A new survey reports that a whopping 14% (1 in 7) of American physicians note that they have used alcohol or a controlled substance while working. Additionally, 46% mentioned consuming alcohol or a controlled substance up to 12 hours before their shift.

We can all guess that healthcare workers have been stressed out since the pandemic started, but what is going on? And, perhaps most importantly, is anyone doing anything about it? Listen as Dr. Philip Hemphill, Chief Clinical Officer and Strategic Board Advisor for APN, shares what the latest findings show.

Dr. Philip Hemphill

A celebrated expert with 30 years of experience in the behavioral health and addictive service industry, Dr. Philip Hemphill serves as Chief Clinical Officer and Strategic Board Advisor for APN, where he is responsible for maintaining excellent clinical care across the entire continuum of care that APN offers. As a highly respected thought leader, Dr. Hemphill regularly publishes academic research and is sought after by the top industry conferences where he’s provided hundreds of professional papers, posters, and workshop presentations throughout his illustrious career. Before joining APN, Dr. Hemphill served as a full-time professor of Practice at Tulane School of Social Work where he helped train the next generation. Prior to that, he held leadership positions at premier addiction and behavioral health treatment facilities as Chief Clinical Officer, consultant, director, board advisor, manager, and coach. He assisted thousands of legal, mental health, and medical professionals in the wake of hurricanes Katrina and Rita and pioneered the assessment and treatment of professionals based on this work. In 2013, he co-authored “Taming Disruptive Behavior” and Dr. Hemphill’s second book entitled “Integrated Care in Addiction Treatment” was published in 2022. He currently maintains a faculty position at LSU Health Sciences, Department of Psychiatry, where he has taught didactics since 2000.

Gabe Howard

Our host, Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without.

To book Gabe for your next event or learn more about him, please visit gabehoward.com.

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.

Gabe Howard: Welcome, everyone. I’m your host, Gabe Howard, and calling in to the show today, we have Dr. Philip Hemphill. Dr. Hemphill is a celebrated expert with 30 years of experience in the behavioral health and addictive service industry. He currently maintains a faculty position at LSU Health Services, Department of Psychiatry. Dr. Hemphill, welcome to the show.

Dr. Philip Hemphill: Thank you, Gabe. Wonderful to be here.

Gabe Howard: Much of our conversation today is going to be informed by APN’s State of Mental Health: American Healthcare Workers Report, which discovered high levels of substance abuse, critical mental health crises and stigma within the health care industry. No, before getting into the findings, can you tell us who APN is and how that report comes together?

Dr. Philip Hemphill: Sure, APN stands for All Points North, we’re a behavioral health and addiction platform that stretches across the telehealth spectrum, also doing located across the country in different cities. But our main facility is in Edwards, Colorado. So, this information was collected on a Web platform. We enlisted the support of researchers who adhere to some pretty strict guidelines with regards with how they collect the data. The individuals that they reach out to for potential participation and how they process the data and how they maintain the confidentiality of the data. So, we you know, we know that the individuals have to have some exposure to the Web, which this day and age is pretty common for most people. They have to want to respond to this particular these particular questions. It is totally voluntary. Then they have to be honest with us about the types of things that they’re they share with us.

Gabe Howard: Thank you, Dr. Hemphill. I really appreciate that. You know, so often we hear about, oh, there was a study done and then like in the really, really small print, you’re like, I asked three of my friends, it’s like, that’s

Dr. Philip Hemphill: Yeah [Laughter].

Gabe Howard: That’s not a study. So, I really like to let our listeners know that what we have on the show is robust and is meaningful because it informs the conversation moving forward. And speaking of which, the most alarming finding, at least for me, was that over 50% of health care workers. That’s a that’s over half. That’s just a startling number reported that they were at their breaking point because of the stress caused by their jobs. How can how can any industry survive if half the people are so stressed out, they want to leave? Let’s not even get into the life-or-death matter of I would feel this way if 50% of construction workers were at their breaking point and they don’t have life in their hands.

Dr. Philip Hemphill: Yeah, yeah. It’s really tragic today in our society that people are under extreme amounts of stress, and health care is just one sector of our society. When we look at these particular responses, the first thing is the platform involves physicians, nurses, physical therapists, a number of health care providers across the spectrum. In the health care industry, we’ve seen this tremendous buildup of need and capacity, and then we’ve seen the intensification of the actual conditions that people are presenting with or they’ve had to stay out of the systems until more recently after the pandemic. As we move into post-pandemic, then we see this, this floodgates open of this need. So, the system has been flooded with individuals and quite frankly, going from a state where there’s a high acuity but low numbers to the point now that there’s huge numbers as well as the acuity of the individuals. So, I think that the stressors that that the health care industry is experiencing is not so unlike other sectors of our society. And we sometimes forget that despite the work that health care workers are providing the whole entire population and being open to the whole entire population, they are human beings as well.

Gabe Howard: Almost equally startling was that nearly half, 46% of physicians in the US reported consuming alcohol or using a controlled substance up to 12 hours before their shift and 1 in 7, about 14%, admitted to consuming alcohol or using a controlled substance while at work. Now, as a mental health advocate, I see that as self-medicating. They’re trying to, for lack of a better phrase, calm themselves down, handle their business, make it through to the next moment. But the patient in me, the consumer, for lack of a better word in me, is like, wait a minute, my, my, my doctor is drinking and using drugs before treating me? Where does that work itself out? Why is this okay if we’re aware that this is happening, it doesn’t seem like there’s any huge push to do anything about it.

Dr. Philip Hemphill: Well, I do think that this is alarming and, there has been this call to action by numerous organizations. The government has even gotten involved. I mean, the surgeon general released a report around this. The College of Physicians released a national plan for healthcare well-being. There’s been resources collectively trying to address this broad concern. And, it is alarming.

Gabe Howard: Now, I’m not a doctor and I don’t work in the healthcare industry. But one of the things that struck me is, okay, the physicians, health care workers, they can’t believe that this behavior is okay. And in fact, that that’s true. Many of them do realize that something has to give. They’re going to make a mistake, but they don’t want to seek help. And the reason that they don’t want to seek help is not arrogance or ego. It’s fear. 23% reported they’re afraid of losing their license, which is, of course, their livelihood. 23% reported that they’re concerned that their family and their colleagues will judge them. And 32% reported that, look, it’s not that they’re unwilling to get help. They just simply don’t have time. In that kind of environment, how can anybody expect to move forward and get the help that they need to resolve this issue? I think those are very reasonable fears in any industry. And I can see the ante being even more so for the healthcare industry.

Dr. Philip Hemphill: Yeah, you’re absolutely right. I mean, the process of training and the healthcare system is one that a great demands of individuals and it has a culture that has been needing to make some shifts for a long period of time. Shifts in the fact that people have difficulties, people have needs, individuals have stressors in their life. There’s a life cycle that everyone goes through. In addition to that, there’s an employment life cycle. There’s a life cycle within an organization. There’s all of these things have an impact and an influence over the culture of the work environment. And this adds to the individual who has already gone through their professional pathway, making a decision early in life, making a commitment, being the brightest, being expected to do things and perform with a lack of sleep, the lack of attention to oneself, the impact that these may have on their own relationships. So, there’s an indoctrination that takes place in the health care industry. Do no harm. Put the others first. These types of things. So then when we’re called to say what happens when you need help, I mean, a lot of health care professionals are just not really good patients in general, including myself, just not the best patient. It’s hard to get feedback. It’s hard to take direction. It’s hard to fully sort of admit to that I can’t really do my job.

Dr. Philip Hemphill: And for the most part, you know, health care becomes people get, you know, really proficient in their skills in health care. It’s all the other things that start to make contribution to the difficulty so they can still function quite, quite well from a skill standpoint. But it’s the other things that start to crumble around the individual. And there’s a lot of fear. There’s still a tremendous amount of stigma around reaching out, asking for help, asking for assistance, you know, and there has been, again, a lot of attention paid in the last couple of years with conferences, education, resources, reaching out to these individuals. But you’re right that there’s a there’s a tremendous fear of judgment. There’s a tremendous fear that I’ll lose my livelihood, my license. There is not organizations out there to assist me. And so, they they’re starting to have a lot more push into what we call safe havens, where not only are the health care organizations and institutions supporting the health care workers, but also the licensing bodies are creating what we call safe havens where people can receive support. Now that’s moderated because it has to come with an assessment to make sure that people are still safe enough to practice their craft and not be a threat or a risk to the public.

Gabe Howard: But I still really get back to this. I don’t want to go to a doctor that’s in harm’s way. I don’t want to go to a doctor that’s abusing drugs and alcohol.

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Gabe Howard: And we’re back discussing the alarming rate of substance abuse within the healthcare industry with Dr. Philip Hemphill. I don’t want to go to a doctor that’s so stressed out they’re having a mental health crisis. I don’t want to go to a doctor or any health care professional who is aware that they need help but is afraid to get it. Yet that is what I have to do, especially in an emergency. I’m not picking my healthcare workers. I’m dialing 911 and whoever is available is going to help me. So, I really think that the public needs to be really, really aware of this and really approach it from this idea of when you’re in crisis, healthcare workers save you. And when you’re in crisis, you don’t get to shop around. How do we get the general public to understand that?

Dr. Philip Hemphill: Yeah, that’s again, that’s the overarching stigma that exists. There is a huge amount of energy that pushes behind stigma, even though people are coming out in record numbers to seek mental health services, substance use services. There’s still a tremendous stigma. So that’s where some of the barrier is with coming forward and acknowledging this. I can’t necessarily speak for the public because I’ve been providing health care services my entire career, and I have to sort of stay focused on what I can do day in and day out. The individuals, the clinicians that I can lead, the individuals that I can work with and have impact on the systems that I can develop and support the build out to assist more and more people. So those are the things I’ve had to focus on, of course, as a, you know, behavioral health mental health provider in the public sphere, I get lots of questions. People sort of, you know, sort of testing me and the public with regards to how do you do that? I can’t believe you do that, or what is it like and just those types of things. So, I think there’s become less and less of a mystery around behavioral health and substance use disorder, but there is still a cloud over it.

Gabe Howard: As you said, there is stigma everywhere in our society. It’s not just on health care professionals. It’s not just on physicians. It’s on everybody from truck drivers to law enforcement to, you know, cleaning folks and fast-food workers and everybody in between. There is always somebody that rolls their eyes at it and just doesn’t want people to get the help that they need. We know that there’s a lot of stigma in society, but let’s talk about how health care workers are speaking to each other and supporting each other. But what have you seen? What’s the internal dialog to help fix this problem from one health care worker to another?

Dr. Philip Hemphill: I think the realization of humanity and people just turning to each other across the room and asking them how they are doing on a day to day basis, using strategies for health and healing in the workplace and having people, you know, try to do more primary or secondary preventive activity with each other as opposed to waiting in a tertiary sense, where after the fact that the person has either burned out or the person has had a difficulty where they have to be removed. So, you know, like recently I worked with someone who talked about being on call for 21 days straight and working night shift, 21 days straight. And this is like tremendous. And, you know, part of it is the individual, part of it is the system. And so, the opportunity to have a better conversation about what’s happening in the system that’s taking away from this peer support and what in the leadership, what in the organization can we do to sort of better support the health care workers at the same time, individuals, you know, being on a team, you know, you mentioned the word team earlier. When you’re talking about you put things out 24 over seven, 365, the key word that you said. And you had a team, you had a team of people, people you could rely on. Not everybody had to always be on 100% of the time. We can sort of look across the hall. We can look across the table, look across the desk and feel like you’re a part of something. You’re a part of a team. People are going to support each other.

Dr. Philip Hemphill: They’re going to sort of be there for each other. They’re going to ask about how you’re doing. You know, the need in health care is the humanity and the need for rest and recovery and care.

Gabe Howard: You know, I really loved everything that you said about the team support and checking in with each other and supporting one another. And I agree. I think that it’s fantastic. But one of the things that I also heard in there is that one of the physicians had been on call for 21 days. I don’t know that anybody can survive being on call for 21 days. And my specific question there is, is who gave him that schedule? Are our hospital systems, our employers, for lack of a better word, doing more to make sure that people aren’t on call for three weeks? It just it just seems like you’re setting people up to fail.

Dr. Philip Hemphill: Yeah, it was a combination of events that led to that. But the individual didn’t really feel like he could reach out and make some changes. But, you know, there’s people that get sick. There’s people that call in. There’s all these different, you know, needs. The health care system is incredibly stressed right now. You know, there’s a need for so many more health care workers. So, you know, at times the stretch may be like that. I mean, we didn’t really, you know, during the pandemic, during the crisis, people were working like that. That was not uncommon. And, you know, post-crisis, again, we have a dearth of providers. There’s a need for more providers and there’s a need for a better responsivity by leadership, by organizations or some form of tracking to say, wait a minute, this is like too many in a row here. Something’s going on, something’s got to give. There’s a need to understand You think you can do this, but we’re not going to let you do this.

Gabe Howard: One of the things that I’m thinking about while you’re talking, Dr. Hemphill, is that my father is a retired semi-truck driver, drove the 18-wheeler. And as a CDL license holder, there were rules. He had to keep log books. He was only allowed to drive so many hours a day. There’s this very rigid set of laws that determines how much my father could drive a semi-truck for the public safety. And I want to tell everybody, my father cannot spell the word surgery, let alone do surgery. He’s not making life or death decisions. He’s just driving a ten, 15, 20-ton truck. But the government has seen the wisdom, for lack of a better word, in making sure that he doesn’t fall asleep at the wheel. Are there similar laws to prevent physicians and health care workers from working ten, 15, 20, 24-hour shifts That again would put them in the position of working with the public when they may again, for lack of a better word, you know, flip over their semi.

Dr. Philip Hemphill: Sure, sure. No, absolutely. These things go back many years that during the training process there was some adverse outcomes. And so therefore, they there was a need to put in some rules and guidelines for trainees. Those things are part of the training process by, you know, the American College of Medical Education. And so those things are in existence during the training process. And once you get out into the actual sphere of working, sometimes people make decisions, individuals make decisions. Now there are systems in place. They have guidelines, they have policies and procedures, just like, you know, your father, who is essentially what we call a safety sensitive worker. There are different rules that processes that apply for substance use or mental health issues related to people who have safety sensitive positions. Because what we’re talking about here is protecting the public health, protecting the public good, and, you know, airline pilots, truck drivers, all of these things that you mentioned, including physicians, obviously in safety sensitive positions. So, yes, there are guidelines for these things. But at the same time, individual systems get stressed and sometimes they sort of don’t follow those guidelines or rules.

Gabe Howard: Dr. Hemphill, thank you so much for being here. Where can folks find more information about you online?

Dr. Philip Hemphill: Well, you can go to the APN.com and I’ve listed there as one of the leaders. I’m the chief clinical officer, but you can find out about the resources that are available and you can have access to me.

Gabe Howard: And a big thank you to all of our listeners as well. My name is Gabe Howard and I am the author of “Mental Illness Is an Asshole and Other Observations.” I’m also an award-winning public speaker who could be available for your next event. My book is on Amazon or you can grab a signed copy with free show swag or learn more about me by heading over to gabehoward.com. Wherever you downloaded this episode, please follow or subscribe to the show. It is absolutely free and do me a favor. Recommend the show to a friend or family member or colleague. Hell, send a text. Do whatever you can because referring the show is how we grow. I will see everybody next Thursday on Inside Mental Health.

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