title: Restoring professionalism: the physician fitness-for-duty evaluation.
abstract: OBJECTIVE
  We compare findings from 10 years of experience evaluating physicians referred for fitness-to-practice assessment to determine whether those referred for disruptive behavior are more or less likely to be declared fit for duty than those referred for mental health, substance abuse or sexual misconduct.
  
  
  METHODS
  Deidentified data from 381 physicians evaluated by the Vanderbilt Comprehensive Assessment Program (2001-2012) were analyzed and compared to general physician population data and also to previous reports of physician psychiatric diagnosis found by MEDLINE search.
  
  
  RESULTS
  Compared to the physicians referred for disruptive behavior (37.5% of evaluations), each of the other groups was statistically significantly less likely to be assessed as fit for practice [substance use, %: odds ratio (OR)=0.22, 95% confidence interval (CI)=0.10-0.47, P<.001; mental health, %: OR=0.14, 95% CI=0.06-0.31, P<.001; sexual boundaries, %: OR=0.27, 95% CI=0.13-0.58, P=.001].
  
  
  CONCLUSIONS
  The number of referrals to evaluate physicians presenting with behavior alleged to be disruptive to clinical care increased following the 2008 Joint Commission guidelines that extended responsibility for professional conduct outside the profession itself to the institutions wherein physicians work. Better strategies to identify and manage disruptive physician behavior may allow those physicians to return to practice safely in the workplace.
authors.affiliation: Department of Psychiatry, Vanderbilt Comprehensive Assessment Program, Vanderbilt University, Nashville, TN 37212, USA. Electronic address: reid.finlayson@vanderbilt.edu.
authors.forename: A J Reid
authors.initials: AJ
authors.lastname: Finlayson
authors.forename: Mary S
authors.initials: MS
authors.lastname: Dietrich
authors.forename: Ron
authors.initials: R
authors.lastname: Neufeld
authors.forename: Howard
authors.initials: H
authors.lastname: Roback
authors.forename: Peter R
authors.initials: PR
authors.lastname: Martin
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D016017:Odds Ratio; D010815:Physician Impairment / Q000706:statistics & numerical data*; D010820:Physicians / Q000523:psychology / Q000706:statistics & numerical data*; D011361:Professional Competence / Q000592:standards / Q000706:statistics & numerical data*; D028743:Professional Misconduct / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology*
keywords: Comprehensive psychiatric assessment; Disruptive behavior; Fitness for duty; Fitness to practice; Medical ethics; Physician health and wellness; Professionalism; Psychiatric diagnosis
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