Should anesthesia residents with a history of substance abuse be allowed to continue training in clinical anesthesia? The results of a survey of anesthesia residency program directors☆☆☆
Received 18 October 2007; received in revised form 17 December 2008; accepted 18 December 2008. published online 26 October 2009.
Abstract
Study Objective
To determine the experience, attitudes, and opinions of program directors regarding the reintroduction of residents in recovery from substance abuse into the clinical practice of anesthesiology.
Design
Survey instrument.
Setting
Anesthesia residency training programs in the United States.
Measurements
After obtaining institutional review board approval, a list of current academic anesthesia residency programs in the United States was compiled. A survey was mailed to 131 program directors along with a self-addressed stamped return envelope to ensure anonymity. Returned surveys were reviewed and data compiled by hand, with categorical variables described as frequency and percentages.
Main Results
A total of 91 (69%) surveys were returned, representing experience with 11,293 residents over the ten-year period from July of 1997 through June of 2007. Fifty-six (62%) program directors reported experience with at least one resident requiring treatment for substance abuse. For residents allowed to continue with anesthesia residency training after treatment, the relapse rate was 29%. For those residents, death was the initial presentation of relapse in 10% of the reported cases. 43% of the program directors surveyed believe residents in recovery from addiction should be allowed to attempt re-entry while 30% believe that residents in recovery from addiction should not.
Conclusions
The practice of allowing residents who have undergone treatment for substance abuse to return to their training program in clinical anesthesia remains highly controversial. They are often lost to follow-up, making it difficult, if not impossible to determine if re-training in a different medical specialty decreases their risk for relapse. A comprehensive assessment of the outcomes associated with alternatives to re-entry into clinical anesthesia training programs is needed.
Department of Anesthesiology, Mount Sinai Hospital, New York, NY 10029, USA
Tel.: +1 212 241 9240; fax: +1 212 876 3906.
☆ Summary Statement: The practice of allowing residents who have undergone treatment for substance abuse to return to their training program in clinical anesthesia remains highly controversial. A comprehensive assessment of the outcomes associated with alternatives to re-entry into clinical anesthesia training programs is needed.
☆☆ Support Statement: Support was provided solely from institutional and departmental sources.
ABSTRACT