Bradley Diner

With a shortage of physicians that is getting steadily worse, the last thing the state needs is to lose physicians because of alcohol or drugs problems.

“Certainly we need more doctors,” said Bradley Diner, MD, medical director, Arkansas Medical Foundation. “There is no question about that. And we certainly need healthy ones. It would be a shame to lose some of the few that we have.”

To prevent that, physicians and other healthcare providers such as physician assistants and respiratory care therapists are provided with the opportunity to get independent, confidential help for alcohol and drug addictions through referral from the non-profit Arkansas Medical Foundation, which is tied to the Arkansas Medical Society.

Often physicians are referred to the program by the Arkansas Medical Board because of complaints that have been filed. In some cases disciplinary intervention includes a requirement for getting comprehensive treatment as a condition to restoration of their license.

The foundation identifies treatment programs for physicians, makes sure the physicians do the program, and monitors them afterward.

“We can help them get the treatment they need so they can stay in practice safely,” Diner said. “We also monitor for disruption behavior—boundary issues—but substance dependence is the biggest thing that we see. Our goal is to make sure the patients in Arkansas are safe. We develop a monitoring program that requires meeting attendance, individual therapy and drug testing so we insure they stay sober and practice safely.”

Although it is a high stress occupation, there is no evidence that drug and alcohol abuse is any worse in physicians than the general population. But with an estimated ten percent of the population with drug or alcohol abuse problems, that would equate to approximately 500 doctors or dentists in Arkansas.

“Most doctors out there do a great job and don’t have the kind of problems that we are talking about,” Diner said. “But it is a very stressful profession with the amount of work we do and the intensity of the work that can predispose people to psychiatric as well as substance abuse problems.”

There can be a genetic predisposition for the problems, and they can occur at anytime from medical school to near retirement age. Often someone has been in practice for a while before the problem is identified.

There are no professional programs in Arkansas that specifically treat physicians, so the Arkansas Medical Foundation refers to treatment centers in other states.

“We use programs, usually lasting 90 days, in Georgia, Louisiana, Mississippi, Tennessee and Florida,” Diner said. “There are problems specific to healthcare providers so more specific treatment is needed. Unfortunately, a lot of general programs are not that successful with a physician. Physicians are extremely adept at isolating feelings. It takes a long time for them to admit problems. Other patients put physicians on a pedestal, so it is not an equitable setting. Physicians put themselves above everyone and don’t get the confrontation they need. When you have other peers and colleagues telling you what you need, it tends to work more effectively.”

The process starts with an evaluation that usually takes a week, and includes physical exams, interviews, psychiatric assessments, evaluation for other conditions like depression, followed by a comprehensive report indicating what intervention is necessary.

There is a high rate of success with the treatment programs.

“We have over a 90-92 percent success rate in people who are monitored by us,” Diner said. “That is remarkable considering the overall relapse rate. We do a great job. And I think the medical board would echo that. We have a high rate of success. Doctors go on and have thriving practices. They turn their lives around. They are very grateful.”

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