An Anapol Weiss analysis of National Practitioner Data Bank (NDPB) data has found nearly 100,000 disciplinary measures taken against U.S. healthcare professionals from 1999-2017.
Substance abuse has long been a problem in our society – and the healthcare industry is no stranger to it. Doctors, nurses, and other professionals in the medical field have consistently seen high numbers of drug and alcohol abuse.
- A 2013 study in the Journal of Addiction Medicine stated that 69% of doctors abused prescription medicine as a means of relief from emotional distress or general stress.
- The American Nurses Association reports that 10 percent of nurses may be impaired or in recovery from drug or alcohol addiction.
- A 2012 University of Washington survey of over 25,000 surgeons revealed that roughly 15 percent have problems with alcohol abuse or dependency.
These lapses in professional conduct and competence commonly result in an adverse disciplinary action from medical boards and other government-sanctioned entities. We wanted to know exactly how many instances of substance abuse were reported (and acted upon) in recent history.
With assistance from data visualization firm 1Point21 Interactive, we analyzed nearly one million adverse action reports from the National Practitioner Data Bank (NPDB) to identify all reports of involving disciplinary action based on substance abuse.
We looked at all NPDB data from 1999-2017 and focused on those adverse actions that were imposed as a result of substance abuse, such as:
- Alcohol or Other Substance Abuse
- Diversion of a Controlled Substance
- Narcotics Violation or Other Violation of a Drug Statute
- Felony Conviction Re: Controlled Substance
- Drug Screening Violations
We found 99,367 instances of medical professionals who received disciplinary measures due to drug or alcohol abuse.
Interactive Map: Adverse Actions by State
When categorized by state, Texas had the most adverse actions by far, followed by California and then Florida. With those three states consistently ranking highest in population, that seems like a plausible distribution of incidents.
However, other states seem to have disproportionately high instances of medical professionals with substance abuse issues. Arizona and Louisiana trail Florida by just a few hundred incidents, despite their respective population sizes. Whether this is due to stricter reporting measures or a larger base of healthcare professionals with dependency problems, it nonetheless merits further investigation.
Nurses are Overwhelmingly Over-Represented
Our analysis does not just cover physicians and dentists, but comprises a wider array of healthcare professionals, with occupations ranging from registered nurses and pharmacists to massage therapists and optometrists.
Drug and Alcohol Violations: Top 30 License Types
[wpdatachart id=1]
When our data is organized by profession, registered nurses show by far the most offenses – nearly six times the number of traditional physicians. Although in the United States, nurses do outnumber doctors by a factor of 3 to 1, these results indicate a greater disparity regarding substance abuse.
Analyzing the Data by Adverse Action
“Adverse clinical privilege actions” are defined as those disciplinary actions enacted as a result of a physician’s professional misconduct. Depending on the governing state, these can vary in frequency and severity. Examples include:
- Suspension, probation, or revocation of medical license
- Reprimand or censure
- Fines or monetary penalties
- Any limitations or restrictions on license to practice
When categorized by adverse action, the data shows license suspension at the top with license probation shortly behind. Following the two are voluntary surrender of license and license revocation.
Most Common Adverse Actions for Drug and Alcohol Abuse
[wpdatachart id=2]
The large number of license suspensions over other offenses may be due to it presumably being a punishment for a first offense – therefore being the most common on this list. In contrast, a revocation of a license is a serious action, ideally reserved for equally serious offenses or repeat offenders.
Drug and Alcohol Abuse Shows Spikes in Specific Years
When these drug and alcohol offenses are organized by year, there are three clear, significant spikes in data: 2000, 2008, and 2010.
The first spike in 2000 is likely due to the change in reporting procedures in the NPDB. Most of the formal codes for drug and alcohol offenses were officially implemented in November of 1999 – meaning 2000 was the first full year that these justifications were officially listed in the NPDB reports.
The spikes in 2008 and 2010 are less clear, but may be due to a few reasons:
- The massive economic downturn from 2008-2010 affected all businesses – including hospitals. In states like CA, job losses and closures of notable hospitals increased emergency room demand significantly – and greatly increased the stress on healthcare employees. A 2016 study of the relationship between alcohol use and professionals found that the Great Recession led to an increase in heavy drinking and intoxication, while another study that same year found that economic downturns can lead to increases in substance use disorders involving prescription pain relievers.
- One of the basis codes we filtered for, Drug Screening Violation, was first implemented in the NPDB in 2009.
- In 2008, the Medical Board of California ended its physician assistance program. This initiative allowed doctors and other health care professionals with substance abuse problems to voluntarily enroll themselves in treatment and rehab in order to continue practicing after treatment – with no disciplinary action reported on public record. By effectively ending this program, any and all verified substance abuse complaints were dealt with accordingly and reported publicly – even if they were enrolled in private treatment programs.
Measures May Be Underreported Due to the NPDB Reporting Process
It’s important to consider that, despite the large, comprehensive dataset, this may actually be an underrepresentation of the addiction problems among healthcare professionals. While hospitals are generally required to report adverse actions, there are a few key exceptions to the rule – which may indicate that some notable offenses go unnoticed.
- Reporting to the NPDB is only required if the professionals in question are physicians or dentists. The reporting of nurses and other adjacent medical professionals is optional, largely up to the hospital or healthcare organization – indicating that numbers of those with substance abuse issues may be larger than what is advertised.
- Reporting to the NPDB is only necessary if the adverse clinical privilege actions last more than 30 days. That means any short-term suspensions of probations are left off the record.
- If the medical professional voluntarily surrenders clinical privileges but is not under any current investigation, their adverse action is not reported in the NPDB. There may be instances where physicians surrender their privileges in exchange for no investigation being conducted – despite these professionals having a serious dependency on drugs and alcohol.
Thus, while a study based on the NPDB data is valuable, it may seriously underplay the severity of the addiction issue in the healthcare community.
About the Data
Our data came from the National Practitioner Data Bank, a government-run program that collects information on medical professionals. Intended to improve the quality of health care in the nation, the NPDB shines a light on any negative actions enacted by physicians and dentists, along with any subsequent adverse actions. Examples include medical malpractice payouts and license suspensions.
Generally, all hospitals are required to report offending physicians and dentists to the NPDB. Under Title IV of Public Law 99-660, health care entities with a formal peer review must report professional review actions imposed on physicians and/or dentists. Professional review actions refer to any adverse clinical privilege actions related to professional competence or conduct.