# Referred for a fitness-for-duty evaluation in residency? The questions to ask in writing Practical Guidance · Published 2026-07-26 · Resident Help **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](https://www.residenthelp.org/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](https://www.residenthelp.org/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](https://www.residenthelp.org/blog/what-you-can-negotiate-when-your-program-wants-you-to-resign) 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](https://www.residenthelp.org/blog/case-study-dismissed-before-required-step-finished) and [what to do after a rescission](https://www.residenthelp.org/blog/residency-dismissal-rescinded-on-appeal-what-next). ## 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](https://www.residenthelp.org/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 - U.S. Equal Employment Opportunity Commission, Enforcement Guidance on Disability-Related Inquiries and Medical Examinations of Employees under the ADA, https://www.eeoc.gov/laws/guidance/enforcement-guidance-disability-related-inquiries-and-medical-examinations-employees - Federation of State Physician Health Programs, https://www.fsphp.org/ This post is general information and not legal advice. Institutional policies and board rules change, so confirm the version in force on your dates. ## Related guidance - [How to request an ADA accommodation in residency: a checklist](https://www.residenthelp.org/blog/how-to-request-accommodation-in-residency): The request you make in writing is the one that counts. This checklist covers how to ask, what the interactive process is, what a determination should contain, and how to check that an approval was put into practice. - [Put on administrative leave during residency: a checklist for the first 72 hours](https://www.residenthelp.org/blog/administrative-leave-residency-first-72-hours): Administrative leave often arrives with no letter, no policy cited, and no return date. What you do in the first three days decides what the record says later. This is the checklist. - [Suspended from residency with no letter: what to do the same day](https://www.residenthelp.org/blog/suspended-from-residency-without-written-notice): Suspensions in residency are often given verbally, with no letter, no policy named, and no end date. Putting the suspension in writing yourself, the same day, protects your appeal rights and your remediation clock. - [FMLA and medical leave in residency: what protects you](https://www.residenthelp.org/blog/fmla-medical-leave-residency): Residents have leave protections from three places: the federal FMLA, the ACGME's institutional leave requirements, and their specialty board's rules. They overlap but are not the same, and the gaps between them are where problems start. ## Start here - [Questions residents ask, answered](https://www.residenthelp.org/faq): Short answers to every question our guides cover, from resignation offers and appeal deadlines to accommodations and visas. - [Know your rights as a resident](https://www.residenthelp.org/rights): What your program owes you under ACGME requirements, what federal law protects, and the first 72 hours. - [Court decisions on resident dismissal and probation](https://www.residenthelp.org/cases): Published opinions every resident should know before a probation, dismissal, or forced-leave decision. - [The free Residency Record](https://www.residenthelp.org/record): The documents every resident should keep, the dates that decide non-renewal, and a private place for both. --- Source: https://www.residenthelp.org/blog/fitness-for-duty-evaluation-residency-what-to-ask Publisher: Resident Help (https://www.residenthelp.org) This website provides general information and is not legal advice. Using this site or submitting a form does not create an attorney client relationship.