Strategies for Managing Disabled Physicians

From HCPro's Medical Staff Briefing , August 23, 2011

Q How do we assess a disabled physician's competence without seeming biased?

A Ongoing professional practice evaluation (OPPE) and focused professional practice evaluation should alert you to any changes in a physician's performance, says Ford. Because OPPE regularly assesses each physician's ability to practice, there is no need to perform ­additional assessments for disabled physicians that the medical staff wouldn't require for nondisabled physicians.

However, the medical staff may require all ­disabled physicians to submit a letter from their ­personal ­physicians as part of the privileging process, says Ford. The letter from the private physician must ­attest to whether the individual is capable of ­continuing to ­practice the privileges that he or she has been granted.

"The medical staff just needs to know that there haven't been any changes and that they don't need to change the accommodations," Ford says.

If the letter from the disabled physician's personal physician indicates that the disabled physician is ­incapable of performing some or all of the privileges that he or she has been granted, it is time for the department chair, the president of the medical staff, or the physician health committee to step in and begin a discussion with the physician about alternate practice arrangements. For example, one option for physicians who can no longer practice is to teach residents, explains Hunt-Watts.

Q How does the hospital and medical staff decide what constitutes a reasonable accommodation?

A According to the ADA, a reasonable accommodation may include:

  • "[M]aking existing facilities used by employees ­readily accessible to and usable by individuals with disabilities"
  • "[J]ob restructuring, part-time or modified work schedules, reassignment to a vacant position, acquisition or modification of equipment or devices, appropriate ­adjustment or modifications of examinations, training materials or policies, the provision of qualified readers or interpreters, and other similar accommodations for individuals with disabilities"

According to Silverstein, the hospital is not required to provide personal use items, such as prosthetic limbs, eyeglasses, hearing aids, or wheelchairs. But the hospital must ensure that its facilities can accommodate an individual who uses such aids.

However, items that might otherwise be considered personal may be required as reasonable accommodations if they are specifically designed to meet job-related rather than personal needs. For example, a hospital may have to provide an individual who has a disabling visual impairment with eyeglasses that are specifically designed to enable him or her to use the office ­computer monitors but are not otherwise needed by the ­individual outside of the office.

One accommodation that many hospitals find unreasonable is allowing physicians to not take call. When a physician drops off the call schedule, it increases the burden for the other physicians on staff and may cause political strife within the organization. O'Brien knows of several disabled physicians who cannot take call because of their disabilities who were terminated from their medical staffs. Many medical staffs won't grant privileges to a physician if he or she can't take call.

"I think that is going to be the biggest thing to come to a head because a lot of physicians don't take call now anyway," O'Brien says, noting that the change in the way physicians practice (e.g., hospitalists) may eventually eliminate this requirement.

If your medical staff currently requires members to take call, you may need to rethink this requirement for disabled physicians. If taking call is a must, consider adjusting the amount of time physicians have to respond to call (many medical staffs require physicians to respond within 30 minutes). A wheelchair-bound physician may need a few extra minutes to get to the hospital.

"Just remember that this person isn't trying to get out of taking call; they are doing the best they can and they have a lot to offer," says O'Brien.

Hospitals and medical staffs that understand how to appropriately manage disabled physicians will not only avoid discrimination lawsuits, but they will also have a more satisfied staff that feels supported and appreciated.

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