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 email

physicianhealthconference@cma.ca Call for Proposals deadline is May 7, 2012