The School of Medicine acknowledges and understands the demands associated with residency training. It has created, through the Faculty Staff Assistance Program (FSAP), a support system for residents, which all residents are invited and encouraged to utilize. Section 8 of this Manual describes the services available from the FSAP and how to access these services. If a resident experiences excessive stress or anxiety, or if a resident begins to
This Section outlines the Behavioral Health Policy and Procedures adopted by the School of Medicine, along with the requisite steps a resident must follow in asking for a release from duty to address behavioral health issues. (Physical health issues, like behavioral health concerns, may qualify for Medical and/or Family Medical leave. Leaves of absence for health concerns should be requested pursuant to the procedures detailed in Section 4 of the Manual.) Information is also included on the steps required for a resident to return to duty. Read this important information closely and remember that the School of Medicine is committed to providing appropriate assistance to the resident suffering from a behavioral health issue as well as its commitment to provide a safe environment for patients, hospital staff, visitors, and other physicians.
9.01 Physician Impairment and Substance Abuse
The Emory University School of Medicine is committed to providing, through its Residency Training Program, the highest levels of graduate medical education, patient care, and research. To realize this commitment, the School of Medicine has developed programs and policies dedicated to advancing the personal and professional development, health, and well being of its residents.
The purpose of this policy is to ensure that all residents are fit for duty and work free from harm to themselves and others. The School of Medicine is committed to providing appropriate and compassionate support to any resident who experiences mental, emotional, or physical health problems, including those who also require professional assistance to deal with substance abuse, psychiatric, or behavioral health issues. It is
When a release from duty is needed in order for the resident to obtain inpatient or outpatient treatment for a behavioral issue, including a psychiatric condition, psychological issue, or substance abuse, such a release shall be requested and processed as stipulated in the provisions of this policy.
The Faculty Staff Assistance Program (FSAP) is available to assist residents as well as Emory faculty and staff in dealing with any issue or concern that is affecting or may affect that individual's ability to live or work in a healthy, productive manner. The FSAP facilitates the ability of its clients to discover options and manage resources that enhance health, productivity, and behavior.
Referral and Assessment Provisions
Emory encourages residents to seek professional assistance at the earliest indication of physical or emotional problems related to job performance or safety. Professional assistance is generally accessed in one of the following ways:
- Self-referral by the resident
- Referral by the resident's department chair or program director
The FSAP is available to provide coaching and consultations on when and how to make a
When a resident comes to the FSAP through self-referral or other means, the FSAP will work with the resident in confidence, to the extent appropriate or permitted by law, to assess the nature of the concern or issue, to determine the cause, and to identify a plan of action. When the result of an assessment leads to the determination that a release from duty is indicated to obtain
Requesting a Release from Duty - Procedure
It is the responsibility of the resident to request in writing an authorized release from duty as soon as possible. The request shall be submitted to the resident's department chair or program director, shall be accompanied by a certification from the health care provider attesting to the medical necessity of the
The request shall also acknowledge that the resident is aware of and will follow the policy and provisions set forth by the School of Medicine and Residency Training Program for returning to duty. This includes a provision related to the resident's responsibility to arrange to have his/her treating provider supply the FSAP and the chairperson (or program director by designee) with timely and sufficiently detailed information regarding his/her condition and any restrictions to the resident's performance when he/she returns. This also includes a provision explaining that the chairperson will determine the resident's ability to safely and effectively continue training within the residency training program based upon the consideration of medical evidence.
Authorizing a Release from Duty
The resident's department chair shall review the request and supporting documentation, and determine whether to grant the resident's request for a release from duty. In the absence of a specific request, the department chair or program director may release a resident from duty where objective evidence suggests that the resident's continuation of work would pose a direct threat to him/herself or others. In such circumstances, the resident shall be referred to the FSAP for a fitness for duty evaluation as otherwise described in this policy. The resident is expected to fully cooperate in these efforts to obtain a fitness for duty evaluation. Disciplinary action, including termination from the Residency Training Program, may result from a resident's lack of cooperation.
9.02 Return to Duty Policy
When an Emory University resident is absent from the training duties of his/her residency training program (RTP) to obtain assistance for behavioral health concerns, including inpatient or outpatient psychiatric treatment, psychological treatment, treatment for substance abuse (including but not limited to treatment for alcohol abuse), or a similar condition that may impact job performance or safety, that resident may resume duties in the RTP based on medical evidence demonstrating the ability to perform the essential functions of his/her duties. Each qualifying resident may be required to submit a return to duty plan prior to his/her return to the RTP in the event that medical evidence demonstrates an ongoing restriction that may impact job performance. This plan must be developed and approved in accordance with the guidelines provided in this policy. The FSAP will serve as the liaison between the resident, the RTP, and the resident's treatment team during the development, implementation, and management phases of the return to duty plan.
Creation and Approval of the Return to Duty Plan
The chairperson of the resident's department or the resident's RTP program director by
Content of the Return to Duty Plan
At a minimum, each return to duty plan should include some, or all, of the following elements, as appropriate to the particular resident's needs and the needs of the RTP:
- the resident's commitment to ongoing care for an appropriate period of time with an addictionologist, psychologist, psychiatrist, or
other appropriate professional , chosen by the resident and endorsed by the FSAP and with whom the resident agrees to fully cooperate - the resident's agreement to submit to clinical testing and/or serum levels as deemed appropriate
- participation by the resident in an appropriate support group, such as the Caduceus Club, another impaired-professionals group, or another appropriate group endorsed by the treatment provider when applicable
- the resident's acknowledgment of responsibility to assure that his/her treating provider supplies the FSAP and the RTP chairperson (or the resident's program director by designation) with timely and sufficiently detailed status reports concerning the resident's ongoing ability to safely and effectively train within the RTP if applicable, at intervals to be determined by the FSAP, the chairperson, and the treatment provider
- commitment by the resident to perform each of his/her training duties and to conduct himself/herself in a satisfactory manner, and commitment by RTP to periodically evaluate the resident to assure that the resident's performance and conduct are satisfactory and render him/her eligible to continue training within the RTP
- commitment to maintain full compliance with Emory University's Substance Abuse/
Drug Free Workplace Policy - if the resident has received treatment for substance abuse, the resident's commitment to abstain from all
mind altering substances, including prescriptive medicine, that are not approved in writing by the resident's substance abuse recovery program treatment provider - agreement by the resident and the RTP to work cooperatively with the Composite State Board of Medical Examiners in all matters involving the Board to assure compliance with any additional or different restrictions or requirements placed on the resident by the Board.
Responsibility of Resident
Any resident who is absent from his/her training duties to obtain psychiatric, psychological or substance abuse treatment and who desires to return to the RTP may be required to meet the following responsibilities. Any resident desiring to return to the RTP may be required to arrange to have his/her treatment provider release in a timely manner information to the chairperson, program director, and the FSAP concerning the nature and scope of the resident's condition as it relates to job performance, any limitations on the resident's ability to perform essential job functions, evidence suggesting that the resident may pose a direct threat, and the provisions of the resident's continuing care program as it relates to or impacts his/her RTP duties. This information will be used to assist the determination of whether the resident is eligible to resume training in the RTP. The resident's failure to meet these responsibilities will result in his/her inability to return to the RTP.
If a resident is allowed to return to the RTP and if that resident has a return to duty plan, he/she must comply with each provision in the return to duty plan until he/she has fulfilled the requirements for release from any continuing care program and any other treatment coordinated by the resident's treatment provider. In addition, the resident must comply with each provision of his/her continuing care program, as developed by the resident's treating provider, and must have arranged to have the treating provider release information to the resident's chairperson, program director, and FSAP concerning the resident's compliance with the continuing care program, if applicable. The RTP and FSAP will make reasonable efforts to coordinate the resident's training schedule and responsibilities with his/her continuing care program commitments. Finally, the returning resident is expected to meet each of the RTP's performance and conduct standards. The resident's failure to meet any of these responsibilities may result in discipline, up to and including the dismissal of the resident from the RTP.
Residency Credit
Upon returning to the RTP after receiving treatment, each resident's eligibility to receive credit for any portion of the residency year in question will be evaluated by the resident's chairperson and program director. In determining the resident's qualification to receive training credit, the chairperson and program director will evaluate the resident's performance prior to receiving treatment, the length of time the resident performed within the residency year prior to leaving the RTP for treatment, the length of the treatment, the length of time remaining in the residency year upon the resident's return to duty, the training received by the resident, and the training missed by the resident while receiving treatment.
Confidentiality
All medical information concerning the resident's absence from the RTP to receive treatment and his/her subsequent return to the RTP, including information provided by the resident's treating provider, will be treated as a confidential record. Medical information concerning the resident, including psychiatric and/or psychological information, will only be disclosed by the chairperson, program director, and FSAP to the resident's other supervisors when, and if, an accommodation or work restriction may be needed by the resident. However, the chairperson, program director, and FSAP will continue to have the right and may have the duty to disclose additional medical information to the appropriate entities and individuals for any other lawful purpose.
Record Keeping
All medical records and other documentation concerning the resident's absence from the RTP to receive treatment and the resident's return to the RTP, including information from the resident's treating provider, will not be maintained in the resident's personnel file, Graduate Medical Education file, or RTP file. Instead, the documentation will be collected and maintained in a separate medical file, which is secured in a locked area in the University's Department of Human Resources or the FSAP.