Pre-placement screening of resident physicians by substance abuse testing: Efficacy, cost, and physician opinions

Abstract

Aims: There is a high risk of physicians developing a chemical dependence. Detection of chemically dependent resident physicians is difficult. Our objective was to assess our experience with pre-placement substance-abuse screening of resident physicians and their attitudes about this procedure. We hypothesized that the frequency of positive pre-employment screening test was low and that resident physicians were generally sympathetic towards testing.

Methods: A population study of drug and alcohol testing and a population-based sample of attitudes towards this testing were performed at an academic health center. Our hospital did pre-placement drug and alcohol testing of 2329 prospective resident physicians from 1997–2004. We tested saliva and urine for alcohol, amphetamines, marijuana, phencyclidine, cocaine, and opiates. A modified form of The Attitudes Towards Employment Screening for Drugs Scale (ATESDS), using a Likert scale, was created for use with resident physicians. It was placed on a website accessible to our hospital's resident physicians for two and a half weeks in 2005 and they received three electronic reminders to complete the survey instrument. The main outcome measures were the incidence of positive pre-placement drug and alcohol tests and responses to the modified ATESDS questionnaire.

Findings: In the first eight years that the pre-placement program existed, there was one confirmed positive test for marijuana out of 2329 individuals tested (0.04%). The total cost to find this one case was $93,160. The North Carolina Physicians Health Program reports that no resident physicians have been referred to them because of pre-placement substance abuse testing from any North Carolina residency program, including ours, in the last six years. Results from the 301 survey respondents (36% response rate) indicated that the requirement for pre-employment drug testing has very little effect on resident physician's decision making in the residency match, is viewed as generally equitable, and not embarrassing. Respondents did not think that testing had a major impact on workplace safety or organizational efficiency, and felt that a major motivating factor for testing was the creation of a positive public attitude towards the hospital.

Conclusions: The resident physicians responding to the questionnaire were favorably disposed to pre-employment drug tests. Pre-employment drug testing, however, has a low yield and is not a replacement for a comprehensive campaign against impaired resident physicians.