colorado physician health program annual report july 1, 2008 through june 30, 2009 by sarah r....
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Colorado Physician Colorado Physician Health ProgramHealth Program
Annual reportAnnual reportJuly 1, 2008 through June 30, 2009
by
Sarah R. Early, PsyD, Executive Director
Michael H. Gendel, MD, Medical Director
Colorado Physician Health Program
The mission of Colorado Physician Health Program is to assist physicians, residents, medical students,
physician assistants and physician assistant students who may have health problems which if left
untreated, could adversely affect their ability to practice medicine safely.
Colorado Physician Health Program
Program HighlightsProgram Highlights July 1, 2008 through June 30, 2009
Board of Directors2008 – 2009
ChairStephen Dilts, MD
Vice-ChairJames Borgstede, MD
SecretaryCaroline M. Gellrick, MD
TreasurerLarry A. Schafer, MD
Director-At-LargeBruce H. Wilson, MD
Director- At- LargeMaureen J. Garrity, PhD
Michael Van Buren Calvin, PA
Thomas G. Currigan, Jr.
George D. Dikeou, Esq
John H. Genrich, MD
Alfred D. Gilchrist
Debbie Lazarus
Michael Michalek, MD
Lawrence Varner, DO
2
•New CPHP Medical Director: CPHP Board of Directors is pleased to announce Doris C. Gundersen, MD, as Medical Director effective July 1, 2009. After a nationwide search, Dr. Gundersen was selected to succeed Michael H. Gendel, MD, who served in this role for ten years. Dr. Gundersen has served as CPHP Associate Medical Director since 2000. For a complete biography please visit www.cphp.org. Dr. Gendel will remain active in the physician health field and will assume the role of Medical Director Emeritus at CPHP. He plans to continue to work with CPHP for the next several years.
•Patient Safety Committee Formation: On February 17, 2009, CPHP Board of Directors created a Patient Safety Advisory Committee. This committee consists of several members of the medical community active in patient safety initiatives. The committee members include Patty Skolnik, Director for the Colorado Citizens for Accountability, Judy Ham, CEO of Cerebral Palsy of Colorado and Edward Dauer, Esq. with the Colorado Patient Safety Coalition. CPHP utilizes this committee to address issues regarding public protection and to provide a forum of objective discussion on CPHP’s policies and procedures in regard to patient safety. CPHP is very pleased of this addition to provide comprehensive, well-considered services to ensure safety to all of Colorado. On June 17, 2009, CPHP representative Doris C. Gundersen, MD, Associate Medical Director, and Ms. Skolnick, attended the Citizen Advocacy Center Annual Meeting in San Francisco, CA. Several members of the Federation of State Physician Health Programs also attended to impart the importance of physician health programs in enhancing patient safety as well as to learn the patient safety issues that are currently being addressed. CPHP is glad to be a part of these essential discussions.
•Spirit of Medicine Campaign: CPHP completed the annual Spirit of Medicine fundraising campaign with successful results! CPHP utilizes fundraising to supplement expenses that exceed the Peer Assistance Budget. The Fundraising Committee led by Board Director Tom Currigan, Jr, coordinates and directs the efforts of this campaign. We appreciate all of our generous contributors and especially want to recognize our donors who provided gifts of $5,000 or more:
•Centura Health•St. Mary’s Hospital and Medical Center•The Medical Center of Aurora•Colorado Permanente Medical Group (CPMG) – We extend special appreciation to CPMG as a charter member of the LivingWell Giving Society•Valley View Hospital – We would like to express our appreciation for their membership as the newest member of the LivingWell Giving Society
All donors are recognized on CPHP website, www.cphp.org, from 2007-2008 campaign.
•CPHP Newsletter Distributed: The Summer 2009 edition of CPHP News was mailed to all active Colorado licensed physicians and physicians assistants and various other medical entities throughout the state. CPHP Education and Outreach Committee chaired by Board Director Mike Calvin, PA, directed this publication effort. CPHP is proud of this initiative in an effort to provide the Colorado medical community with informative physician health articles and to promote CPHP’s mission and services. Given the importance of this educational and outreach venture, we are committed to publishing CPHP News annually. CPHP News is also available for download from our website at www.cphp.org.
Colorado Physician Health ProgramNational/international research and conferencesNational/international research and conferences
July 1, 2008 through June 30, 2009
Medical/Associate Directors
Medical Director
Michael H. Gendel, MD
Associate Medical Directors
Mary Ellen Caiati, MD
Doris C. Gundersen, MD
Scott H. Humphreys, MD
Jay H. Shore, MD
Michael S. Sturges, MD
Elizabeth Stuyt, MD
Staff
Executive Director
Sarah R. Early, Psy.D
Director of Clinical Services
Cae Allison, LCSW
Director of Finance
Karen Chipley, MBA
Receptionist
Megan Curry
Clinicians
Lynne Klaus, LCSW, CACIII
Christine Lewis, MA, EdS, LPC
Sally Moody, MSW, LCSW
Compliance Coordinator
Joyce Muniz
Executive Assistant
Amanda Parry
Administrative Assistant
Tracy Sue Walters
Developmental Specialist
Todd Weiss
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CPHP prioritizes physician health research and interaction among the national and international community of physician health practitioners to promote best treatment practices for physicians and enhance public protection. All research efforts and conferences attended out of state are compensated through CPHP fundraising efforts. No Peer Assistance Funds are utilized for these activities.
•Kaiser Permanente Grant supported National Research Meeting: CPHP hosted a National Research Meeting for Physician Health Researchers on April 17, 2009 in Denver, thanks to the generous support from Kaiser Permanente. Researchers prominent in the field of physician health across North America attended. The purpose of the meeting was to develop coordinated national research projects to scientifically evaluate physician health matters. The efforts put forth by this conference will ultimately inform others through publication of best practices and to guide public policy. CPHP extends appreciation to Kaiser Permanente for supporting this research. •Publications:
•Elizabeth Stuyt, MD, Doris C. Gundersen, Jay H. Shore, Elizabeth Brooks, and Michael H. Gendel published “Tobacco Use by Physicians in a Physician Health Program, Implications for Treatment and Monitoring” in the March 2, 2009 issue of American Journal of Addiction. Dr. Stuyt’s spearheaded this study and her interest in tobacco use by impaired physicians has been a driving campaign across the country to examine the link between tobacco and sustained recovery. In fact her research and advocacy efforts have prompted several national physician inpatient treatment center to go tobacco-free. •Dr. Gendel, along with four other physician health authors published “How are Addicted Physicians Treated? A National Survey of Physician Health Programs” in the July 2009 edition of the Journal of Substance Abuse Treatment. This article educates as to the various treatment practices and success of addicted physicians monitored by physician health programs.
•Physician Health Conferences:•International Conference on Doctor’s Health: CPHP Medical Director, Executive Director, and Associate Medical Directors attended the International Conference on Doctor’s Health in London, England November 17-19, 2008. CPHP provided the following research presentations:
•“Tobacco Use by Physicians in a Physician Health Program, Implications for Treatment and Monitoring” – Authors: Libby Stuyt, Doris Gundersen, Jay Shore, Elizabeth Brooks and Michael Gendel•“Physician Boundary Issues in a Physician Health Program: A 19-Year Review” – Authors: Jay Shore, Elizabeth Brooks and Michael Gendel •“Blueprint Project, Colorado Site: A study of physicians with substance use disorders followed by the Colorado Physician Health Program” - Authors: Michael Gendel, Jay Shore and Elizabeth Brooks •“Gender Differences and Predictors of Reactivation at a Physician Health Program, Implications for Outreach and Intervention” – Authors: Nahid Hotchkiss and Sarah Early
•Western Region of the Federation of State Physician Health Programs (FSPHP) Annual Meeting: CPHP Medical Director and Associate Medical Directors attended the Western Region of the FSPHP Annual Meeting in Seattle, WA September 4-6, 2008. Associate Medical Director, Elizabeth Stuyt, MD provided a presentation on the topic “Tobacco Use by Physicians in a Physician Health Program, Implications for Treatment and Monitoring.” •Federation of State Physician Health Programs (FSPHP) and CPHP Involvement: CPHP Medical Director, Associate Medical Directors and Executive Director attended the FSPHP Annual Meeting in New Orleans, LA from April 27-30, 2009. Doris C. Gundersen, MD, Associate Medical Director presented on “Research Projects & Future Directions.”
We welcomed the opportunity to learn about physician health research and activities from around the world at these conferences.
Colorado Physician Health Program
New referral HighlightsNew referral Highlights July 1, 2008 through June 30, 2009
CPHP received 318 New Referrals in the Fiscal Year 2008-2009! This is the largest number of annual New Referrals in CPHP history! In Fiscal Year 2007-2008, CPHP received 276 referrals. This shows a 15% increase in New Referrals.
The average active caseload at any given period during this quarter was 465 participants. This represents a 2% increase from the Fiscal Year 2007-2008 which had 457 active participants at any given time.
Of the 318 New Referrals in the Fiscal Year 2008-2009, 53% were voluntary and 47% were mandatory.
25% of the New Referrals (N=80) that came to CPHP are able to utilize the Safe Haven Provision on medical licensure application/reapplication.
Yearly Comparison of New Referrals to the CPHP 1986-Present
4
9%
7%
14%
3%
65%
2%
0 50 100 150 200 250
Medical
PA
Training
Applicant
OOS
Student
N=318
Licensure of New Referrals
Of the total New Referrals this year, 77% had active Colorado Medical Licensure. The
breakdown of licensure is as follows; Medical license 65%, PA license 3%, Training License
14%, Applicant for Colorado licensure 7%, Out of State 2% and Medical or PA Students 9%.
0
50
100
150
200
250
300
350
85*-86
86-87
87*-88
88-89
89*-90
90-91
91*-92
92-93
93*-94
94-95
95*-96
96-97
97*-98
98-99
99*-00
00-01
01*-02
02-03
03*-04
04-05
05*-06
06-07
07*-08
08-09
* = BME License Renewal Years
Colorado Physician Health Program
Referral SpecificationsReferral Specifications July 1, 2008 through June 30, 2009
3%
.5%
.5%
7%
9%
26%
1.5%
6%
4%
34%
8%
.5%
0 20 40 60 80 100 120
Administration
BME
Family
Hospital
Proactive
Medical School
Self
Residency Program
PA Program
Peer
Treatment Provider
Other
1%
.5%
.5%
1.5%
1.75%
4.5%
2%
7%
6.25%
11%
24%
7%
16%
2%
13%
2%
0 10 20 30 40 50 60
Stress
Behavioral
Family
DUI/DWAI
Physical/Medical
Psychiatric
Legal
Work Stress
Substance Abuse
Psychiatric/Substance
Professional Boundaries
Domestic Violence
Career
Emotional
Financial
Other
The highest single source of New Referrals for the Fiscal Year 2008-2009 were Self at 34%. The second highest source of New Referrals was the BME at 26%. CPHP continues to be proud of the number of Self Referrals to the program demonstrating trust and confidence in CPHP.
75 out of the 318 New Referrals were “reactivated” thus, 24% of New Referrals were previously seen at CPHP.
A Primary Presenting Problem area which best represents the participant is identified by the clinical
team following the completion of the initial intake interview. In an effort to better understand the
relevancy of this data, CPHP has removed cases that are “in process” or have not yet been assigned
a primary presenting problem. Of the 318 New Referrals in the Fiscal Year 2008-2009, 94 were in
process at the time of this report, thus 224 were assigned a primary presenting problem.
The majority of New Referrals presented with a psychiatric problem (24%), followed by a
DUI/DWAI (16%), and lastly a behavioral problem (13%).
In an effort to reflect the true representation of specialties served, CPHP is reporting on cases where specialty
information has been collected at the time of intake. Of the 318 New Referrals in the Fiscal Year 2008-2009, 94 had not completed an initial intake session at the time of
this report, thus for 224 New Referrals, specialty information had been collected.
For the Fiscal Year 2008-2009, there was a wide variety of specialties represented. The most frequently seen specialty at CPHP was Family Practice and Internal
Medicine both at 16%.
Sources of New Referrals
Primary Presenting Problem New Referrals
Specialty of New Referrals
N=318
N=224
N=224
34% were Female and 66% were Male (N=224).
Gender of New Referrals
N/A = Student or PAOther = Allergy/Immunology, Hematology/Oncology, Neurology, Ophthalmology, Orthopedics, Otolaryngology, Physical Medicine and Rehabilitation, Podiatry, and Spinal Cord Injury Other Surgery = Plastic Surgery, Neurological Surgery, and Thoracic Surgery. 5
Pathology3%
Radiology5.5%
Psychiatry3%
Other surgery3%
Other6%General Surgery
4%
Pediatrics7%
Orthopedic Surgery
4% OB/GYN7%
N/A10%
Internal Medicine
16%
Family Practice16%
Emergency Medicine
5.5%
Anesthesiology10%
Colorado Physician Health Program
Inactivations and COUNTIES SERVEDInactivations and COUNTIES SERVED July 1, 2008 through June 30, 2009
Deceased 1%
Rescinded Order
1%Non-Compliance
3%
Evaluation Imcomplete
1%Monitoring Complete
30%
Monitoring Declined
6%
Other1%
Referral Declined
9%
Application Withdrawn
1%
Consultation Complete
5%
Evaluation Complete
32%
Evaluation Declined
7%
Relocated4%
“Inactivation” refers to when a case is closed at CPHP. During the Fiscal Year 2008-2009 there were 312 cases inactivated. Of these 312 inactivations, 27 referrals were declined, 2 did not complete an evaluations, 3 withdrew their BME application, 22 declined evaluations, 14 completed consultation, 2 had their BME order rescinded, 12 relocated, 3 categorized as “Other”, and 2 unfortunately died therefore, 225 were evaluated. Of the 225 evaluated, 197 (88%) were inactivated with an outcome considered to be successful and/or satisfactory.
Inactivations
N=312
RegionRegion NumberNumber PercentPercent
Adams 15 7%
Arapahoe 25 11%
Boulder 23 10%
Broomfield 4 2%
Clear Creek 1 .5%
Denver 66 30%
Douglas 12 5%
El Paso 19 9%
Fremont 1 .5%
Garfield 1 .5%
Jefferson 15 7%
La Plata 1 .5%
Of the 224 New Referrals seen for a full initial evaluation, regional data has been collected. During the Fiscal Year 2008-2009 New Referrals resided in 23 Colorado counties.
Counties that contain less than 10 physicians, based on a BME listing of Colorado licensed physicians (obtained in September 2008) are grouped into one category (Other) to protect the confidentiality of clients residing in those counties. Counties in this category include: Archuleta, Baca, Cheyenne, Conejos, Crowley, Custer, Dolores, Hinsdale, Jackson, Kiowa, Mineral, Park, Phillips, Rio Blanco, Saguache, San Juan and Sedgwick.
Counties Served
6
Length of Active Status at CPHP is depicted to the right. The majority of participants (67%) completed the necessary involvement with CPHP in one year or less. Last fiscal year 2007-2008, 63% of participants completed the necessary involvement of CPHP in one year or less.
Length of Active Status
1-2 Years15%
2-3 Years8%
3-4 Years3%
4-5 years1% 5+ Years
6%
0-3 Months16%
4-6 Months20.5%
7-9 Months20%
10-12 Months10.5%
N=312
RegionRegion NumberNumber PercentPercent
Larimer 7 3%
Logan 1 .5%
Mesa 2 .5%
Montezuma 1 .5%
Morgan 1 .5%
Otero 1 .5%
Other 1 .5%
Out of State 15 7%
Pitkin 2 .5%
Pueblo 4 3%
Summit 1 .5%
Fiscal Year 2008-2009
N= 224 100%
Colorado Physician Health Program
REACTIVATIONSREACTIVATIONS July 1, 2008 through June 30, 2009
7
110 137 143 119 130 112 153 132187 175 184 170
234 194 218 2401821 24
22 18 16
4732
29 38 46
5647
5878
45
050
100150200250300350
1993-1994
1994-1995
1995-1996
1996-1997
1997-1998
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
2003-2004
2004-2005
2005-2006
2006-2007
2007-2008
2008-2009
Referrals Reactivations
“Reactivation” refers to when a participant returns to CPHP after having been inactivated.
Of the 318 New Referrals in Fiscal Year 2008-2009, 78 were Reactivations. This represents 25% of the total New Referrals. This is an increase in 4% when compared to Fiscal Year 2007-08.
Referrals versus Reactivations
2%
4%
7%
2%
7%
5%
11%
15%
9%
15%
4%
17%
2%
0 2 4 6 8 10
Stress
Behavioral
Family
DUI/DWAI
Physical/Medical
Psychiatric
Legal
Work Stress
Substance Abuse
Psychiatric/Substance
Professional Boundaries
Domestic Violence
Career
1.5%
11%
37%
5%
10%
27.5%
4%
4%
0 5 10 15 20 25 30 35
Administration
BME
Hospital
Proactive
Medical School
Self
Residency Program
Other
The highest single source of Reactivations for the Fiscal Year 2008-2009 were BME at 37%. The second highest source of Reactivations was the Self at 27.5%. CPHP continues to be proud of the number of Self Referrals to the program demonstrating trust and confidence in CPHP.
Of the Reactivations in Fiscal Year 2008-2009, 42% came back to CPHP voluntarily, and 58% were mandated. The number of voluntary referrals shows an 8% decrease for Reactivations when compared to last Fiscal Year.
A Primary Presenting Problem area which best represents the participant is identified by the clinical team following the completion of the initial intake interview. In an effort to better understand the relevancy of this data, CPHP has removed cases that are “in process” or have not yet been assigned a primary presenting problem. Of the 78 Reactivations in the Fiscal Year 2008-2009, 24 were in process at the time of this report, thus 54 were assigned a primary presenting problem.
The majority of Reactivations presented with a behavioral problem (17%), followed by a DUI/DWAI or psychiatric problems both at 15%.
Primary Presenting Problem Reactivations
Sources of Reactivations
N=78
N=54
Colorado Physician Health ProgramReport requests and Financial BreakdownReport requests and Financial Breakdown
July 1, 2008 through June 30, 2009
8
CPHP processed 1530 requests for reports during the Fiscal Year 2008-2009. In Fiscal Year 2007-2008 CPHP received 1331 report requests. This shows an increase of 13% in report requests.
Report RequestsOne-Time
Status22%
BME Evaluation5%
Credentialing12% Standing
Status32%
BME Quarterly19%
BME Interim/ Addendum
10%
N=1530
Financial Summary
CPHP finished the Fourth Quarter and Fiscal Year with a Year-to-Date Peer Assistance Net Loss of $64,105.92 versus a Year-to-Date Budgeted Loss of $87,251.00. Year-to-Date
Revenue is largely on target with Year-to-Date Expenses approximately $22,800.00 less than budget primarily due to staff shortages. The Net Loss was supplemented with cash
reserves from the annual Spirit of Medicine campaign.
Contracts4%
Peer Assistance Contract
75%
Donations16%
Honorarium&
Presentation Fees
1%
FFS3%
Reports, Chart
Copies & Interest
1%
Revenue Sources
The majority of revenue that was generated at CPHP during Fiscal Year 2008-09 was from the Peer Assistance Contract (75%). The next largest source of revenue was from Donations (16%) which were contributions to the CPHP annual Spirit of Medicine fundraising campaign.
Colorado Physician Health Program
COMMUNITY OUTREACHCOMMUNITY OUTREACHJuly 1, 2008 through June 30, 2009
9
•Availability of Services: In addition to CPHP providing services to Colorado licensed physicians and physician assistants, contracts exist to provide services for residents, medical students and physician assistant students. CPHP is proud to assist medical professionals early in their career to promote personal good health and wellbeing. CPHP currently serves the following programs:
•Residency Programs • University of Colorado Health Sciences Center • St. Joseph Hospital Residency Program • St. Anthony Family Medicine Residency • Southern Colorado Family Medicine Residency • St. Mary’s Family Practice Residency Program • Colorado Health Foundation Transitional Residency Program at Presbyterian/St. Luke’s Hospital• Denver Health Emergency Medicine Residency• Fort Collins Family Practice Residency
•Physician Assistant Training Programs • University of Colorado Health Sciences Center • Red Rocks Community College Physician Assistant Program
•Medical School • University of Colorado Health Sciences Center
•CPHP and COPIC Continue Educational Collaboration: CPHP and COPIC have again partnered to continue the ninth series of educational presentations for Colorado physicians. Presentations are provided throughout Colorado on the subjects listed to the left.
•COPIC Financial Assistance Fund: COPIC Companies provide CPHP with the Financial Assistance Fund to directly assist CPHP physician clients that would otherwise be unable to afford our services. Their generous donation of $20,000 is greatly appreciated. Thank you!
•Community Presentations: CPHP conducted various presentations about CPHP and related physician health topics. Audiences included Medical and Professional Societies, Hospital Administration, Medical Staff Offices, Group Practices and Training Programs. 42 presentations were conducted this past year!
•CPHP Exhibits at Numerous Conferences throughout Colorado: CPHP strives to educate the medical community about our resources and services. CPHP utilizes these conferences to cultivate relationships and to educate about CPHP services within the medical community.
•Colorado Academy of Physician Assistants Annual Summer Metro Meeting •Colorado Academy of Physician Assistants Mid-Winter Conference •Colorado Association of Medical Staff Services Conference•Colorado Chapter of American Academy of Pediatrics •Colorado Hospital Association Annual Conference•Colorado Medical Society Annual Meeting •Colorado Non-Profit Association Conference•Colorado Rural Health Conference •Colorado Society of Anesthesiologists Conference •Colorado Society of Osteopathic Medicine Annual Winter Meeting•Colorado Society of Osteopathic Medicine Summer Conference
Client Services:•Assessment
•Treatment referral•Monitoring and support
•Family support•Documentation
Workplace and Referral Source Services:•Consultation on identifying physicians who
need assistance•Consultation on making referrals
•Workplace consultations•Educational presentations
Medical Community Services:•Promote physician health awareness
•Educational presentations•Partnership with organizations to meet
special needs•Develop meaningful research on physician
health
Presentation Topics: •Colorado Physician Health Program services
•Physician stress and stress management•Substance abuse, addiction
•Professional boundaries •Self-care and physician health issues
•Disruptive physician management •Women in medicine
•Physicians in relationships and families•Physician depression and suicide
•Occupational hazards of physicians
CPHP SERVICES
Address:899 Logan St., Suite 410
Denver, CO 80203Phone: 303-860-0122Fax: 303-860-7426
www.cphp.org
Office Hours:Monday – Friday
8:30 a.m. – 4:30 p.m.
Audiences
American Academy of Pediatrics Colorado Chapter
Aurora Medical Center
Avista Adventist Hospital
Centura Health Administration
Center for Personalized Education for Physicians
Center for Creative Leadership
Child Health Associate/Physician Assistants Training Program
Children’s Hospital Department of Psychiatry
Children’s Hospital Medical Executive Committee
Colorado Academy for Physician Assistants
Colorado Association for Medical Staff Services
Colorado Association for Nonprofit Organizations
Colorado Acute Long Term Hospital
Colorado Board of Medical Examiners
Colorado Hospital Association
Colorado Health Foundation Transitional Year Fellows
Colorado Nurses Health Program
Colorado Medical Society
COPIC
Colorado Rural Health Association
Colorado Society of Osteopathic Medicine
Colorado Permanente Medical Group
Delta County Memorial Hospital
Denver Health Hospital
Exempla Good Samaritan Hospital
Federation of State Physician Health Programs
Fort Collins Family Practice Residency
Grand River Hospital in Rifle
McKee Medical Center
Memorial Health System
North Suburban Medical Center
Longmont United Hospital
Lutheran Medical Center
Memorial Health System
McKee Medical Center
Parkview Medical Center
Parker Adventist Hospital
Porter Adventist Hospital
Presbyterian/St. Luke’s Hospital
Colorado Physician Health Program
Community outreachCommunity outreach Continued…July 1, 2008 through June 30, 2009
N
10
Red Rocks Community College
Rocky Mountain Vista University
Rocky Mountain Society of Gastroenterology Nurses
Spalding Rehabilitation Center
Southern Colorado Family Practice Residency
St. Anthony Summit Medical Center
St. Anthony’s Residency Program
St. Joseph’s Residency Program
St. Mary’s Hospital
St. Mary-Corwin Hospital
Swedish Hospital
UCHSC Anesthesiology Department
UCHSC Department of Psychiatry
UCHSC Graduate Medical Education
UCHSC Neurosurgery Department
UCHSC School of Medicine
Veterans Affairs Hospital Denver