Addiction and Physicians - Why Having an MD Doesn't Make You Special

Haven't posted much lately, though not necessarily by intention. Life's been very crazy lately, but in a very good way.

Wanted to touch on a story that's rightfully making the rounds on social media, of a Canadian physician talking about his addiction to Fentanyl. Fentanyl is the new addict drug of choice in much of Canada, particularly in southern Ontario. It's been building for a few years. Every conversation I have with those in addictions or drug enforcement says that this is where we're seeing a big focus. It's a very powerful narcotic, one that's definitely overprescribed, and it has numerous routes of absorption. In many ways, it's the most recent culmination of the wider opioid crisis that's been growing for decades now.

Dr Gebien's tale is worth reading for its account of the devastating effects of opioid addiction, and the hubris of physicians who think they're immune to such common human failings. On the former point, there's enough written by more knowledgeable people than me that I won't say much besides a reiteration that I want my practice to be very opioid-averse. As far as I'm concerned, unless something's going to cure your pain very soon (usually by an operation of some sort), or we expect you to die at some point in the near future, I have trouble seeing the role of opioids. They don't work well long term, they're addictive, and they come with tons of side-effects. They're not really a treatment for pain, they're a way to stall it in the short-term.

On the second point, it can't be emphasized enough - doctors are human and we fall victim to all the things humans fall victim to, including addiction. One particular point to mention about this story is the hazards of self-prescribing. Physicians are not supposed to treat anyone who isn't their patient, including themselves. That means no treating family or friends except in very unique circumstances. That means no treating co-workers. That means no treating fellow physicians unless they're in your office for a valid reason. I can't say how often I've seen a physician write off a prescription to one of their colleagues based on that colleague's word alone. No history. No physical. No investigations. Just "I need this script, can you help me out?", and bam, done. In one instance, a physician asked a colleague for a medication for their child, effectively treating their own kid with the help of a fellow physician who never even laid eyes on that child! Don't do this. Yes, it sucks to have to go to your GP to get a simple script. Yes, you know exactly what needs to be done. You know who else it sucks for to have to do that? EVERYONE! Being a physician should not get you a fast track to basic medical care, nor should it allow you to skip the basic components of treatment, such as a proper evaluation. Please, colleagues, supervisors, and anyone coming afterwards, just don't do this, and don't help others do this. It's unethical and can lead to some very dark outcomes.

There's a few other elements to this story that deserve a quick mention, since they probably contributed to his situation and are much more common traps for physicians to fall into then addiction. First is proper money management. He was making $300k a year and needed parental assistance to cover two rehab-related bills of $10k and $80k, in addition to needing to put $35k on a line-of-credit. Everyone, regardless of profession, should have an Emergency fund of at least 6 months of living expenses, ideally 1 year's worth. In his case, it doesn't sound like he had anywhere close to that. I don't doubt that a fair bit of money was going to feed or hide is addiction. Yet, there are other clear missteps. Buying a large house, luxury cars, and a boat weren't necessary and probably weren't affordable. Even if your means are great, you still need to live within them.

Secondly, this story highlights the need for a robust support system. Here we see only one side of the story, so it's hard to draw conclusions, but I don't get the sense of a reliable base of support from Dr Gebien's wife or parents. Their relationships seem dysfunctional and his mother, who looked to be dealing with her own problems of opioid use, was an enabler in his addiction. Building connections with reliable people before, during, and after medical training is important. Equally important is picking the right partner - they're the one family member you get to choose.

Overall, Dr Gebien's story serves as an excellent case study in the hazards of being a physician, and the failings too many of us assume we'll avoid just by having an MD after our names. He doesn't come across well in telling his own story, and there are numerous areas to find fault in beyond just his addiction. Yet, that makes his story all the more valuable to share. Being a doctor doesn't make anyone special, better, or more capable at handling the challenges of life. When physicians start to think that it does, they start engaging in behaviours that are destructive to their own lives or, as Dr Gebien's story briefly mentions, the lives of loved ones and colleagues. Staying grounded, staying humble, and remaining self-critical of our own behaviours is critical for physicians.

Comments on the Match

With the match now over and my class now aware of their results, we've had a bit of time to decompress and look ahead to residency preparations. On that latter point, there is a lot to get done - forms to fill out, organizations to sign-up with, some certifications to arrange, figuring out how to get paid (but yay, money!).

While I know where most of my class is headed now, it's all been through voluntary disclosures, which means I pretty much only know about my classmates who are happy with their results (and all the classmates I'm closer to all matched). Seems like my school had a pretty good year, but I know I'm only getting a partial picture. We do get a debrief on the school's overall match results soon, so I'll know more then. Here's hoping my class did as well as I think they did, and those who didn't match are getting enough support for the next steps.

I wanted to comment quickly on the only match stats we have at this time - the list of spots left unfilled from the 1st iteration. Interpretation of these is always a bit hazardous, as these positions mix both the CMG and IMG unfilled positions together. You can make some inferences, but there's naturally a bit of guesswork.

Some of the results aren't terribly surprising. There's a handful of positions left in the smaller, more technical fields with poorer job prospects. There's a few positions in typically competitive fields (like Derm) that are most likely IMG spots that were intentionally left unfilled. And there's the crush of positions in Quebec that go habitually unfilled as Quebec oversupplies its residency positions.

Some of the results aren't exactly shocking, but are notable. Internal filled almost every spot. Internal did see a jump in competitiveness last year, and the word is that trend continued in a big way this year. While this data doesn't confirm that perception on its own, it's certainly consistent with it. In the other direction, Psychiatry had a few more unfilled spots than I expected, given that it is also garnering a bit more attention. Psychiatry has been steadily gaining positions, however, and the remaining spots are generally in more remote locations - ironically, the places that are probably lacking the psychiatrists those extra positions were meant to train.

Lastly, Family Medicine had an absolute ton of unfilled spots this year. Family usually has a number, but the proportion of Family spots left open is greater than it has been in the recent past. Interest in Family, which took a bit of a dip last year, may be a bit low this year as well. That would fit with the notion that Internal has jumped in popularity - while overall competitiveness for CMGs in CaRMS has increased somewhat, Internal is a huge specialty and for it to become more competitive means other larger specialties have to get less competitive. It makes sense that a rise in interest in Internal would be coupled with a drop in interest in Family. We'll have to see when the full match stats eventually come out.

Matched

Quick update because I'm still processing the result - successfully matched today in Family Medicine to my top-choice program. Whew.

It's a huge sigh of relief, but I know it means that the real work is only just beginning. I now have a ticking clock of two short years to get myself practice-ready. It all feels very real now, but I'm pretty excited knowing that this is where the stakes get higher. Onwards and upwards and all that!