Study: does job choice cause drug use among physicians?

Physicians tend to be physically healthy, but research indicates that they suffer disproportionately from substance abuse disorder and mental health problems. But is the choice of profession responsible for these things? Would doctors who overuse prescription drugs have done so had they chosen to become, say, engineers?

Is it the people, in other words, or the job?

An international research quartet believes it has answered that question. The researchers’ findings appear in a working paper distributed this month by the National Bureau of Educational Research. “The Effects of Becoming a Physician on Prescription Drug Use and Mental Health Treatment” has not been peer-reviewed, and it has been distributed only for purposes of discussion. But its findings are intriguing, if not entirely surprising.

As economists often do, the team looked for a natural experiment. They found it in the Netherlands, where until recently a GPA-weighted lottery system determined medical school acceptance. The study examined lottery participants from 1987 until 1999, when medical schools were given more control over admissions.

To measure prescription drug use, the researchers used a database that contains information on all people for whom the Netherlands’ national insurance program provides drugs. The period in question extended from 2006 to 2018. The researchers collected information about mental health treatment from a similar database.

So, what did they find?

In short, it’s the job.

Becoming a physician increases the use of antidepressants, opioids, anti-anxiety mediations and especially sedatives. And for female physicians with relatively low incoming grade point averages, joining the profession increases the likelihood of receiving treatment from a mental health facility.

The study did not seek to explain these results, though the paper points to a number of likely causes. Doctors work long and irregular hours, which can affect sleep and relationships. Malpractice lawsuits take a psychological toll. Recent increases in administrative work, coupled with the adoption of electronic health records, contribute to burnout. Meanwhile, female physicians experience sex-based harassment and added pressure to balance responsibilities related to family and work.

The paper’s authors are D. Mark Anderson, an associate professor in the Montana State University Department of Agricultural Economics and Economics; Raymond Montizaan, a researcher at Maastricht University in the Netherlands; Ron Diris, an assistant professor in economics at Leiden University in the Netherlands; and Daniel Rees, a professor of economics at the Universidad Carlos III de Madrid in Spain.

The paper is available for download on the website of the National Bureau of Economic Research.

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