Physician health and safety-sensitive positions

Most registrants are aware of their statutory duty under the Health Professions Act to notify the College when they “on reasonable and probable grounds, believe(s) that the continued practice of a designated health profession by the other person might constitute a danger to the public.” What is sometimes forgotten is that underlying this legal requirement is the founding ethical principle of not practising medicine when not well enough to do so.

The CMA Code of Ethics states, “Practise the art and science of medicine competently, with integrity and without impairment.” It goes on to say, “Seek help from colleagues and appropriately qualified professionals for personal problems that might adversely affect your service to patients, society or the profession.”

These principles recognize that health issues could affect the competent practice of medicine. When a physician (or a medical student) becomes aware of such a health issue, either in themselves or in a colleague, they are ethically and professionally responsible to either stop practice or to advise a colleague to do the same. This can be very difficult. The unwell physician may display a lack of insight, may have impaired judgement, or may be affected by declining cognitive ability. Sometimes there are compelling personal relationships or financial issues involved.

The medical profession is aware that some workplace positions are designated as “safety sensitive.” Registrants are all familiar with their responsibility to advise patients who may be impaired by illness and who work in a safety-sensitive occupation that they should take a leave. They know that if a patient is not well, she or he should not drive a school bus, fly a plane or operate equipment on which other peoples’ safety depends. 

The practice of medicine may also be a safety-sensitive profession. As stated in the Canadian Human Rights Commission’s Policy on Alcohol and Drug Testing released in October 2009, “A safety-sensitive position is one in which incapacity due to drug or alcohol impairment could result in direct and significant risk of injury to the employee, others or the environment.”

In order to encourage physicians and medical students to appropriately leave practice when they are unwell, the College has a new section on its website called Taking Time Away which outlines the steps involved in taking a leave of absence. A form requesting a change in licensure status to temporarily inactive can be downloaded directly from the College website and submitted by email, fax or regular mail. Registrants who inform the College of a leave of absence due to health reasons or a parental leave also receive a pro-rated refund of annual licence renewal fees, and a deferral of future fees for up to three years or until a return to active practice.

In these situations, it is always appropriate to call and speak to College staff for advice; however, it is not mandatory to do so at the time of absenting oneself from practice. As a resource, the College also encourages registrants dealing with health concerns to seek the assistance of the Physician Health Program