Physicians are at a crisis point. Even before COVID-19, we saw an alarming increase in the number of doctors experiencing burnout, loss of connection, or even moral exhaustion with their work. The pandemic has only exacerbated this frustration and fatigue. CPSO recognizes the extraordinary pressures inherent in the practice of medicine, as well as the threat physician burnout poses to patient care. The pandemic has caused chaos and misery, but it also began normalizing conversations about physician mental health. As the regulator, we need to be a part of this crucial conversation. We hope this series of articles conveys our support for physicians and encourages those who need help to seek it out. Also in this series: Reclaiming Herself and Pandemic and Mental Health.

Ensuring a safe pathway to help

By any measure, Dr. George Photopoulos should not be alive today.

And yet here he is, radiating happiness and good health, and talking openly about how his eight-year addiction took him to a very dark place.

In the worst days of his disease, he was taking 90 Percocets a day. To keep himself awake, he would consume 240 mg of Dexedrine once to twice a day. And then at night, in order to sleep, he would wash a handful of benzodiazepines down with vodka.

“How is that I am still alive?” asks the 57-year-old Toronto family physician. “I should have gone through at least two or three livers with that amount of abuse. I was a complete and utter nightmare … just on the precipice of catastrophe,” he remembers.

Reeling from a painful divorce and practising in a way that he no longer loved, Dr. Photopoulos says he was simply trying to numb the pain.

“I’m a doctor and doctors don’t ask for help. I was prepared to self-destruct, to go down with the ship before I’d ask for help. I remember feeling so much righteous indignation, which is very common for addicts. My feeling was ‘I’ll show you all — I’ll hurt me,’” he remembers.

It was his receptionist who called CPSO to make a complaint that her boss was an addict who was putting his patients at risk.

It was an action that Dr. Photopoulos is grateful for today. At the time, however, he was scared. With CPSO now involved, Dr. Photopoulos says he was terrified of losing his license. “I started to feel the noose tighten around my neck.”

He and his lawyer decided to be proactive. He volunteered to take the steps CPSO would shortly be requiring of him — specifically, giving up his prescribing of controlled substances, undergoing several independent medical examinations and reaching out to the Ontario Medical Association’s (OMA) Physician Health Program (PHP) for help.

The next big step towards recovery, with the assistance of the PHP and his treatment providers, was residential treatment at Homewood Health Centre. He entered December 9, 2008, still simmering with anger, and five weeks later was discharged, feeling something he had not felt in years — a sense of hope.

“I felt that it was within my reach to become a better person, father and physician,” says Dr. Photopoulos.

As part of his personal accountability, he enrolled in a five-year monitoring program with the PHP and met regularly with his PHP clinical coordinator. He also saw his treating clinicians, participated in self-help groups and a Caduceus group prior to a gradual return to full-time practice. He also rediscovered his passion for medicine. “I have the same enthusiasm I had when I first started practising. I look forward to helping my patients.”

This experience had an unanticipated impact, it also changed his perception of his regulatory body.

“I had always considered the College to be the 'Big Bad Wolf.' But that was not my experience throughout any of this,” he says. “The College needs to do their thing — making sure patients are safe from harm. So they wanted to make sure I was safe to practise and they wanted confirmation from the PHP that my addiction disorder was under control. Once it became clear to them that I was on a road to recovery, the College mostly stayed out of my way and just let me continue to get better.”

Even though he has had the opportunity to re-apply for his prescribing privileges for controlled substances several years ago, he has yet to do so. “Maybe I will at some point,” he says. “But honestly, it just does not feel important to me. My family practice is so busy. I certainly haven’t had any trouble attracting patients to my practice.”

Dr. Photopoulos is convinced that if he had remained on the road he was travelling, he would not be alive today. He credits his participation in the PHP for saving his life. “They were there for me 110%, advocating for me professionally and personally.”

With the stresses of practising medicine exacerbated by the COVID-19 pandemic, he is worried about his peers who have been brought dangerously close to the edge of their ability to cope.

“I am sure that there are so many physicians who are suffering in silence. I urge them to get help. I think of the years that I lost because I was afraid to say I needed help. I endured so much unnecessary pain,” he says.

Too many physicians remain wary of seeking help for burnout or health issues for fear of the detrimental impact it may have on their ability to renew or retain their medical license or hospital privileges. Feeling overwhelmed, depressed or anxious and believing there is no safe place to seek help compounds their suffering and increases the risk to them, often impacting their family and potentially, their work.

CPSO and the PHP recognize that mental health and substance use conditions are illnesses that deserve treatment and care and ensuring a safe pathway to help is critical, says Dr. Janet van Vlymen, College President. “CPSO supports the expertise of the PHP and in many cases, the PHP will assist physicians in safely returning to work within a monitored program without CPSO’s involvement or even awareness,” she said.

CPSO is unequivocal in offering its full support and encouragement to those who reach out for help in managing their mental health.

“The College has a duty to protect the public interest, which includes ensuring that members are healthy enough to practise safely and not pose any risk to their patients. But that duty goes together with our goal of ensuring physicians can get the help they need. An unwell physician who is not addressing their health concerns can put patients at risk,” said Dr. van Vlymen.

“No physician should feel they need to walk this road alone. Help is available,” she continued.

The PHP services provide confidential support for doctors who are struggling with mental health concerns, substance abuse and other behaviours that can impact their personal and professional lives. Sometimes, doctors make the call to PHP anonymously. Often, they call because they have been urged to by a treating health care professional, a family member, a training program or workplace. Others reach out because they are concerned about a colleague.

The PHP will assist, support and connect physicians to the help they need and deserve.

A physician, medical learner or family member can directly reach out by email or phone and speak with highly trained clinical staff who can assist with the next step. Services available are:        

1. Intake which connects the caller to a health or wellness resource (e.g., psychiatrist, addiction medicine physician, therapist, coach etc.) and
2.  Assistance with accountability needs by carrying out assessments or following an individual prospectively in PSAAP — Physician Support Advocacy and Accountability Programs (formerly known as “monitoring”).

A PHP study published in the BMJ in 2008 found that more than 80 percent of the doctors in the program were in remission from substance use problems after five years. Doctors with mental health conditions can also get personal support by contacting the PHP, and it is also possible to enter into an agreement for support and advocacy.

The pandemic illustrates the importance of having safe places to call, as calls to the PHP in 2021 were more than 25 percent higher than pre-pandemic levels.

“It’s incredibly important for learners, early career and even experienced physicians to have a safe space to express themselves without fear of professional or personal harm,” says Dr. Adam Kassam, OMA President. “I am thankful that a resource like the Physician Health Program exists to support our members who often bear the brunt of trauma, as they help others.”

If you need help, please call or reach out to the PHP at php@oma.org or 1-800-851-6606. 
If you are interested in accepting a distressed physician, resident or medical student into your practice, please reach out to the PHP at php@oma.org or 1-800-851-6606