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POSTED: December 17th, 2025
POSTED IN: 2025 EM Pulse - Q4, EM Pulse - The Official Newsletter of MOCEP, forum, Forum Topic,

Emergency Medicine practitioners operate in high-stakes environments where rapid decision-making, emotional resilience and physical endurance are essential. Burnout is common and driven by individual, department, and systemic factors. Increasing administrative demands and EHR burdens reduce meaningful patient interaction — a core motivator for entering medicine. EM clinicians also face additional stressors: extreme fatigue from complex decision-making under pressure, dissatisfied patients who have extended waits, workplace violence, and constant exposure to patient suffering, trauma, and death. 

The consequences of the impairment that burnout causes can be profound: increased medical errors, reduced quality of care, lower patient and employee satisfaction, absenteeism, turnover, and diminished productivity.^1,2,3 On a personal level, burnout can also lead to depression, anxiety, substance use disorders, broken relationships, and even suicide.⁴

Impairment Beyond Burnout

Clinician impairment can also result from substance use disorders, mental illness, or age-related cognitive decline. The lifetime prevalence of substance misuse among physicians is around 10-15%, with alcohol being the most common.⁵ Prescription drug misuse is also a concern due to increased access.

Impairment compromises a clinician’s ability to provide safe care and often affects personal relationships. That’s why comprehensive, stigma-free well-being strategies are essential in today’s health care landscape.

Strengthening Missouri’s Healthcare Workforce: Aligning Health System Well-Being Strategies with the Missouri Medical Professionals Health and Wellness Program (MO PHP)

Given the intensity of medicine, clinician well-being isn’t optional – it’s foundational. In 2019, the University of Missouri Academic Health System opened the Office of Well-Being (OWB) to support physicians; today, OWB is available to all team members, and well-being is a system-wide strategic priority. What began as skepticism about the role of Chief Wellness Officer and health care well-being has evolved into a shared understanding: our mission of saving and improving lives depends on the health and well-being of our health care workforce.

Long before OWB existed, Mizzou’s academic health system relied on the statewide Missouri Physician and Health Professionals Wellness Programs—now MO PHP. Today, OWB and MO PHP collaborate to provide a comprehensive, trauma-informed safety net for Mizzou’s health care workforce, offering a model Missouri health systems can adapt. When internal resources are limited or when clinicians prefer support outside of their workplace, MO PHP stands ready to help. MO PHP addresses impairment with discretion and expertise, ensuring healthcare professionals receive care before patient safety is at risk. The program offers confidential, compassionate, and expert assistance to Missouri’s licensed health professionals and learners, helping safeguard well-being while maintaining safe, high-quality care.

MO PHP Mission and Structure

MO PHP is a donation-funded, integrity-driven program offering confidential services to physicians, residents, fellows, medical students, advanced practice providers (APPs), and other allied healthcare professionals across Missouri. With a highly specialized team, it provides early intervention, treatment coordination, and long-term monitoring for burnout, mental health concerns, and substance use issues. The program is non-punitive and restorative—prioritizing recovery and sustainable return-to-practice, strengthening the well-being and longevity of Missouri’s healthcare workforce. Operating under legislative authority and guided by protocols modeled after the Federation of State Physician Health Programs (FSPHP) and endorsed by the American Medical Association (AMA), MO PHP upholds the highest standards of confidentiality, compassion, and professional integrity.

Evidence-Based Guidelines and Treatment

MO PHP has developed evidence-based, comprehensive guidelines for intervention, treatment recommendations, drug screening, and aftercare tailored to healthcare professionals. When impairment is suspected, clinicians undergo a full evaluation by board-approved programs that specialize in treating medical professionals, often at a higher level of intensity than the general population. Throughout recovery, participants are monitored closely, and MO PHP ensures a safe, sustainable return to practice. This rigorous approach yields strong outcomes: A previous study showed that 81% of participants who completed treatment maintained sobriety for five years. ⁶

Referral and Intervention

Referrals to MO PHP come from many sources, including self-referrals, family, colleagues and attorneys. When colleagues suspect impairment or distress, a stepwise approach is encouraged: if patient harm is not imminent, a direct conversation may be appropriate. When there is concern for potential or actual harm, reporting to a clinical supervisor or licensing board—often anonymously — is advised.⁷

Intervention can be complicated by denial and rationalization, which are common among clinicians.⁸ Of note, female physicians with substance use disorder may be less likely to be referred for treatment, despite a higher gender association for risk of depression and suicide.⁹

Delaying or avoiding intervention results in serious consequences: patient harm, legal or professional sanctions, missed opportunities for recovery, and long-term damage to the physician’s personal and professional life. Early identification and treatment through MO PHP significantly improve outcomes.

Prevention and Wellness Services

MO PHP offers a proactive and preventative approach to physician well-being through lectures at medical schools, health systems, and conferences. At the medical school level, we help foster curricula that promote wellness as a core professional value and reduce stigma around seeing support. Additional services include additional counseling and physician coaching for distressed licensed medical professionals or families experiencing early signs of distress before impairment occurs. Professional coaching may lead to decreased emotional exhaustion and general symptoms of burnout, as well as improved resilience and quality of life.¹⁰

Strengthening Missouri’s Healthcare Workforce

Together, health system well-being initiatives and MO PHP create a trusted safety net for Missouri’s health care workforce – supporting hope, healing, recovery, and sustainable practice while protecting safe, high-quality patient care.

MO PHP is sustained entirely through donations and led by experts in wellness, addiction, case management, therapy, and clinician health. It saves lives and reduces institutional risk. For EM practitioners – who face high burnout and impairment risk – MO PHP is a vital lifeline.

Through prevention, early intervention, or long-term recovery support, MO PHP ensures Missouri’s licensed healthcare professionals receive the care deserved to continue caring for others.

Connect with MO PHP         

To learn more about our program, please visit https://www.muhealth.org/php or call 573-632-5562.

Additional resources:

• To connect with Mizzou’s Academic Health System’s Office of Well-Being: [email protected].
• Inside the rehab program helping doctors recover from addiction

References:

1. West, et al. Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. JAMA. 2006 Sep 6;296(9):1071–8. doi: 10.1001/jama.296.9.1071. [DOI] [PubMed] [Google Scholar]
2. Shanafelt, et al. Longitudinal Study Evaluating the Association Between Physician Burnout and Changes in Professional Work Effort. Mayo clinic proceedings. 2016 Apr;91(4):422–431. doi: 10.1016/j.mayocp.2016.02.001. [DOI] [PubMed] [Google Scholar]
3. Shanafelt, et al. The Business Case for Investing in Physician Well-being. JAMA Intern Med. Special Communication. Sep 25, 2017. [Accessed December 1, 2020]. https://omahamedical.com/wp-content/uploads/2017/10/The-Business-Case-for-Investing-in-Physician-Well-being.pdf. [DOI] [PubMed]
4. Dyrbye LN, Massie FS, Eacker A, et al. Relationship between burnout and professional conduct and attitudes among US medical students. JAMA. 2010;304:1173–1180. doi: 10.1001/jama.2010.1318. [DOI] [PubMed] [Google Scholar]
5. Merlo, et al. Reasons for Misuse of Prescription Medication Among Physicians Undergoing Monitoring by a Physician Health Program. J Addict Med. 2013 Sep-Oct;7(5) doi: 10.1097/ADM.0b013e31829da074. [DOI] [PMC free article] [PubMed] [Google Scholar]
6. McLellan AT, Skipper GS, Campbell M, DuPont RL. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. BMJ. 2008;337:2038–2044. doi: 10.1136/bmj.a2038. [DOI] [PMC free article] [PubMed] [Google Scholar]
7. Candilis, et al. Physician Impairment and Rehabilitation: Reintegration Into Medical Practice While Ensuring Patient Safety: A Position Paper From the American College of Physicians. Ann Intern Med. 2019;170(12):871–879. doi: 10.7326/M18-3605. [DOI] [PubMed] [Google Scholar]
8. Substance use disorders in physicians: Epidemiology, clinical manifestations, identification, and engagement. UpToDate; Oct, 2020. [Accessed December 1, 2020]. https://www.uptodate.com/contents/substance-use-disorders-in-physicians-epidemiology-clinical-manifestations-identification-and-engagement. [Google Scholar]
9. Wunsch, et al. Women physicians and addiction. J Addict Dis. 2007;26:35. doi: 10.1300/J069v26n02_05. [DOI] [PubMed] [Google Scholar]
10. Dyrbye, et al. Effect of a Professional Coaching Intervention on the Well-being and Distress of Physicians A Pilot Randomized Clinical Trial. JAMA Intern Med. 2019;179(10):1406–1414. doi: 10.1001/jamainternmed.2019.2425. [DOI] [PMC free article] [PubMed] [Google Scholar]

DISCLOSURE: This paper draws upon an article first published in Missouri Medicine: The Journal of the Missouri State Medical Association and is published with permission. In some passages, text is taken verbatim from that article.