A Public Heath Perspective

 Physician health should be a high priority  Physicians are surprisingly unhealthy considering our finances, our education, and sense of the importance of good health  Public health interventions can work

 Individual Impacts (morbidity and mortality)  Patient Impacts (capacity, attitude, modeling)  Physician satisfaction with life correlates highly with patient satisfaction with service and with following recommendations  Colleague Impacts (teamwork)  Community Impacts (resources, leadership)

 Smoking—Our best index, but still not zero  Preventive Interventions—Needs Work  Obesity/Nutrition—Needs work  Exercise—Limited and Conflicting data  Mood Disorders--Unknown  Substance Use—Unknown

 Current research on smoking habits of American physicians is not available  Nurses’ Study showed smoking rates of about 8% in the US in 2003  3% of a big survey of Canadian Physicians in 2009 reported smoking (Erica Frank, MD, MPH)  The low smoking rates are likely a huge factor in the better survival rates of physicians over the general population

 Once again data on most interventions is limited on American physicians  But we do know that the health care worker rate of vaccination for seasonal flu has been abysmal until very recently, with rates dropping into the 30-40% range. What does this say about other interventions— mammograms, pap smears, colonoscopies, update on tetanus ????

 A 2004 study of male physicians demonstrated that 44% of male physicians were overweight and 6% obese  Nurses Study demonstrated 28% overweight and 11% obese  8% of Canadian physicians reported being obese in 2009  While this is not as bad as the general population, it is disappointing.

 Again, no solid data for the US and contradictory data elsewhere  A 2011 study published in the British Journal of Sports Medicine found only 21% of those physicians surveyed got 30 minutes of moderate exercise 5 days a week—in other words 8/10 physicians failed this modest test of good health in Great Britain  The 2009 Canadian study found an average of 4.7 hours exercise per week, or more than expected

 1200 practicing physicians surveyed  6 in 10 doctors have considered leaving medicine  77% experience fatigue  67% experience burnout  33% depression & family discord  NOVEMBER DECEMBER 2006 THE PHYSICIAN EXECUTIVE

 The 2009 Canadian study reported that 11% of the total respondents disagreed with the statement: “If I can, I work when I am ill”. In other words, 89% agreed that they would work while ill.

 High Stress work environment—long hours, important decisions, limited support, constantly changing rules, lack of control  Trying to find balance between family and work  High expectations of self and Type A Personality  Denial  Difficulty accessing health care (no time, embarrassment, confidentiality concers)

 Pilots are required to have medical examinations on annual or even semi-annual basis, many physicians don’t have a PCP  There are long lists of exclusionary conditions that must be dealt with before pilots can fly  New “pilot-fatigue” rules were issued this year. Their new rest requirements would be the envy of many physicians

 Physicians with vulnerabilities will be unable to maintain healthy habits or seek care  This may manifest as smoking, obesity, lack of exercise, use of alcohol or drugs, disruptive behavior in the workplace or even death

 Better data collection on an on-going basis  Screening early in training and organized interventions  Education about the risks of the profession, and tools for protection  Development of Evaluation and Treatment Plan when needed (MPHP model)  On-going Careful Follow-up Contract when needed (MPHP model)

 Case management program for medical professionals affected by substance abuse or dependency  January 2012—Launch pilot project in case management for pure behavioral contracts  Success rate is high nationally—75-85%  Problems include—no health insurance support for testing, confidentiality issues, late identification of illness

 “From Awareness to Action”  October 25-27, 2012  Le Westin Montreal Hotel, Montreal, Quebec, Canada  Visit cma.ca/physicianhealth or  Call for Proposals deadline is May 7, 2012