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Strategies for Managing Disabled Physicians

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

Q What kinds of accommodations might the ­hospital and medical staff consider providing?

A According to Jonathan H. Burroughs, MD, MBA, FACPE, CMSL, senior consultant at The Greeley Company, a division of HCPro, Inc., in Danvers, MA, common accommodations include:

  • Enabling emergency medicine physicians in their 70s to work shorter day shifts instead of 12-hour night shifts
  • Providing a stool in the operating room for individuals who can't stand for long periods of time
  • Allowing diabetics time for regular meal breaks and ­glucose checks
  • Providing radiologists who have early cataracts with special magnification lenses

For O'Brien, who was diagnosed with myasthenia gravis (an autoimmune disorder) in 2000, shorter days were the key to coping with her primary symptom: fatigue. She originally started working five three-quarter days, then five half days, then three half days, then two half days, then two three-hour days until she eventually left her practice. Because of that accommodation, O'Brien was able to continue working for 10 years after being diagnosed.

Hospitals and medical staffs may also have to consider providing dictation assistance to physicians with voice disorders, designated parking spaces for physicians in wheelchairs, and breaks for physicians or surgeons who have trouble standing for long periods. The medical staff may also need to consider relieving a physician of his or her responsibility to take call. For O'Brien, seeing patients at night became increasingly difficult as her disease progressed, and another physician had to take over for her.

Accommodations may go beyond an individual physician's day-to-day practice. During its many emergency practice drills, Dameron Hospital teaches every employee and provider in the hospital how to help their disabled colleagues exit the building safely during a disaster. "We have floor plans and know where the physicians who have disabilities are located," says Ford.

Q Is the hospital or medical staff allowed to ask physicians whether they are disabled during the ­application process so that we know what kinds of ­accommodations we may need to provide?

A Asking an applicant whether he or she is disabled is against the ADA because the applicant's answer may taint an organization's decision regarding his or her appointment and/or employment.

"What you should be asking is, ‘Can you perform the essential functions of the job with or without an accommodation?' " says Silverstein. "However, an employer cannot ask a question in a manner that requires the individual to disclose the need for an accommodation." In other words, organizations are allowed to ask if an applicant is qualified and can fulfill the responsibilities of the position regardless of whether he or she needs an accommodation.

Once the application process is complete and the ­hospital or medical staff has established a conditional offer of employment with the physician, the hospital can then ask more specific questions, such as "Do you need an accommodation?" explains Silverstein.

Although many physicians fear that they will not be able to join a medical staff due to their disability, they should be up front about their diagnoses and the ­accommodations they require, says O'Brien. "You should report things that affect your practice. I've met physicians who didn't report when they should have. They were afraid of losing their jobs, but it was also an ego thing. People who are physicians have a certain personality type that makes it hard to admit that they can't do everything they used to," O'Brien says.

When physicians present their diagnoses up front, the medical staff is empowered to help them continue doing what they love without jeopardizing patient safety.

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