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Reno, NV (Matsumura) Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, arnold.berry{at}emoryhealthcare.org (Berry)
To the Editor:
Collins et al. (1) recently reported data on chemical dependency in anesthesiology residents and their outcome after treatment. We would like to comment on several of the findings and recommendations made by the authors.
In their introductory remarks, the authors state that "Anesthesiology appears to be the specialty with the largest percentage of impaired physicians" citing 1987 data from Talbott et al.’s treatment program (2). More recent data suggest that the earlier finding of over-representation of anesthesiologists in treatment was not related to an increased prevalence of addiction in the specialty. McGovern et al. (3) found that of 108 physicians evaluated for substance use disorders, 4.6% were anesthesiologists, and that the specialty was not over-represented. Hughes et al. (4) assessed residents in 11 medical specialties and found that the highest rates of use occurred among emergency medicine and psychiatry residents. This information is particularly pertinent when anesthesiology residents are directed to other medical specialties after treatment for addiction.
Although the authors concluded that "redirection of rehabilitated residents into lower-risk specialties may allow a larger number to achieve successful medical careers," they do not provide data to support this. There are incomplete data on the relapse rate of the 67 residents that entered other specialties. Moreover, for the 100 residents that ultimately continued in anesthesiology training programs, 9 died of drug-related causes, but there are no long-term outcome data provided on the other 91 residents who completed anesthesia residency. It is not stated whether there were relapses in this cohort. Are there data to confirm that there was a decreased rate of relapse in residents directed to another specialty compared with those who remained in anesthesiology? It would also be interesting to know if the residents who left anesthesiology but remained in medicine entered specialties associated with increased rates of substance use disorders (4).
In the concluding paragraph, the authors state that "increased use of substance abuse screening of prospective house staff coupled with pre-employment drug testing may allow for identification of high-risk individuals." (1) They provide no data to support this. Data from the current study indicated that 18 programs routinely performed drug screening as part of the selection process and 17 required urine testing before employment. Were the rates of chemical dependency in the training programs that screened for drug use significantly less than the rate in those that did not?
Finally, the use of major opioids, a family history of chemical dependency, and coexisting psychiatric disease are the major risk factors associated with relapse in physicians with addiction (5). The presence or absence of these factors should be considered in deciding whether residents should reenter anesthesiology training. It would have been helpful if the data from the present study contained information on these factors to help us understand how recommendations were made to direct the treated residents.
References
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