[MCOH-EH] [EXTERNAL] Physician Physical Impairment & Job Descriptions - Question for ListServ

[Radke, Laura L. M.D.]

Completely agree with Melanie.  I have participated both directly and indirectly in the evaluation of physicians with performance/safety concerns in the past and have worked with both employed and independent physicians with issues.  In general the hospital or physician group will pay for the cost of the evaluation, and the report can be directed either to the employee health/occupational health medical director or the medical director/VP of Medical Staff for the healthcare entity.

I have also worked with a private consulting group to assist in getting these set up outside of our healthcare system.  This helps to address concerns of confidentiality with the involved physician.  We ask the manager or human resources to provide clear descriptions of the concerns identified, any patient complaints or other employee observations.  Many times the involved physician is well aware of their impairment but needs to have another physician validate the issues before they are willing to admit their deficits.

Best of luck to you – these are difficult situations!

Laura
Laura L Radke, MD
Medical Director, F&MCW Occupational Health Services
Phone:  262-253-8197  | Fax:  262-253-5152 Cell Phone:  414-530-0723
E-mail: laura.radke at froedtert.com<mailto:laura.radke at froedtert.com>

Froedtert & the Medical College of Wisconsin Workforce Health / North Hills Health Center Building B First Floor
W129 N7055 Northfield Dr.
Menomonee Falls, WI 53051



From: MCOH-EH <mcoh-eh-bounces at mylist.net> On Behalf Of Swift, Melanie D., M.D., M.P.H. via MCOH-EH
Sent: Wednesday, January 8, 2020 9:47 AM
To: 'mcoh-eh at mylist.net' <mcoh-eh at mylist.net>
Cc: Swift, Melanie D., M.D., M.P.H. <Swift.Melanie at mayo.edu>
Subject: Re: [MCOH-EH] [EXTERNAL] Physician Physical Impairment & Job Descriptions - Question for ListServ


What you are describing is a potential patient safety concern. We see this type of situation weekly in our Physician Health Center. A hospital can certainly suspend privileges based on a credible safety concern, and can require the physician have an evaluation at an appropriate program before reinstating. Most give the physician an option of 2 - 3 places that can do the evaluation. They can (and would be wise to) require a report directly from the evaluator, even if they don’t foot the bill, but the authorization should be set up ahead of time.



Most if not all states require physicians to report to their licensing board if they have privileges suspended due to a condition that makes them unable to practice safely. The Board has more authority to require an evaluation and ongoing monitoring for progressive conditions. We frequently see physicians whose Board has required a medical evaluation.



We do need to know what procedures they do, but we don’t need a formal job description. We ask the employer to answer a few questions describing the concern, the practice, observations, and communications they've had with the physician. Our report to the employer would detail the procedures the physician and their employer/referring entity reports they are doing, and how we assessed them (e.g. simple or advanced formal simulation with an observer from their specialty, less formal simulation like a suture board, or a clinical evaluation.)



Happy to provide more info off-list if you’d like to discuss or want referral instructions. Just email me directly at swift.melanie at mayo.edu<mailto:swift.melanie at mayo.edu> .


Melanie

Melanie Swift, MD, MPH
Medical Director, Mayo Clinic Physician Health Center<https://www.mayoclinic.org/departments-centers/preventive-occupational-aerospace-medicine/physician-health-center/referrals>
Associate Medical Director, Occupational Health Service
Senior Associate Consultant
Assistant Professor of Medicine
Division of Preventive, Occupational, and Aerospace Medicine
Phone 507.284.2560
_______________________________
Mayo Clinic
200 First Street SW
Rochester, MN 55905
www.mayoclinic.org<http://www.mayoclinic.org/>






> On Jan 7, 2020, at 7:08 PM, Dr. Mona Khanna <drmona10 at gmail.com<mailto:drmona10 at gmail.com>> wrote:

>

> 

> An independent physician in solo practice who is on the medical staff of a hospital is reported by hospital support staff of continuing to perform procedures with worsening hand tremor and new blindness in one eye. The hospital administration is worried about its liability but the physician has full medical staff privileges and refuses to succumb to testing and an occupational medical evaluation. What authority might the hospital have to enforce fitness for duty testing or functional capacity evaluations? How would that evaluation be performed in the absence of job descriptions? Is there such a thing as specialty-specific job descriptions (neurology, surgery, cardiology) for physicians that must be adhered to? How can we get job descriptions to which to hold the physician accountable?

>

> How might this situation be different for physicians who are employed? Does their employer - a hospital or medical group - have more power to enforce fitness for duty testing or functional capacity evaluations under the threat of termination?

>

> Thanks in advance.

>

> Prerna Khanna, MD



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