Anesthesiology residents, despite having direct access to controlled substances, often are inadequately trained in the symptoms of substance abuse disorder (SUD) and resources for addressing it.
A study conducted by Rutgers New Jersey Medical School, in Newark, found that 40% of surveyed residents felt underprepared for managing SUD. The results were presented at the PostGraduate Assembly in Anesthesiology.
“Anesthesiologists have the highest rate of substance abuse among all physicians,” said Melinda Ball, DO, the study’s lead author. “Seven percent of residents who become addicted over the course of their residency wind up having mortality associated with their substance abuse, and 1% of all residents will present with an SUD.” In both physicians and CRNAs, the incidence of addiction is highest during the first five years of giving anesthesia.
A High-Risk Career
Long work hours, high levels of stress and familiarity with pharmacology are all risk factors for SUD. Yet, according to Dr. Ball, the greatest challenge is access. “While other physicians have no direct access to controlled substances, we don’t have a middleman,” she said.
After the death of a Rutgers resident, Dr. Ball and her team decided to investigate. “As a department, we were asking many questions of ourselves,” said Michal Gajewski, DO, the residency assistant program director at Rutgers’s medical school. “What could have been done to have prevented this untimely death? And more importantly, what can and needs to be done so that it doesn’t occur again?”
Scope of the Problem
A questionnaire was created, which Dr. Ball and her co-authors administered to Rutgers’ anesthesia care providers using a private, online application. “We administered a simple, eight-question survey to all of our CRNAs, attendees and residents to assess for baseline knowledge,” Dr. Ball said.
What they found was striking. Whereas 70% of the providers felt they knew the risk factors for substance use, upon follow-up none of them was able to identify all such factors. Additionally, 40% of those surveyed admitted to feeling inadequately educated on the problem by lectures, unclear about the appropriate steps to follow if they suspect a colleague has a substance abuse problem, or where to find appropriate help for themselves (Figure).
Fear was also prevalent. “Everyone fears reporting their colleague and having them lose their license, or being reported themselves,” Dr. Ball said. “There is a fear of ruining someone’s career, or their life.”
The study has helped Rutgers determine where to focus their efforts to combat this problem. “We found that residents previously had one lecture on substance abuse, which took place before [the] beginning of their clinical anesthesia year,” Dr. Ball noted. To address this knowledge gap, a curriculum was developed that includes grand rounds lectures hosted throughout the year, as well as a New Jersey Medical School Substance Use Disorder Symposium, which includes lectures by addiction psychiatrists.
In an effort to address the fear of sharing sensitive information, the group is raising awareness about the Professional Assistance Program of New Jersey, which provides counseling and rehabilitation for doctors and nurses. “Most of the anesthesia providers thought that once you were suspected of substance use, you would be reported to the state board and lose your license,” Dr. Ball reported, “but there is actually another pathway.”
In addition, a Resident Wellness Committee was formed. The committee hosts monthly gatherings and frequent volunteer opportunities, all geared toward creating a happy, healthy workplace with increased social bonding.
Dr. Gajewski is pleased with the efforts so far. “I feel that Dr. Ball’s approach was informative yet empathetic,” he said. “Knowledge can bring healing, and as this was a resident-driven initiative it allowed the residents to participate. The results we found were not totally unexpected but they did open our eyes to the fact that our department needed to do more. As an educator, I really do believe that it is a lack of inclusion that can worsen a person’s struggle and make it so much easier for them to turn to substance abuse as a coping mechanism. Working as anesthesiologists, we should try to educate the future generations that although we may practice independently, we do not practice alone.”