Management of Impaired GME Residents

Scope

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Policy Statement

IUSM requires all residents to report to work on time and in a mental and physical condition appropriate for the performance of their duties, including maintaining fitness for duty throughout the entire assigned on-call responsibilities.  It is recommended that all residents practice preventative health management and recognize significant changes in their physical and mental health. If their physical and/or mental health may be affecting their performance in the training program, the resident should review their concerns with program leadership.

In addition to mental and/or physical conditions, drug dependence or addiction can also contribute to impaired work performance. It is the school’s intent and obligation to provide a drug-free, healthy, and secure work environment that promotes safe and quality patient care. The University, the School, and the affiliated hospitals recognize drug dependency as an illness and a major health problem as well as a safety and security issue. They also recognize drug usage as a potential health, safety, and security problem. IUSM absolutely prohibits the unlawful manufacture, distribution, dispensation, possession, or use of a controlled substance on university premises or while conducting university business off university premises. Violations of this policy may result in removal from clinical duty and potential termination of employment.

It is the belief of IUSM that an impaired resident physician is an ill colleague in need of treatment.  The approach to impairment should be through medical intervention, care, and compassion, as opposed to punitive or threatening methods.

Mental health or substance abuse evaluations may be requested by a Program Director or the Senior Associate Dean for Graduate Medical Education when there is concern that a resident’s performance may be impaired by psychiatric illness and/or substance abuse. 

IUSM utilizes the Indiana State Medical Association (ISMA) Physician Assistance Program (PAP) to coordinate efforts in identifying and assisting IUSM physicians with chemical dependency and/or psychiatric illnesses impairing their ability to practice medicine. It is expected that the impaired resident physician will enter and complete treatment in order to return to training as soon as possible. Refusal to cooperate with a mental health or substance abuse evaluation may be considered grounds for termination from the training program.

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Reason for Policy

The purpose of this policy is to address the identification and management of a suspected or confirmed impaired GME resident providing clinical care in any area of the IUSM Clinical Learning Environment, including affiliate hospitals, clinics, or associated clinical practice areas. It is the intent of this policy to provide a means to recognize impaired resident physicians with the goal of assisting the resident in finding appropriate medical care or rehabilitating the physician and ensuring patient safety. Impairment may be due to suspected substance use, physical health, mental health disorder, or other concerns.

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Procedures

Any faculty, resident, or staff that suspects a resident is impaired should report to the resident’s program director or supervisor at the time of the concern (Attachment 1).  The program director or supervisor will assess the resident. The program director should use the IUSM GME – Impairment Concern Intake & Stepwise Guide at the time of concern to capture objective facts and guide the next steps. If the resident is suspected to be acutely impaired, the resident must be removed from clinical activity at that moment in the interest of patient safety and the well-being of all involved, and a summary suspension should be considered and reported to the Senior Associate Dean or Director of GME prior to proceeding through the GME Procedure for Evaluation of Potentially Impaired Residents (Attachment 1).  

PLEASE NOTE: If an infraction such as arrest, charges, conviction, and the disposition of any outstanding charges occur during training, the resident must notify their program director and the Office of Graduate Medical Education within 72 hours of the occurrence. This includes any occurrences at any time during the length of training.

Fitness for Duty Evaluation

The resident may be referred for a comprehensive multidisciplinary evaluation before a return to work is granted. A Comprehensive Multidisciplinary Evaluation will be assessed on a case-by-case basis utilizing the ISMA PAP.

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Definitions

ACGME is the Accreditation Council for Graduate Medical Education. 

A resident is an IUSM resident or fellow, or a non-IUSM resident or fellow electively rotating through IUSM who provides clinical care as part of a GME program. 

Clinical Learning Environment is any area in the IUSM learning environment where residents participate in clinical activities. 

Impairment is a state in which a physician is unable to practice medicine with reasonable skill and safety due to illness, substance use disorder, or other conditions. (Adopted by the Federation of State Medical Boards House of Delegates, April 2021.)

The Indiana State Medical Association Physician Assistant Program (ISMA PAP) is a program of the Indiana State Medical Association that addresses the needs of physicians impaired by chemical dependence, psychiatric disorders, and physical disability, as well as the needs of disruptive physicians. 

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Implementation

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Oversight

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History

1. Policy IUSM-GME-PO-0002 approved by GMEC and published on 13 February 2013. 
2. Policy approved by the GMEC on 07 September 2016.
3. Policy updated for formatting 27 February 2018. 
4. Policy updated for formatting 27 June 2018.
5. Policy updated 28 April 2020. 
6. Policy updated 14 January 2025.
7. Policy approved by GMEC 21 January 2026. 

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