The following statement was written by the American College of Surgeons (ACS) Surgeon Well-Being Workgroup with support and feedback from the ACS Board of Governors Physician Health and Competency Workgroup. It was approved at the February 5−6, 2022, virtual meeting of the ACS Board of Regents.
In light of the projected shortage of surgeons by 2030, well-being implications of the COVID-19 pandemic, and increasing negative drivers and factors affecting surgeon well-being, the ACS advocates for pathways for physicians who ask for help before serious events and consequences occur, or physicians who are receptive to help when approached by leadership, peers, colleagues, family, friends, and other support systems. By self-reporting, surgeons acknowledge that they are experiencing impairment or illness and that they are seeking assistance with wellness before being forced to do so by their institutions or state medical boards.
Although each state has its own pathway for physician reporting, evaluation, treatment, and monitoring, the ACS supports a general framework that incorporates the most recent recommendations and considerations from the Federation of State Medical Boards (FSMB) “Policy on Physician Illness and Impairment: Towards a Model that Optimizes Patient Safety and Physician Health.”*
The FSMB revised and expanded its policy on the issue in response to new and emerging issues. Seeking access to physician health programs can be a critical intervention for physicians and surgeons, especially to maintain patient safety and physician well-being. As the COVID-19 pandemic laid bare the systemic barriers and challenges facing our healthcare system, it is important to rebuild the system to include mechanisms that positively support and encourage physicians to prioritize their overall well-being.
The ACS supports the FSMB’s expanded policy and key recommendations and considerations, including:
- Distinguishing between impairment and illness
- Reducing stigma and barriers to treatment, including:
- Reducing obstacles to seeking treatment by allowing treatment to be sought confidentially for impairing illness and not requiring this to be reported as part of the licensing process
- For medical students, residents, and fellows, avoiding the inclusion of questions about current medical or psychiatric conditions or counseling, or previous history of impairment on applications for medical licensure, or offering a safe haven alternative of not reporting treatment sought either through the physician health program (PHP) model or a physician expert model that involves comprehensive care management and monitoring
- For medical students, residents, and fellows, increasing the availability of information about the considerations, processes, and timelines that state medical boards use to arrive at licensing decisions related to employment
- Reporting
- When a timely intervention to ensure that an impaired physician ceases practicing and receiving appropriate PHP assistance is sufficient to protect patients, the ethical duty towards patients and colleagues has been discharged
- In the case of PHP reporting on participants to medical boards, only board-mandated participants should be identified by name, whereas confidential participants are identified by number to maintain privacy. Confidential PHP participants risk forfeiting that privilege should they be found to have substantive nonadherence to an agreement with their PHP and will forfeit their confidentiality should they pose a risk to the public
- Distinct voluntary and mandated referral track for ill or impaired physicians
- Expanded criteria for referral for professional assessment, especially the inclusion of behavioral, affective, cognitive, or other mental problems that raise reasonable concern for public safety
- The identification of characteristics of an ideal relationship between a state medical board and a PHP, including:
- A commitment by both parties to open lines of communication and collaboration within the bounds of applicable confidentiality protections
- Mutual understanding of each organization’s responsibility to program participants and the public
- No discrimination nor denial of PHP services based on a physician’s race, creed, color, national origin, religion, sexual orientation, gender, gender identity, specialty, professional degree, or membership affiliations
- PHP acceptance of physician participants experiencing financial difficulties who otherwise meet program eligibility criteria, and availability for referrals by boards and other individuals or entities in need of services
- State medical board endorsement of a PHP and support to ensure the PHP has adequate staff and funding to meet its mission and goals
- PHP arrangement for emergency interventions and evaluations, where possible
- PHP establishment of a health monitoring agreement template designed to optimize continuing care, physician rehabilitation, and patient safety; details of each agreement should be individualized and subject to change based on case specifics
- Periodic review of laws and regulations by state medical boards, in consultation with PHPs, to ensure that the PHPs are legally able to adapt to evolving best practices
The ACS supports pathways for surgeons to seek medical and professional support and treatment without fear of negative personal and professional repercussions that have negative implications for their reputation, practice volume, and financial livelihood.
*Federation of State Medical Boards, Policy on Physician Illness and Impairment: Towards a Model that Optimizes Patient Safety and Physician Health. Available at: https://www.fsmb.org/siteassets/advocacy/policies/policy-on-physician-impairment.pdf. Accessed February 24, 2022.
