Fitness-for-Duty Evaluations of Physicians and Health Care Professionals: Treating Providers and Protecting the Public

  • Marilyn Price
  • Donald J. Meyer


Health care providers practicing their profession with reasonable skill and safety is essential for the safety and well-being of the public. Physicians and other health care professionals may have their fitness for duty questioned by a variety of agencies tasked with oversight of the behavior of health care professionals. Mental health clinicians performing a fitness-for-duty evaluation of a physician or other health care professional will be required to conduct a comprehensive assessment, taking into account the impact of any disabling conditions, and provide opinions regarding the prognosis with treatment, the side effects of treatment, and the present and future impacts on the practice of medicine. The evaluating clinician will be asked for recommendations about whether treatment or professional workplace supervision may be needed to decrease the risk of future deterioration of professional capacities.


Fitness for duty Physician impairment Disruptive behavior State Medical Boards Physician Health Programs Discipline Diversion 


  1. Alexander, B.H., Checkoway, H., Nagahama, S.I., et al.: Cause–specific mortality risks of anesthesiologists. Anesthesiology 93, 922–930 (2000)PubMedCrossRefGoogle Scholar
  2. American Board of Medical Specialties: Board Certification Editorial Background. Accessed 12 Dec 2011
  3. American Medical Association. Model medical staff code of conduct: https// Accessed 12 Dec 2011, Revised 24 May 2010
  4. American Medical Association Opinion E-9.0305 Physician Health and Wellness: American Medical Association., Accessed 2 Feb 2012, Issued June 2004
  5. American Medical Association Opinion on Professional Rights and Responsibilities E-9.045 Physicians with Disruptive Behavior: American Medical Association. Accessed 2 Feb 2012, Issued Dec 2000
  6. American Medical Association: Physician Characteristics and Distribution in the U.S. AMA Press, Chicago (2002–2003)Google Scholar
  7. American Psychiatric Association: The Diagnostic and Statistical Manual of Mental Disorder, 4th edn. (Text revision). American Psychiatric Association, Washington, DC (2000)Google Scholar
  8. Anfang, S.A., Faulkner, L.R., Fromson, J.A., et al.: The American Psychiatric Association’s resource document on guidelines for fitness-for-duty evaluations of physicians. J. Am. Acad. Psychiatry Law 33(1), 85–88 (2005)PubMedGoogle Scholar
  9. Buhl, A., Oreskovich, M.R., Meredith, C.W., et al.: Prognosis for the recovery of surgeons from chemical dependency, a 5 year outcome study. Arch. Surg. 146(11), 1286–1291 (2011)PubMedCrossRefGoogle Scholar
  10. Bryson, E.A.: Should anesthesia residents with a history of substance abuse be allowed to continue training in clinical anesthesia? The results of a survey of anesthesia residency program directors. J. Clin. Anesth. 21, 508–513 (2009)PubMedCrossRefGoogle Scholar
  11. Collins, C.B.: Chemical dependency treatment outcomes of residents in anesthesiology: Results of a survey. Anesth. Analg. 101, 1457–1462 (2005)PubMedCrossRefGoogle Scholar
  12. Cummings, S.M., Merlo, L., Cottler, L.: Mechanisms of prescription drug diversion among impaired physicians. J. Addict. Dis. 30(3), 195–202 (2011)PubMedCrossRefGoogle Scholar
  13. DesRoches, C.M., Rao, S.R., Fromson, J.A., et al.: Physicians’ perceptions, preparedness for reporting, and experiences related to impaired and incompetent colleagues. JAMA 304(2), 187–193 (2010)PubMedCrossRefGoogle Scholar
  14. Domino, K.B., Hornbeim, T.F., Polissar, N.L.: Risk factors for relapse in health care professionals with substance abuse disorders. JAMA 293(12), 1453–1460 (2005)PubMedCrossRefGoogle Scholar
  15. Dupont, R.L., McLellan, A.T., White, W.L., et al.: Setting a standard for recovery: Physicians’ health programs. J. Subst. Abuse Treat. 36, 159–171 (2009a)PubMedCrossRefGoogle Scholar
  16. DuPont, R.L., McLellan, A.T., Carr, G., et al.: How are addicted physicians treated? A national survey of Physician Health Programs. J. Subst. Abuse Treat. 37(1), 1–7 (2009b)PubMedCrossRefGoogle Scholar
  17. Epstein, R.H., Gratch, D.M., Grunwald, A.: Development of a scheduled drug diversion surveillance system based on an analysis of atypical drug interactions. Anesth. Analg. 105, 1053–1060 (2007)PubMedCrossRefGoogle Scholar
  18. Farber, N.G., Gilbert, S.G., Aboff, B.M., et al.: Physicians’ willingness to report unimpaired colleagues. Soc. Sci. Med. 61(8), 1772–1775 (2005)PubMedCrossRefGoogle Scholar
  19. Federation of State Medical Boards of the United States, Inc.: A Guide to the Essentials of the Modern Medical and Osteopathic Practice Act. http://fsmb/org/pdf/GRPOL_essentials.pdf (2009). Accessed 12 Dec 2011
  20. Federation of State Medical Boards of the United States, Inc.: Addressing Sexual Boundaries: Guidelines for State Medical Boards. http://fsmb/org/pdf/GRPOL_Sexual%20Boundaries.pdf (2006). Accessed 12 Dec 2011
  21. Federation of State Medical Boards of the United States: Policy on Physician Impairment. Accessed Apr 2011Google Scholar
  22. Federation of State Medical Boards of the United States: Summary of 2011 Board Activities. Accessed 17 Mar 2012
  23. Federation of State Physician Health Programs: Physician Health Program Guidelines (2005). Accessed 12 Dec 2011
  24. Flaherty, J.A., Richman, J.A.: Substance use and addiction among medical students, residents, and physicians. Psychiatr. Clin. N. Am. 16(1), 189–197 (1993)Google Scholar
  25. Gabbard, G.O.: Psychotherapists who transgress boundaries with patients. Bulletin of the Menninger Clinic 58, 124–135 (1994)Google Scholar
  26. Gold, L.H., Anfang, S.A., Drukteinis, A.M., et al.: AAPL practice guideline for the forensic evaluation of psychiatric disability. J. Am. Acad. Psychiatry Law 36(4), S3–S50 (2008)PubMedGoogle Scholar
  27. Gold, M.S., Graham, N.A., Goldberger, B.A.: Second-hand and third-hand drug exposures in the operating room: A factor in anesthesiologists’ dependency on fentanyl. J. Addict. Dis. 29, 280–281 (2010)PubMedCrossRefGoogle Scholar
  28. Grant, D., Alford, K.: Sanction and recidivism: An evaluation of physician discipline by State Medical Boards. J. Health Polit. Policy Law 35(1), 867–855 (2007)CrossRefGoogle Scholar
  29. Heath Care Quality Improvement Act, 42 U.S.C. 11101 ct seq (1986)Google Scholar
  30. Hickson, G.B., Federspeil, C.F., Pichert, J.W., et al.: Patient complaints and malpractice risks. J. Am. Med. Assoc. 287(22), 2951–2957 (2001)CrossRefGoogle Scholar
  31. Hilliard, J.T.: The threat worse than malpractice. Med. Econ. 80, 38 (2003)PubMedGoogle Scholar
  32. Hughes, P.H., Brandenburg, N., Baldwin, D.C., et al.: Prevalence of substance use among US physicians. JAMA 267(17), 2333–2339 (1992)PubMedCrossRefGoogle Scholar
  33. Irons, R.: The behaviorally disruptive professional. Paradigm Summer, 6–7 (2001)Google Scholar
  34. Janofsky, J.S.: Competency to practice and licensing. In: Buchanan, A., Norko, M.A. (eds.) The Psychiatric Report, Principals and Practice of Forensic Writing, pp. 145–157. Cambridge University Press, Cambridge (2011)CrossRefGoogle Scholar
  35. Jesilow, P., Ohlander, J.: The impact of the National Practitioner Data Bank on licensing actions by state medical licensing boards. J. Health Hum. Serv. Adm. 33(1), 94–126 (2010)PubMedGoogle Scholar
  36. Jost, T.S.: Legal issues in quality of care oversight in the United States: Recent developments. Eur. J. Health Law 10, 11–25 (2003)PubMedCrossRefGoogle Scholar
  37. The Joint Commission: Issue 40: Behaviors that undermine a culture of safety issued 9 July 2008. (2008). Accessed 2 Feb 2012
  38. The Joint Commission: Leadership in healthcare organization. A guide to Joint Commission leadership standards: A governance institute white paper, Winter 2009 Governance Institute San Diego. (2009). Accessed 2 Feb 2012
  39. Knight, J.R., Sanchez, L.T., Sherritt, L., et al.: Outcomes of a monitoring program for physicians with mental and behavioral health problems. J. Psychiat. Pract. 13(1), 25–32 (2007)CrossRefGoogle Scholar
  40. Kohatsu, N.D., Gould, D., Ross, L.K., et al.: Characteristics associated with physician discipline: A case control study. Arch. Intern. Med. 164, 653–658 (2004)PubMedCrossRefGoogle Scholar
  41. Kissoon, N., Lapenta, S., Armstrong, G.: Diagnosis and therapy for the disruptive physician. Physician Exec. 28, 54–58 (2002)PubMedGoogle Scholar
  42. Krizek, T.J.: The impaired surgical resident. Surg. Clin. N. Am. 84(6), 1587–1604 (2004)PubMedCrossRefGoogle Scholar
  43. Kuerer, H.M., Eberlein, T.J., Pollock, R.E., et al.: Career satisfaction, practice patterns and burnout among surgical oncologists: Report on the quality of life of members of the Society of Surgical Oncology. Ann. Surg. Oncol. 14(11), 3043–3053 (2007)PubMedCrossRefGoogle Scholar
  44. Leape, L.L., Fromson, J.A.: Problem doctors: Is there a system-level solution? Ann. Int. Med. 144, 107–115 (2006)Google Scholar
  45. Mass. Gen. Laws Ann. ch. 112 § 5f (Westlaw, Current through Chapter 102 of the 2012 2nd Annual Session)Google Scholar
  46. McLellan, A.T., Skipper, G.S., Campbell, M., et al.: Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. BMJ 337, 1–6 (2008)CrossRefGoogle Scholar
  47. Merlo, L.J., Greene, W.M.: Physician views regarding substance use-related participation in a state physician health committee. Am. J. Addict. Psychiatry 19, 529–533 (2010)CrossRefGoogle Scholar
  48. Meyer, D.J., Price, M.: Forensic psychiatric assessments of behaviorally disruptive physicians. J. Am. Acad. Psychiatry Law 34(1), 72–81 (2006)PubMedGoogle Scholar
  49. Meyer, D.J., Price, M.: Peer review committees and state licensing boards: Responding to allegations of physician misconduct. J. Am. Acad. Psychiatry Law 40, 193–201 (2012)Google Scholar
  50. National Practitioner Data Bank, 42 U.S.C. 11101 ct seq (1986)Google Scholar
  51. North Carolina Medical Board: Survey of the effect of disciplinary actions on board certification. Accessed 12 Dec 2011
  52. Patel, P., Robinson, B.S., Novicoff, W.M., et al.: The disruptive orthopedic surgeon: Implications for patient safety and malpractice liability. J. Bone. Joint Surg. Am. 93, e126(1–6). (2011)
  53. Pelton, C., Lang, D.A., Nye, G.S., et al.: Physician diversion program experience with successful graduates. J. Psychoact. Drugs 25(2), 159–164 (1993)CrossRefGoogle Scholar
  54. Pfifferling, J.H.: Physicians’ disruptive behavior: Consequences for medical quality and safety. Am. J. Med. Qual. 203, 96–105 (2008)Google Scholar
  55. Piper, L.E.: Addressing the phenomenon of disruptive physician behavior. Health Care Manag. 22, 335–337 (2003)Google Scholar
  56. Roback, H.B., Strassberg, D., Iannelli, R.J., et al.: Problematic physicians: A comparison of personality profiles by offense type. Can. J. Psychiatry 52(5), 315–322 (2007)PubMedGoogle Scholar
  57. Roberts, L.W., Warner, T.D., Rogers, M., et al.: Medical student illness and impairment: A vignette-based survey study involving 955 students at 9 medical schools. Compr. Psychiatry 46(3), 229–237 (2005)PubMedCrossRefGoogle Scholar
  58. Rose, G.L., Brown, R.E.: The impaired anesthesiologist: Not just about drugs and alcohol anymore. J. Clin. Anesth. 22, 179–384 (2010)CrossRefGoogle Scholar
  59. Rosenstein, A.H., Russell, H., Lauve, R.: Disruptive physician behavior contributes to nursing shortage. Physician Exec. 28(6), 8–11 (2002)PubMedGoogle Scholar
  60. Rosenstein, A.H.: Nurse-physician relationship: Impact on nurse satisfaction and retention. Am. J. Nurs. 102(6), 26–34 (2002)PubMedCrossRefGoogle Scholar
  61. Rosenstein, A.H., O’Daniel, M.: A survey of the impact of disruptive behaviors and communication defects on patient safety. Jt. Comm. J. Qual. Patient Saf. 34(8), 464–471 (2008a)PubMedGoogle Scholar
  62. Rosenstein, A.H., O’Daniel, M.: Managing disruptive physician behavior: Impact on staff relationships and patient care. Neurology 70(17), 1564–1570 (2008b)PubMedCrossRefGoogle Scholar
  63. Rosenstein, A.H.: The quality and economic impact of disruptive behaviors on clinical outcomes of patient care. Am. J. Med. Qual. 26(5), 372–379 (2011)PubMedCrossRefGoogle Scholar
  64. Rosenstein, A.H., Naylor, B.: Incidence and impact of physician and nurse disruptive behaviors in the emergency room. J. Emerg. Med. (March 19 published online ahead of print, 2011)Google Scholar
  65. Schwenk, T.L., Gorenflo, D.W., Leja, L.M.: A survey on the impact of being depressed on the professional status and mental health care of physicians. J. Clin. Psychiatry 69(4), 617–620 (2008)PubMedCrossRefGoogle Scholar
  66. Shore, J.H.: The Oregon experience with impaired physicians on probation: An eight-year follow-up. JAMA 257(21), 2931–2934 (1987)PubMedCrossRefGoogle Scholar
  67. Stelfox, H.T., Ghandi, T.K., Orav, J., et al.: The relation of patient satisfaction with complaints against physicians, risk management episodes and malpractice lawsuits. Am. J. Med. 118(10), 1126–1133 (2005)PubMedCrossRefGoogle Scholar
  68. Substance Abuse and Mental Health Services Administration. Results from the 2009 National Survey on Drug Use and Health: Summary of National Findings, vol. 1. Accessed 20 Dec 2011
  69. Wall, B.W.: Commentary: The clinical implications of doctors evaluating doctors. J. Am. Acad. Psychiatry Law 33, 89–9 (2005)PubMedGoogle Scholar
  70. Waters, T.M., Parsons, J., Warnecke, R., et al.: How useful is the information provided by the National Practitioner Data Bank? Jt. Comm. J. Qual. Saf. 29, 416–4 (2003)PubMedGoogle Scholar
  71. Wettstein, R.M.: Commentary: Quality improvement and psychiatric fitness-for-duty evaluations of physicians. J. Am. Acad. Psychiatry Law 33, 92–94 (2005)PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Beth Israel Deaconess Medical CenterHarvard Medical SchoolBoston MAUSA

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