Emily Zarse, MD

By Richard Gunderman, MD, PhD
ISMA President-elect
ISMA Wellness Steering Committee Chair

As humans, physicians are not immune to the same mental health problems, substance use disorders, and disruptive behaviors that afflict many patients. For physicians facing such challenges, the ISMA Physician Assistance Program (PAP) offers a lifeline that includes screening, referral for evaluation and treatment, and case management and monitoring services. Providing medical oversight of the PAP is ISMA’s Commission on Physician Assistance (COPA).

As of November, the new medical consultant for the PAP is Emily Zarse, MD, former COPA chair since 2021.  A native of Bloomington, Dr. Zarse graduated from the Indiana University School of Medicine and completed her psychiatry residency and fellowship at IU before becoming director of the addiction medicine fellowship at Community Health Network. This was the state’s first such fellowship, and she has been serving as director since 2021.  
She first identified her passion for addiction medicine in her third year of medical school. 

“I realized that this field touches all kinds of patients in virtually every medical field,” Dr. Zarse said. “For example, addiction precipitates many emergency department visits for overdoses, withdrawal, and accidents. And there are so many barriers to access, including not just cost and availability of services, but also the stigma often associated with addiction.”
Dr. Zarse sees in addiction medicine the opportunity to address some of the fundamental challenges that drew her into medicine in the first place. 

“When I came to medical school, I was most interested in preventing disease,” she said. “We still have a lot of work to do in preventing addiction, but if we can foster recovery relatively early in life, before people have children, we can stop it in its tracks, preventing it from becoming intergenerational.”

She cites this as one of the most rewarding aspects of addiction medicine. 

“When you help one person, you often help a whole family,” Dr. Zarse said. “Other members are less likely to develop addictions themselves, and everyone is spared the social and economic traumas of living with someone in its throes. Such people tend not to have much support and to be stigmatized, so helping them is really gratifying.”

One key, she says, is to ensure that individuals struggling with addiction have someone who listens and cares. She mentions a patient who grew up with both a father and brother who were users. He suffered an injury and ended up on prescription opioids, and once he could no longer obtain those, he began using illicit opioids. Eventually, despite losing both his father and brother to addiction, he achieved sobriety and is now recognized as a top performer at his work.

Another key is simply to get people to come back. Some patients will relapse and be lost to follow-up. But no matter how far they stray, they need to know they have a place and a health professional they can return to. They need to be held accountable, but they should never feel abandoned. Sometimes they will come back months or years later, and each time, there is an opportunity to help them change their lives.

As for COPA’s mission to care for physicians, Dr. Zarse says one of the greatest barriers physicians face is shame. 

“They are not alone,” she said. “We want to show them that building connections is the key to recovery. Our mission is to be here for them and accompany them on what to many can otherwise seem a very lonely journey. We do not want physicians to feel like the PAP is any kind of punishment. We are 100 percent pulling for them, not against them. We are here to help them toward recovery and to continue practicing medicine.” 

Just as physicians must earn their patients’ trust, the PAP works hard to earn the trust of the physicians it assists, which means “being open and honest and addressing questions directly.” 

She describes COPA as a learning community in which members teach and learn from one another. It is very gratifying to help an individual physician, she says, but by enabling a physician facing difficulties to return to practice, the program is also indirectly helping hundreds and thousands of patients for whom each physician can continue to care. Keeping just one physician in practice can make a huge difference for a community.  

“It is really rewarding,” Dr. Zarse said. “We take someone who has felt alone, ashamed, and paralyzed by stigma and begin to get them the help they need. Most people think this must be very hard work, and it can be, but helping people in such situations provides a regular reminder of why we do it. People carry the lessons they learn for the rest of their lives, and when the one we help is a physician, those same lessons get shared with many more people.”