What Is Physician Impairment?
Physician impairment is defined as the inability to practice medicine with reasonable skill and safety due to illness or injury. This definition, established by the American Psychiatric Association [1], American Medical Association [2], and Federation of State Medical Boards [3], emphasizes functional capacity rather than mere presence of a diagnosis.
Impairment is distinct from disability. A physician may have a diagnosed condition—depression, diabetes, or a treated substance use disorder—without being impaired. Conversely, a physician may be impaired in the absence of a diagnosable condition.
When Is an FFD Evaluation Needed?
Evaluations are typically requested when observable concerns suggest a physician may not be able to fulfill professional responsibilities safely:
Performance and Behavioral Indicators
These indicators do not automatically establish impairment—they signal the need for formal assessment to determine whether functional impairment exists and to what degree.
Conditions That May Impair Practice
Several categories of conditions commonly prompt FFD evaluations:
Substance Use Disorders
The most common reason for physician FFD evaluations. Untreated substance use disorders can impair judgment, reaction time, manual dexterity, and decision-making—posing immediate risks to patient safety.
Mental Health Conditions
Depression, anxiety, bipolar disorder, burnout, and other psychiatric conditions can significantly impair concentration, memory, decision-making, and emotional regulation. Early recognition and treatment are essential.
Cognitive Impairment
As the physician workforce ages, cognitive decline—whether from neurodegenerative disease, stroke, or traumatic brain injury—presents growing concerns. Even mild impairment can compromise complex clinical decision-making.
Disruptive Behavior
Not all FFD referrals involve medical diagnoses. Chronic interpersonal dysfunction, boundary violations, or patterns of disruptive behavior may reflect personality-related issues requiring careful assessment to determine whether they compromise patient safety [5].
Medical Conditions
Physical illnesses affecting stamina, sensory function, or requiring impairing medications may also necessitate FFD evaluation to assess functional capacity.
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Who Should Request an FFD Evaluation?
Referrals are welcomed from:
• Medical boards and professional licensing bodies
• Hospitals, medical staffs, and credentialing committees
• Healthcare employers and group practices
• Physician health programs and well-being committees
• Legal counsel representing organizations or individual physicians
• Individual physicians seeking independent evaluation
Taking the Next Step
When concerns about a physician's fitness for duty arise, timely and objective evaluation is essential. Dr. Granovetter's comprehensive approach provides clarity for decision-makers, diagnostic accuracy for physicians, and actionable recommendations that prioritize patient safety while respecting physician dignity and potential for recovery.
For more detailed information about fitness-for-duty evaluations, including in-depth discussion of specific conditions, barriers to recognition, and the evaluation methodology, read our comprehensive guide [6].
To discuss a specific case or schedule an evaluation, contact Dr. Granovetter for a confidential consultation.
- Fitness for Duty Evaluations -
Protecting Patients, Supporting Physicians
A fitness-for-duty (FFD) evaluation represents one of the most consequential assessments in a physician's professional life. When concerns arise about a physician's ability to practice medicine safely and competently, a comprehensive, evidence-based evaluation becomes essential—protecting patients while providing the physician with accurate diagnosis, fair assessment, and a clear path forward.
Physicians function as safety-sensitive professionals—individuals whose impairment can have profound consequences for those under their care. Like airline pilots, air traffic controllers, first responders, nuclear power plant operators, and law enforcement officers, healthcare professionals work in roles where even subtle functional impairments can result in serious harm. The risk is determined by two factors: the number of individuals potentially affected and the severity of potential harm.
Dr. Granovetter's approach integrates specialized expertise in addiction medicine, psychiatric assessment, and physician wellness with deep understanding of the unique demands placed on healthcare professionals. Each evaluation is conducted with rigor, objectivity, and respect for both public safety and the physician's dignity.
The Challenge of Recognition
Physician impairment often goes unrecognized despite its prevalence. Multiple barriers contribute to this gap:
• Physician reluctance: Many avoid the patient role and tend to self-diagnose rather than seek professional care
• Professional culture: Medical training emphasizes stoicism and self-sacrifice, making admission of vulnerability difficult
• Fear of consequences: Concerns about license restrictions, employment loss, and professional stigma
• Stigma: Both external judgment and internal shame surrounding mental illness and addiction
• Colleague hesitation: Physicians often fail to report impaired colleagues due to uncertainty, fear of retribution, or doubt about effectiveness
These barriers have serious implications for patient safety. Research documents that 210,000 to 400,000 deaths annually are associated with preventable medical errors [4], many attributed to physician burnout and impairment. Early identification and intervention are critical to protecting both patients and physicians.
The Evaluation Process
Dr. Granovetter's FFD evaluations follow a structured, evidence-based approach. Please visit the Evaluations Overview Page for a full description.
A Dual Commitment
Dr. Granovetter approaches every FFD evaluation with dual commitment: protecting patient safety and treating the physician being evaluated with fairness, respect, and compassion.
Physicians facing evaluation are often in crisis, confronting potential loss of career, income, and professional identity. While the evaluation must be rigorous and objective, it is also an opportunity to provide clarity, accurate diagnosis, and—where possible—a roadmap for recovery.
The goal is not punishment. The goal is truth, and when achievable, healing.
Alignment with Professional Standards
Dr. Granovetter's FFD evaluation methodology aligns with established guidelines from:
• American Psychiatric Association (APA) Resource Document on FFD Evaluations
• Federation of State Physician Health Programs (FSPHP) Guidelines
• California Public Protection & Physician Health (CPPPH) Evaluation Guidelines
• American Psychological Association (APA) Professional Practice Guidelines
• Federation of State Medical Boards (FSMB) Policy on Physician Impairment
Frequently Asked Questions
What is the difference between an FFD evaluation and treatment? An FFD evaluation is a non-clinical, forensic assessment conducted to answer specific questions about a physician's current capacity to practice safely. It is not a treatment relationship. The evaluator serves the referring entity and provides an objective opinion.
How long does an FFD evaluation take? Most evaluations require 4-6 weeks from referral to final report, including record review, clinical interviews, testing, and report preparation. Urgent cases may be expedited.
Will the physician receive a copy of the report? This depends on the evaluation agreement. Typically, the report goes to the referring entity. The physician may receive a copy if authorized or as required by law.
What if the evaluation finds the physician is not fit for duty? An "unfit" determination does not necessarily end a career. The report includes specific recommendations for treatment, monitoring, and conditions under which safe return to practice may be possible.
How is confidentiality protected? Evaluations are conducted under clearly defined confidentiality agreements specifying who receives the report, what information is included, and limits of confidentiality as required by law. Dr. Granovetter adheres strictly to HIPAA regulations and professional ethical standards.
All inquiries are handled with absolute confidentiality.