Practical Guidance

Referred for a fitness-for-duty evaluation in residency? The questions to ask in writing

Short answer

Ask in writing who the evaluator is, what question the evaluation is meant to answer, what the program will receive, whether there is a deadline to return, and what happens to your leave and any remediation plan while the process runs. Keep your own updates short and factual, and ask for any finding a decision relies on in writing.

A fitness-for-duty referral rarely arrives as a standalone medical question. It arrives as a condition: complete this process, and then we will talk about your return. That makes the process the gate to your training, and a gate has a clock.

If you have been referred, tell us when and what you were told the process requires: start a confidential intake.

What the law says about required exams

Under the ADA, an employer may require a medical examination of a current employee only when the exam is job-related and consistent with business necessity.

The EEOC's guidance describes that as a reasonable belief, based on objective evidence, that the employee cannot perform essential functions or poses a direct threat. Our Know Your Rights page covers the standard. Whether a particular referral meets it is a question for counsel.

Questions to ask in writing, at the start

  1. Who is the evaluator, and what specific question is the evaluation meant to answer?
  2. What will the program receive: a full report, a summary, or only a fitness determination?
  3. Is there a deadline by which you must return, and is a return date required?
  4. What happens if the process outlasts your approved leave?
  5. Is your remediation plan, if you have one, paused while the process runs?
  6. If the program calls the process "the pathway to your return," save that message. It is the program choosing the cure process.

Keep your own updates short and factual

Send a brief written status update after each step: what you completed and when. Assume the program will quote your updates back to you. Leave out clinical detail entirely.

Know what the health program is telling your program

A physician health program may communicate with your training program directly. Find out early what it is sending, and ask the health program for its position in writing, so no decision rests only on someone's description of it.

"Still in monitoring" is not the same as "found unfit." When a decision cites an outside determination, ask for the document itself. You cannot rebut a finding you have not seen.

Keep any release narrow

A release of information can be scoped. Name who may disclose, the single recipient, the specific categories of information, and one purpose. Add a fixed expiration and your right to revoke it. Records should go to the institution only at your direction.

If the process is still running when an adverse decision arrives

Ask, in writing, to finish the process the program itself required, and for the decision to be revisited on a complete record. That modest ask is often the strongest one. What a realistic outcome can look like covers the others.

In a matter we worked on, an institutional appeal committee found that a program had dismissed a resident before letting them finish a required evaluation and remediation, and the dismissal was rescinded. See the case study and what to do after a rescission.

If this is happening to you

Tell us when you were referred and what you were told the process requires. We will review your situation confidentially and point you to the right next step: start a confidential intake.

Resident Help is not a law firm, and submitting an intake does not create an attorney-client relationship. If your situation needs a lawyer, we will tell you and help you find one.

Common questions

Can my residency program require a fitness-for-duty evaluation?
An employer may require a medical examination of a current employee only when it is job-related and consistent with business necessity, which generally means a reasonable belief, based on objective evidence, that the employee cannot perform essential functions or poses a direct threat. Whether a particular referral meets that standard is a question for counsel.
What is a physician health program?
A physician health program is an organization, usually one per state, that provides assessment, referral to treatment, and monitoring for physicians and trainees. Programs often use them for fitness-for-duty referrals, and the program may communicate with your training program directly.
Can I be dismissed while a fitness-for-duty process is still running?
It happens. A program may require an outside process as the pathway to return, then dismiss for an inability to return or the absence of a return date before that process is finished. Ask early, in writing, whether a return deadline exists and what happens if the process outlasts your approved leave.
What should I ask a physician health program in writing?
In writing: whether you have completed and complied with everything since referral, whether any finding of unfitness has been made and when, any findings or an expected date for them, and an updated compliance letter, or the reasons it declines to provide one.

Sources

If this is happening to you

You can send us a short note in about ninety seconds. It is free, it is confidential, and it does not commit you to anything.

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This post is general information and not legal advice. Institutional policies and board rules change, so confirm the version in force on your dates.