Louis E. Baxter, Sr., M.D., DFASAM, DABAM Residents and Fellows in Recovery: How to Evaluate for Training Programs Louis E. Baxter, Sr., M.D., DFASAM, DABAM President and CEO Professional Assistance Program of NJ Director Addiction Medicine Foundation (ABAM) Assistant Clinical Professor Medicine Rutgers New Jersey Medical School Co-Director Addiction Medicine fellowship Howard University Hospital

What Are The Considerations ? What is “recovery” ? Recovery from what ? How is recovery measured? What is the quality of recovery? How long should one be in recovery before selection? What are the risks? What are the benefits? Documentation of recovery … ADA and HIPPA

What is “Recovery” ? Noun… “a return to a normal state of health, mind, or strength” SAMHSA … “a process of change through which individuals improve their health and wellness, live self-directed lives and strive to reach their full potential.” Signs of recovery: 1. I can address problems without using; 2. I have at least one person I can be completely honest with; 3. I have personal boundaries; 4. I take time to restore my energy physical and emotional

How much “recovery” time is enough? How much recovery time is sufficient before hiring? Does recovery time need to be documented? Some entities require 90 days to 6 months up to 1 or 2 years of documented recovery (licensing boards, insurance panels, and medical groups) Fellowship programs need to decide Promising candidates without documentation can be enrolled in PHPs

Recovery Status / Risks and Benefits Candidate in poor or undocumented recovery may relapse Institutional and Program liability (ADA & Malpractice Exposure) Patient care issues – competent medical care Documented recovery and ongoing monitoring of recovery provides advocacy for the candidate and Provides the program with added assurances of ongoing wellness

Assessing Recovery Status Is Candidate currently enrolled in a PHP? If so request documentation of recovery status If not, consider enrollment for assessment, documentation and advocacy of ongoing recovery Is candidate attending 12 Step Recovery or other recovery support groups, IDAA, ongoing counseling or therapy

Red Flags … No documentation of recovery or monitoring No UDS screening history No support or treatment history when a diagnosis of SUD or Psychiatric illness exists Multiple training programs and postgraduate facilities History of suspended licenses or training permits Resistance to suggestion of ongoing monitoring for advocacy

Recommendations Pre-employment UDS testing and “for cause” testing Psychiatric Clearance for those with mental illness history Enrollment in PHP for ongoing documentation and advocacy of recovery status Protects Fellows from allegations of impairment Protects the Fellowship Program Helps to assure the ongoing wellness of the Fellow selected

ADA and HIPPA Compliance ADA (reasonable accommodations) must not be violated (i.e. Discrimination because of SUD or psychiatric history) HIPPA Be sure rules and regulations are followed in collecting recovery information Signed Employment agreements that encompass employment expectations

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