what it means to be ill."
Pomm says that it's unfortunate some physicians react so negatively to the concept. “We're talking about a change of culture that's not a negative change, but one intended to lessen stigma, and let people know it's OK to have a problem if it decreases denial so the person can get help.”
The concept of requiring physician wellness education was launched a year ago after the medical board closed down its controversial "diversion" program last June. The program was intended for "diverted" substance-abusing physicians from having their licenses disciplined into a five-year system that attempted to monitor their recovery.
But a series of reports and a state audit concluded that diversion had failed to protect patients from harm caused by enrolled physicians who were still impaired. About 250 physicians were enrolled at any time, without disclosure to patients under their care and often without limits on their practices.
The board decided it could not ethically safeguard patients while being aware that impaired physicians were continuing to practice. The needs of the physician wrongly had more priority than the needs of patients.
A $500,000 effort to correct major loopholes was unsuccessful.
The program's failure prompted Fantozzi to consider what to do next. Whatever the diversion program did or didn't do, it never tried to prevent physician behavior problems in the first place, he says.
Studies suggest that at any given point in time, 3.5% to 4% of physicians are impaired by substance abuse and another 10% are at risk of becoming so. Among California's 100,000 active physicians, "we should have had 3,500 in diversion, but we only had 250. And we know there were 10,000 to 15,000 others who are at risk," he says.