Trends in Case Complexity and Implications for Physician Health Programs: An Analysis of Referrals to the Colorado Physician Health Program

Introduction:. The Colorado Physician Health Program (CPHP) provides evaluation, diagnosis, treatment referral, and monitoring for physicians, physician assistants and anesthesiology assistants experiencing health or psycho-social problems. We examined trends in complexity of cases presenting to CPHP between fiscal years 2016-2017 and 2020-2021.Methods:. Case complexity was rated as mild, moderate, or high based on clinical and administrative complexity. Differences in complexity were examined by year and participant demographic, practice, and case characteristics, using chi-square and logistic regression analysis.Results:. Mild complexity cases declined from 57% to 14% and moderate cases increased from 25% to 73% (P<.001). Cases with high complexity (15% of cases) remained relatively stable. Complexity was higher for older participants (P=.04), primary presenting problem of DUI/DWAI (P=.01), mandatory referrals (P<.001), and longer participation (P<.001), and lower for participants with work stress/burnout (P=.04).Conclusion:. Potential reasons for the changes in complexity observed include increased stress in work settings, proposed changes in the regulatory environment that could threaten confidentiality, and the emergence of in-house wellness programs. Physician health programs need to prepare for increases in case complexity and the accompanying need for more referrals for care, higher levels of monitoring, and greater skill in diagnosing and addressing health and behavioral issues.