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- Page navigation anchor for Call to Action: Resources Needed for Physicians with Disabilities and Chronic ConditionsCall to Action: Resources Needed for Physicians with Disabilities and Chronic Conditions
Raising awareness and improving inclusion of physicians with disabilities and chronic conditions should be considered a priority in the medical community. Stergiopoulos et al reviewed physicians with health conditions at medical licensure registration in Canada (1). Reviewers identified that licensing policy is an important opportunity to improve, as jurisdictions are not following best practice guidance. The authors recommended that medical regulatory authorities process transparent communication about privacy, disclosure requirements and consequences, and physician health program monitoring. This was an important article that begins to highlight the lack of information and resources available for practicing Canadian physicians with disabilities or chronic conditions.
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In 2021, 3864 physicians completed the Canadian Medical Association (CMA) National Physician Health Survey2. 23% of these physicians reported having a disability, with 10% having chronic conditions, and 8% having mental health conditions. These physicians with disabilities were more likely to be suffering in their mental health, burned out, anxious, depressed, and to have considered suicide. This survey highlights the significant number of practicing physicians with self-reported disabilities.
Regulatory bodies are responsible for ensuring that physicians do not pose risks to patients by working while impaired by a condition that affects their competence. Medical associations must advocate for...Competing Interests: None declared.References
- (1) Stergiopoulos E, Martimianakis MAT, Zaheer J. Questioning physicians about health conditions at medical licensure registration: How should policy evolve in Canada? CMAJ. May 23 2023;195(20):E710-e716. doi:10.1503/cmaj.221097
- (2) CMA National Physician Health Survey – A National Snapshot. Canadian Medical Association Accessed May 11, 2023. https://www.cma.ca/sites/default/files/2018-11/nph-survey-e.pdf
- Page navigation anchor for RE: The Role of Occupational Medicine PhysiciansRE: The Role of Occupational Medicine Physicians
We commend the authors for addressing challenges in establishing physicians’ fitness to practice in light of disabling conditions, particularly those involving mental health. These are in fact issues central to the field of occupational medicine. While we appreciate the value of this review of regulatory policies, as occupational medicine physicians, we wish to highlight some details that warrant greater attention.
First, the terminology used by the authors is not consistent with how these terms are used in practice, such as the important distinction between the terms impairment and disability, the latter being the term we would consider more correct. Impairment relates to physiological changes that are the result of an underlying disease process, while disability is more about the functional impact of those changes, and it is these functional impacts that define one’s fitness to work. Occupational medicine has a front and center role in determining how one’s medical conditions impact one’s ability to work, either as limitations in what physicians can perform, or as restrictions in what one must not perform as a matter of safety for themselves or others. The idea that past impairment should have no bearing on current assessments of functional ability is misguided, since many medical conditions have a variable course and prognosis that need to be taken into context when assessing the risk of adverse impacts at work.
Second, it should be noted that the s...
Show MoreCompeting Interests: None declared.References
- 1) Canadian Human Rights Commission. A guide for managing the return to work [Internet]. Ottawa, Ontario: Minister of Public Works and Government Services, 2007. Available from: https://www.chrc-ccdp.gc.ca/sites/default/files/gmrw_ggrt_en_2.pdf
- 2) Employment Services and Development Canada. National Occupational Classification: 31102 - General practitioners and family physicians [Internet]. 2023 June [cited 2023 Jun 25]. Available from: https://noc.esdc.gc.ca.
- 3) Royal College of Physicians and Surgeons of Canada. Objectives of training in the subspecialty of occupational medicine [Internet]. 2013 [cited 2023 Jun 25]. Available at:https://www.royalcollege.ca/ca/en/ibd-search.html
- 4) Occupational Medicine Specialists of Canada. About OMSOC [Internet]. [cited 2023 Jun 25]. Available at: https://www.omsoc.org/About
- 5) Occupational and Environmental Medical Association of Canada. OEMAC Background [Internet]. 2018 [cited 2023 Jun 25]. Available at:https://oemac.org/about/background/
- Page navigation anchor for It's not just physicians who fear the consequences of disclosing mental health conditions RE: Questioning physicians about health conditions at medical licensure registration: How should policy evolve in Canada?It's not just physicians who fear the consequences of disclosing mental health conditions RE: Questioning physicians about health conditions at medical licensure registration: How should policy evolve in Canada?
The questioning of physician health on medical licensure applications has far-reaching effects, with privacy concerns and fear of licence restrictions not only preventing practicing physicians from seeking help, but also prospective ones, particularly with regards to mental health challenges.
In 2021, I published a humanities encounters article describing my experience applying to medical school as a student living with a mental illness—the way I was questioning if I could be open about my illness experience or, if doing so would prevent my acceptance [1]. At the time, I ultimately decided not to be open about my experiences living with mental illness, which meant I was also unable to share the ways in which those experiences shaped me as a person, my passion for medicine, and the kind of doctor I wanted to become. I emerged from the application process feeling empty, unsettled, and unsatisfied, having not been able to bring my whole self to the experience, which led me to writing “Is there anything else I can do for you?” [1]. If I was going to practice medicine and be a kind, caring, compassionate physician, I knew I needed to be able to be my authentic self.
The fear of consequences stemming from disclosing a mental illness was, for me, confirmed in the weeks leading up to my article’s publication when an editor reached out to me to ensure that I had “thought through” my decision to go public with my mental illness diagnosis. “Writing this may harm your c...
Show MoreCompeting Interests: None declared.References
- 1. Schreyer L. Is there anything else I can do for you? [humanities]. CMAJ. 2021;193(20):E1180-E1181. DOI: 10.1503/cmaj.210704
- 2. Dyrbye LN, Eacker A, Durning SJ, et al. The impact of stigma and personal experiences on the help-seeking behaviors of medical students with burnout. Acad Med. 2015;90:961–969. DOI: 10.1097/ACM.0000000000000655
- 3. Fletcher I, Castle M, Scarpa A, Myers O, Lawrence E. An exploration of medical student attitudes towards disclosure of mental illness. Med Educ Online. 2020;25(1):1727713. DOI:10.1080/10872981.2020.1727713
- 4. Grandey A, Foo SC, Groth M, Goodwin RE. Free to be you and me: a climate of authenticity alleviates burnout from emotional labor. J Occup Health Psychol. 2012;17(1):1-14. DOI: 10.1037/a0025102.
- 5. Shanafelt TD, West CP, Dyrbye LN, Trockel M, Tutty M, Wang H, Carlasare LE, Sinsky C. Changes in Burnout and Satisfaction With Work-Life Integration in Physicians During the First 2 Years of the COVID-19 Pandemic. Mayo Clin Proc. 2022;97(12):2248-2258.
- Page navigation anchor for Trust is Key RE: Questioning physicians at medical licensure registrationTrust is Key RE: Questioning physicians at medical licensure registration
I suspect that the foundation of all of the issues surrounding this matter focus on a lack of trust and a dysfunctional culture that has demonstrated a failure to perform in alignment with its stated values. Some of the issues may be due to ignorance and an evolving information platform but I am skeptical that is a major player. Regulatory colleges do indeed have a balancing act to perform. However, in my mind, first they must demonstrate empathy and compassion for their regulated members and convince them the regulatory college is there to help them and their disciplinary role is only a last ditch effort to honour their legislative responsibilities. The questionnaires that this article is focusing on only emphasize a lack of trust. Bandaid solutions like changing the questions will not have any material effect on the culture. Whether true or not regulatory colleges are perceived as 'the bad man' by most physicians even though they appreciate the need for them. The medical culture has a lot of work to do to change that. At least it is trying. In order to provide optimal patient care and behave in congruence with stated values, including self-determination and agency in a patient-centred manner, the healthcare culture needs to change. Its hierarchical and compartmentalized nature has led to a dysfunctional culture which fails healthcare providers and patients. There is an urgent need for a meaningful commitment to a fully collaborative effort where individualizati...
Show MoreCompeting Interests: None declared.References
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