Remediation and Retraining

The Emergency Medicine Practice Committee (EMPC) in collaboration with the Academic Affairs Committee compiled a list of resources on remediation, retraining, and behavior modification. These resources will assist emergency medicine physician groups, academicians, or individual physicians in addressing clinical or non-clinical behavior issues.

Physicians impaired by physical illness, mental illness, substance abuse disorders, or behavioral problems have been documented throughout history. Informal and formal efforts to deal with physician impairment existed as far back as 1958. In a ground-breaking policy acknowledging physician impairment, the American Medical Association's (AMA) Council on Mental Health developed, "The Sick Physician: Impairment by Psychiatric Disorders, Including Alcoholism, and Drug Dependence."

Emergency physicians who have been absent from clinical practice due to illness, injury, or pursuit of professional or personal goals outside of the clinical area may need retraining upon assuming clinical duties. Physicians with observed behavioral problems may need behavior modification. Recognizing and responding to a perceived need of its members the American College of Emergency Physicians (ACEP) has gathered resources regarding these issues.

Resources

Federation of State Medical Board Directory of Physician Assessment and Remedial Education Programs
A listing of more than 45 programs available for physician assessment and remediation/retraining including contact information.

Physician Credentialing and Delineation of Clinical Privileges, ACEP Policy Statement

Physician Credentialing and Delineation of Clinical Privileges, ACEP PREP

Chemical Dependency Issues in Emergency Medicine Residency Programs Council of Emergency Medicine Residency Directors

Michigan Health Professional Recovery Corporation

Staff Less Tolerant of Rude Doctors,American Medical News, September 2004

Additional Reading

Leape LL, Fromson JA. Problem doctors: Is there a system-level solution? Ann Intern Med. 2006;144:107-115. Available at: http://www.annals.org/cgi/reprint/144/2/107.pdf

Neff KE. Understanding and Managing Physicians with Disruptive Behavior. In Enhancing Physician Performance-Advanced Principles of Medical Management American College of Physician Executives, Tampa Florida, 2000, Chapter 4.

Tabott GD, Galleogos KV, Angres DH. Impairment and Recovery in Physicians and Other Health Professionals. In: Principles of Addiction Medicine. American Society of Addiction Medicine, Chevy Chase, Maryland, 1998, Chapter 3.

Rosner F, Balint JA, Stein RM. Remedial medical education. Arch Intern Med. 1994 Feb 14;154(3): 274-279.

Turnbull J, Carbotte R, Hanna E, et al. Cognitive difficulty in physicians. Acad Med. 2000 Feb; 75(2):177-181.

Grant WD. An individualized educational model for the remediation of physicians. Arch Fam Med. 1995 Sep:4(9):767-772; discussion 773.

Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA. 2002 Jan 9; 287(2A)226-235.

Mark S, Gupta J. Reentry into clinical practice: Challenges and strategies. JAMA. 2002 Sept 4;288(9): 1091-1096.

Terry K. When doctors put patients at risk. Med Econ. 2002 Nov 22: 79(22):25-26, 31