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Colorado Physician Health Program Annual Report July 2007 - June 2008

Colorado Physician Health Program Annual Report July 2007 - June 2008. Executive Director: Sarah R. Early, PsyD Medical Director: Michael H. Gendel, MD. The mission of Colorado Physician Health Program

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Colorado Physician Health Program Annual Report July 2007 - June 2008

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  1. Colorado Physician Health ProgramAnnual Report July 2007 - June 2008 Executive Director: Sarah R. Early, PsyD Medical Director: Michael H. Gendel, MD 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.

  2. Table of ContentsAnnual ReportJuly 2007 - June 2008 • Referral Summary Page 3 • Number of New Referrals - Program History Page 4 • Source of New Referrals - Year-to-Date Page 5 • Primary Presenting Problem -Year-to-Date Page 6 • Specialty of New Referrals - Year-to-Date Page 7 • License Type of New Referrals - Year-to-Date Page 8 • New Referrals – Geographical Area - Year-to-Date Page 9 • Referrals & Reactivations 1993 - Present Page 10 • Reactivations - Year-to-Date Page 11 • Inactivations (Reasons/Outcome) - Year-to-Date Page 12 • Participants Documentation Requests Page 13 • Program Highlights Page 14 • Community Outreach Highlights Page 15 • Services Provided by CPHP Page 16 • CPHP Board of Directors and Staff Page 17 APPENDIX • Definition of Terms Page 19

  3. Referral Summary July 2007 - June 2008 • New Referrals: CPHP continued to receive steady New Referrals throughout Fiscal Year 2007-08 with 276 New Referrals, representing a 15% increase compared to last Fiscal Year (241 New Referrals). Total New Referrals from 2007-08 represents a 5% decrease in the number of New Referrals for a medical license Renewal Year (compared to 290 in 2005-06). • Caseload:The average active caseload at any given period during Fiscal Year 2007-08 was 457 clients. This represents an increase of 6% compared to Fiscal Year 2006-07 (433 active client caseload). • Overview: Significantly, 60% of New Referrals came to CPHP voluntarily. 40% were mandatory referrals. Of the total New Referrals this year, 60% had an active Colorado Medical License, 15% had a Colorado Resident Training License, and 5% held Physician Assistant Licenses. 20% did not hold any license which includes 11% Applicants, 7% students and 2% out-of-state/non-medical licensed clients. • Demographic Data Collected at time of Intake: • Age: 1% (20-25),11% (25-29), 13% (30-34), 13% (35-39), 14% (40-44), 16% (45-49), 13% (50-54), 11% (55-59), 6% (60-64), 2% (65+) • Gender: 39% female and 61% male • CPHP served New Referral clients from 22 counties of residence throughout Colorado during Fiscal Year 2007-08. • Referral Source: The highest single source of New Referrals was Self referrals, representing 38% of New Referrals. The second highest source of New Referrals was the Board of Medical Examiners, BME (13%). Administration (11%) and Hospitals (11%) were the third highest categories of referral source. • Primary Presenting Problems of New Referrals: The three most common primary presenting problems among the 276 New Referrals were: Psychiatric at 26%, followed by Behavioral at 13% and lastly Substance Abuse and Work Stress at 8%. • Specialty of New Referrals: Family Practice (21%) is the most frequent specialty of New Referrals, followed by Internal Medicine (16%) and lastly GeneralSurgery and Anesthesiology (both at 7%). • Reactivations: Of the 276 New Referrals, 58 were Reactivations. This represents 21% of the total New Referrals. • Outcome: Of 246 inactivations, 30 declined referral, 11 declined evaluation, 3 withdrew license application, 17 completed a consultation, 5 relocated, and unfortunately 2 died; therefore, 174 clients were evaluated. Of the 174 evaluated, 161 (93%) were inactivated with an outcome considered successful and/or satisfactory. CPHP is pleased with our continued high rate of satisfactory outcomes! • Documentation Requests: CPHP processed 1,331 report requests during Fiscal Year 2007-08. • Total Participants in CPHP History: Since the inception of the program in 1986, CPHP has served 2917 participants.

  4. Annual Number of New Referrals Program History 1986 - Present • New Referrals: CPHP continued to receive steady New Referrals throughout Fiscal Year 2007-08 with 276 New Referrals, representing a 15% increase compared to last Fiscal Year (241 New Referrals). Total New Referrals from 2007-08 represents a 5% decrease in the number of New Referrals for a medical license Renewal Year (compared to 290 in 2005-06). • When compared to Fiscal Year 2006-07, CPHP experienced an increase of 35 cases, or 15%. In addition, the average active caseload continues to grow. The average active caseload at any given period during Fiscal Year 2007-08 was 457 clients. This represents an increase of 6% compared to Fiscal Year 2006-07 (433 active client caseload). • * = BME License Renewal Years

  5. Source of New Referrals July 2007 - June 2008 Self & Voluntary Referrals Remain High! Client Medical Profession Other = Podiatrist Other = PHP, Other Regulatory Boards N=276 • During Fiscal Year 2007-08, the highest single source of New Referrals was Self referrals, representing 37% of New Referrals, which is similar to last year. CPHP continues to be proud of the high number of Self Referrals to the program demonstrating trust and confidence in CPHP. • Significantly, 60% of New Referrals came to CPHP voluntarily. 40% were mandatory referrals. CPHP continues to be proud of the high percentage of referrals that are voluntary, as this reflects the respect for the program among physicians within the state and medical community. CPHP attributes this high level of voluntary referrals to the relationship building efforts made in the community, the positive and caring approach of CPHP’s staff, and provision of educational materials that normalizes physician experiences and illness. • The second highest source of New Referrals was the BME (13%). This is less than 2005-06, the last medical license renewal year, where 24% of New Referrals were from the BME. (Last year comprised 18% of BME New Referrals.) This is likely due to the Safe Haven language on Medical and Physician Assistant License Applications and Reapplications which afford confidentiality for certain health conditions if the individual is “Known to CPHP.” • Administration and Hospitals (both at 11%) were the third highest categories of referral source. CPHP appreciates the referrals received from Colorado workplaces to assist physicians in evaluating potential health issues that may effect their ability to practice medicine safely. • Please note definitions of referral source categories. See Page 19. • The pie chart on the above-right reflects the medical profession of CPHP clients. The majority of clients are Physicians without a resident status (MD and DO)(69%). Residents (18%) comprise the second largest group served and Physician Assistants (6%) comprise the third largest group.

  6. Primary Presenting Problem of New Referrals July 2007 - June 2008 Other= Credentialing Matter N=190 • In an effort to better understand the relevancy of the primary presenting problem data, CPHP has removed cases that are “in process” or have not yet been assigned a primary presenting problem. Of the 276 New Referrals received during Fiscal Year 2007-08, 86 were in process at the time of this report, thus 190 were assigned a primary presenting problem. • A primary presenting problem area which best represents the participant is identified by the clinical team following the completion of the initial intake interview. This does not mean that other problem areas are not present or being addressed with the participant at CPHP. Rather, the primary presenting problem is identified for data collection and reporting purposes. • The three most common primary presenting problems among the 190 New Referrals were: Psychiatric at 26%, followed by Behavioral at 13% and lastly Substance Abuse and Work Stress both at 8%. • This representation is similar to Fiscal Year 2006-07 with the top three categories of Psychiatric at 32%, followed by Behavioral at 12% and Substance Abuse at 11%.

  7. Specialty of New Referrals July 2007 – June 2008 N=190 Other Surgery= Neurological Surgery, Plastic Surgery N/A = Student • In an effort to reflect the true representation of specialties served, CPHP is reporting on cases where specialty information has been collected. The data on specialty is collected at the time of intake. Of the 276 New Referrals received during Fiscal Year 2007-08, 86 had not completed an initial intake session at the time of this report, thus for 190 New Referrals, specialty information had been collected. • Specialty of New Referrals: Family Practice (21%) is the most frequent specialty of New Referrals, followed by Internal Medicine (16%) and lastly General Surgery and Anesthesiology (both at 7%). • The percentage representation is similar to Fiscal Year 2006-07 with the two most frequent specialties of Internal Medicine (16%), followed by Family Practice (14%). • The specialty statistics among CPHP participants are only meaningful if there is a deviation from the specialty populations of practicing physicians in Colorado. CPHP does not posses current information to determine the significance of this data.

  8. License Type of New Referrals July 2007 - June 2008 Other = Out of State and PhD N=276 • This pie chart shows the medical license type of each New Referral to CPHP at the time of referral. • Of the total New Referrals this year, 60% had an active Colorado Medical License, 15% had a Colorado Training License and 5% held Physician Assistant Licenses. 20% did not hold any Colorado license which includes 11% Applicants, 7% students and 2% out-of-state/non-medical licensed clients.

  9. Colorado Counties Served by CPHP July 2007 - June 2008 ^ ^ * * ^ * N * * * ^ * * * * * * * * * * ^ ^ ^ * * ^ ^ ^ ^ ^ ^ * ^ ^ ^ ^ * ^ = Other Other includes counties that contain less than 10 physicians, based on a BME listing (obtained in September 2005) of Colorado licensed physicians. These counties are grouped into one category (Other) to protect the confidentiality of clients residing in those counties. Counties in this category include: Baca, Cheyenne, Conejos, Crowley, Custer, Dolores, Hinsdale, Jackson, Kiowa, Mineral, Park, Phillips, Rio Blanco, Saguache, San Juan and Sedgwick. ^ = County Served * • CPHP served New Referral clients from 22 counties of residence throughout Colorado during Fiscal Year 2007-08. • The most frequent county of residence among New Referrals was Denver County at 33%.

  10. Referrals & Reactivations1993 - Present • Of the 276 New Referrals, 58 were Reactivations. This represents 21% of the total New Referrals, which is consistent to last year.

  11. ReactivationsJuly 2007 - June 2008 Referral Source Primary Presenting Problem N=58 N = 45 • “Reactivation” refers to when a participant returns to CPHP after having been inactivated. • Referral sources of reactivated clients are depicted on the left pie chart. Of 58 who reactivated, 33% Self Referred. This represents a decrease when compared to Fiscal Year 2006-07 when 41% of Reactivations Self Referred. • The second most frequent referral source among reactivated clients was the BME (17%). This is a decrease of 9% when compared to last Fiscal Year in which BME Referrals comprised 26% of the Reactivation sample. • Reactivation referrals increased 10% in both the Hospital and Administration categories compared to Fiscal Year 2006-07. • 50% of Reactivations voluntarily returned to CPHP during Fiscal Year 2007-08. This is a decrease of 16% when compared to Fiscal Year 2006-07 which had 66% voluntary Reactivations. • Primary presenting problems of reactivated clients are illustrated on the right pie chart. These statistics reflect that Reactivations most commonly present with Psychiatric issues (25%), followed by Substance Abuse (14%). This distribution was similar to last year’s Reactivation primary presenting problems.

  12. 246 Participants Inactivated (Reasons/Outcome)July 2007 - June 2008 Length of Active Status at CPHP N=246 • “Inactivation” refers to when a case is closed at CPHP. See definitions of Reasons for inactivation on Page 19. • Of 246 inactivations, 17 declined referral, 25 declined evaluation, 2 did not complete evaluations (noncompliant), 5 withdrew license application, 7 completed a consultation, 6 relocated, and unfortunately 3 died; therefore, 182 clients were evaluated. Of the 182 evaluated, 160 (88%) were inactivated with an outcome considered successful and/orsatisfactory. CPHP is pleased with our continued high rate of satisfactory outcomes! • Length of Active Status at CPHP is depicted on the right pie chart. The majority of participants (63%) completed the necessary involvement with CPHP in one year or less. Last Fiscal Year 2006-07, 71% of participants completed the necessary involvement with CPHP in one year or less.

  13. Participants Documentation Requests July 2007 - June 2008 • CPHP processed 1,331 report requests during Fiscal Year 2007-08. N= 1331

  14. Program HighlightsJuly 2007 - June 2008 • CPHP Welcomes New CPHP Board Director: At the May 13, 2008 Board of Directors meeting, CPHP welcomed back Board Director, James Borgstede, MD. Dr. Borgstede previously served on the CPHP Board of Directors from 2002-06 serving in Officer positions of Director-at-Large, Treasurer and Chair. He left Colorado to complete a fellowship in California in Magnetic Resonance Imaging and returned to Colorado in 2008 to serve as Vice Chair of Radiology at the University of Colorado Health Science Center. We welcome back Dr. Borgstede to CPHP! • 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 training and career to promote personal good health and well-being. 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– New this year! 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 • Federation of State Physician Health Programs (FSPHP): CPHP continued active national involvement with the FSPHP during Fiscal Year 2007-08 with CPHP Medical Director, Michael H. Gendel, MD, serving as Immediate Past President of this organization. As always, CPHP welcomes FSPHP meetings as a forum for education and exchange of information among state physician health programs. • Western Region of the Federation of State Physician Health Programs (FSPHP) Annual Meeting: CPHP Medical Director, Executive Director, and Associate Medical Directors attended the Western Region of the FSPHP Annual Meeting at Jackson Hole, Wyoming September 6-8, 2007. CPHP representatives provided a panel presentation on the topic Assessing and Monitoring Illness in Physicians. We welcomed the opportunity to network with colleagues from other Physician Health Programs and gain valuable information about physician health related issues. • FSPHP Annual Meeting: CPHP Medical Director, Associate Medical Directors and Executive Director attended the FSPHP Annual Meeting in San Antonio from April 28-May 1, 2008. Doris C. Gundersen, MD presented on Addressing Anger, Violence and Security in the Workplace and coordinated a panel on The Evolution of Physician Health Programs. Michael H. Gendel, MD co-presented on Research Initiatives. Sarah R. Early, Psy.D. co-presented on Defining Physician Health Program Evaluations and Audits. • FSPHP and Federation of State Medical Boards (FSMB) Collaboration: Michael H. Gendel, MD and Sue Kim, Esq, Assistant Attorney General for the Colorado Board of Medical Examiners served on a joint panel session with FSPHP and FSMB addressing How Physician Health Programs Work, Value to the Profession, and Their Relationship with State Medical Boards on May 1, 2008. CPHP is pleased with the collaboration of these two Federations to best assist physicians and provide public protection. • Spirit of Medicine Fundraising Campaign: CPHP completed the annual Spirit of Medicine fundraising campaign with successful results! CPHP utilizes fundraising efforts to supplement expenses that exceed the Peer Assistance Budget. CPHP Board of Directors along with the Development Specialist and Staff work together to cultivate and extend fundraising efforts throughout the Colorado medical community. We appreciate all of our generous contributors and especially want to recognize our donors who provided gifts over $5,000: • Centura Health • Exempla Good Samaritan Medical Center • 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 organizational member of the LivingWell Giving Society who pledged to give a gift for five years.

  15. Community Outreach Highlights July 2007 - June 2008 • COPIC Financial Assistance Fund: COPIC Companies provided the 2007-2008 Fiscal Year 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! • CPHP and COPIC Continue Educational Collaboration: CPHP and COPIC have again partnered to continue the seventh series of educational presentations for Colorado physicians. Presentations are provided throughout Colorado on Physician Stress and Stress Management, Professional Boundaries, Physicians in Relationships and Families, and Women in Medicine. • Community Presentations: CPHP conducted various presentations about CPHP and related physician health topics. Audiences included Residency Programs, Medical and Physician Assistant Programs, Medical and Professional Societies, Medical Staff Offices and Group Practices. 37 presentations were conducted this past year! • CPHP Outreaches to Hospitals across Colorado: Over the past year Sarah Early, PsyD, Executive Director along with other CPHP representatives traveled throughout Colorado to meet hospital administration and medical staff in an effort to educate regarding the breath and depth of CPHP services in order to make effective referrals to assist Colorado physicians. CPHP visited 61 hospitals during the past Fiscal Year! In addition, CPHP provided informative packets on how to best facilitate a formal referral to all Colorado Hospitals and Medical Groups (comprimised of 15 people or more). • CPHP Exhibits at Numerous Conferences throughout Colorado: CPHP utilizes these conferences to cultivate relationships with the medical community and provide education about our resources and services. • Colorado Rural Health Conference • Colorado Society of Osteopathic Medicine Summer Conference • Colorado Academy of Physician Assistants Annual Summer Metro Meeting • Colorado Hospital Association Annual Conference • Colorado Society of Anesthesiologists Conference • Colorado Medical Society Annual Meeting • Colorado Academy of Physician AssistantsMid-Winter Conference • Colorado Society of Osteopathic MedicineAnnual Meeting • Colorado Chapter of American Academy of Pediatrics • University of Colorado Medical School Panel Meeting • Colorado Association of Medical Staff Services Conference • University of Colorado Medical School Graduate Medical Education Orientation • CPHP Newsletter Distributed: The Summer 2008 edition of CPHP News was mailed to all active Colorado licensed physicians and physicians assistants and various other medical entities throughout the state.  CPHP is proud of this initiative in an effort to provide the Colorado medical community with articles pertaining to physician health 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. • Participant Monitoring Visits: CPHP Medical Director and Associate Medical Directors traveled to various areas in the state for client appointments outside of Metro Denver including Fort Collins, Greeley, Grand Junction, Durango, Steamboat Springs and Pueblo.

  16. Services Provided by CPHP • 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

  17. CPHP Board of Directors and Staff

  18. APPENDIX

  19. Definition of Terms REFERRAL SOURCES For the purpose of this report, the following definitions are applied: Administrative (Admin): Dept. Heads, Directors, Partners, Presidents, CEO’s (which are not part of a hospital system). For example, Vail Clinic, CFO of a Radiology group, managed care such as Kaiser Permanente Attorney: Referrals made by a CPHP client’s attorney Board of Medical Examiners (BME): Any referral made by the BME or required evaluations as part of the application or renewal process to Colorado Hospital: MEC, Medical Staff Offices, Quality Management, Chief of Staff, Credentialing Committees Malpractice: A malpractice company Medical School: Any referrals made by the Medical School Faculty, administration and personnel Peer: Any MD, DO, or PA that does not fit into another category Physician Assistant Program: Any referrals made by a Physician Assistant School Faculty, administration and personnel Proactive: Self referral who request services who will have or would likely have consequences with other entities or organizations if they do not follow Resident Program (Res Prog): Any referrals made by Residency Directors and personnel Self: Voluntary referrals who request services on their own and there are not consequences with other entities or organizations if they do not follow through Treatment Provider (Tx Prov): Professionals in community that provide treatment to CPHP participants REASONS FOR INACTIVATION Application Withdrawn: Individual decides not to pursue a Colorado license after the application was submitted. Or, individual decides not to submit a Colorado license application. Consultation Complete:Referral Source other than self was provided program information, referral guidelines and options regarding specific new referral. Initial intake not completed at this time. No potential safety or patient safety issues identified. Deceased: Client deceased. Evaluation Completed (Eval Comp): Client completed evaluation, no treatment or monitoring recommended. Also used for out of state clients who will follow-up with treatment and/or monitoring in own state. Evaluation Declined (Eval Declined): Client referred for evaluation. Refused or declined to have evaluation or cannot be located. No patient safety issues identified. Evaluation Incomplete (Eval In Comp): Client begins evaluation process but does not comply with completion of CPHP evaluation. No potential safety or patient safety issues identified. Monitoring Completed (Mon Comp): Client has followed CPHP recommendations for treatment and/or monitoring. Monitoring no longer warranted. Monitoring Declined (Mon Declined): Client completed evaluation. Client declined CPHP recommendations for treatment and/or monitoring. No patient safety issues identified. Non-Compliance: Client did not comply with the completion of CPHP evaluation and/or did not comply with CPHP treatment and/or monitoring recommendations. Potential safety or patient safety issues identified. Other: Any reasons that does not fit another category Referral Declined:Self referral was provided program information, referral guidelines and options regarding specific circumstance. Initial intake not completed at this time. No potential safety or patient safety issues identified. Relocated: Client relocated after evaluation completed. No patient safety issues identified. Rescinded Order: BME rescinded the order for CPHP evaluation and individual is no longer required to have one. Client may or may not have completed an initial intake or received monitoring services.

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