February 01, 2012 | | Comments 35
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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. 

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Filed Under: Bylawsmedical staff leadershipMedical staff servicesPhysician competency

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Error: Unable to create directory uploads. Is its parent directory writable by the server? 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.

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  1. I could not agree more enthusiastically that physicians returning to practice after a prolonged absence (whether by choice or forced to do so due to health conditions) need an objective process to assess their readiness to return to practice for the hospital’s, the physician’s, and the patients’ sakes. A research study that my colleagues and I authored showed that approximately three-quarters of the physicians returning to practice after a voluntary leave who presented to the CPEP Reentry Program demonstrated the need for some sort of educational remediation; a small percentage of these physicians had significant gaps. [J Contin Educ Health Prof 2011; 31(1):49- 55]
    http://www.jcehp.com/vol31/3101_grace.asp

    A majority of these physicians can address their educational gaps and resume a productive career. Formal reentry programs can help the physician understand what s/he needs to do to return to practice, provide the support they need while they return to practice, and provide a resolution with which the hospital can feel comfortable.
    Elizabeth S. Grace, M.D.

  2. Error: Unable to create directory uploads. Is its parent directory writable by the server?

    Dr. Grace: Thanks for your comments and the reference to your research. Current competency is one of the most difficult tasks for credentials committees to deal with regardless of whether the physician has been impaired or not.
    Dean

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