Holy Moly, He Wants to Come Back!
Okay, here are the questions:
- What do you do when the physician requests his privileges be restored after he returns from rehab for his cocaine and sexual addictions?
- What do you do when the 67-year-old internist, who retired five years ago, has just been hired by administration to be your new hospitalist?
- What do you do when your favorite cardiologist returns from a medical leave of absence after suffering a significant stroke?
Of course, these scenarios cause more questions than answers. You suddenly wish you had declined the invitation to be chief of staff of your medical staff. The fact remains that demographics apply to physicians as well as the general public.
Alcohol and substance abuse is 12-14% in the general population and is the same or somewhat higher in the physician population. (P Hughes, Prevalence of Substance Abuse Among US physicians, JAMA, 1992) Sexual addiction, especially cyber addiction to pornography, is present in 6-8% of the general population and one out of five are women. (Carnes, Am J Prev Psychology Neurology, 1991, 3:16-23) Dementia is present in 13.9% of individuals 71 and older and 9.7% of these have Alzheimer’s disease. (Plassman, et al, Neuroepid, 2007) Stroke recovery is possible, but of course, varies widely depending on age, severity of the injury, rehabilitation efforts, and support to name a few. None of us are immune from these possibilities.
Okay, now a few answers. Patients are more important than physicians. Don’t get caught in the trap of treating physicians as “special people.” First and foremost, you should have a concrete policy for dealing with all of the above possibilities. It must be iron clad, fair and equitable, be consistent with HIPPA and the American Disability Act, should be patient-safety focused but also allow for the physician to return to your medical staff. This begins with a viable and credible Physician Health Committee, an engaged credentials committee, OPPE and FPPE plans on steroids, legal advice, and a “Fitness to Work” evaluation from an objective and independent physician.
Want more from Dr. White? R Dean White DDS, MS, of Dean White Consulting, will be speaking about how to create a physician re-entry process at the 15th Annual Credentialing Resource Center Symposium, May 10-11. For more information, click here.
About the Author: R. Dean White, DDS, MS, has been involved in medical staff governance for the last 33 years. He has served on every medical staff committee including chairing the credentials and bylaws committees. He also served as chief of the medical staff in 1999 and 2000 at Texas Health Harris Methodist HEB Hospital in the Dallas Fort Worth Metroplex. He served on the board of trustees of the same hospital for six years.
Evelyn Starr | Apr 30, 2012 | Reply
I have an OB/GYN that took about two years off to be with her children, now she wants to come back to practice. I’ve been looking on sites trying to find competency criteria and cannot locate it easily.
The Chair of the Department and I discussed it and I have documentation that the doctor that wants to come back has done educational modules to stay up on safety training and things of that sort, but I know she may need some sort of proctoring or a refresher course. Can’t seem to lay my hands on documented information to provide to the Chair. Thanks.
Dean White | Apr 30, 2012 | Reply
Hi Evelyn:
I don’t have any hard and fast documentation to answer your question, but I would approach the physician basically as a new physician on staff.
He or she will object, but the only way you can really assess is to apply OPPE and FPPE as you would anyone else. If that involves proctoring so much the
better. I would be careful about choosing proctors and split them between “partners and competitors” if you can.
You could streamline the process but I would caution against that, two years is a long time in the life of a physician.
Hope this helps.
Dean