RP 201 – Session 3: Physician Impairment & Well-being (13 March 2019)

Session Readings



We spend years of intense training and devote our lives to caring for the sick and wounded.  We are problem solvers, care-takers, bearers of bad news and beacons of hope.  We are busy, pressed for time, perhaps overwhelmed.  We may forget (and perhaps others forget) that we are human; that we, just like our patients, can get sick, and perhaps suffer from addiction or mental or emotional health problems.  We may try to hide it; and in hiding it, may ultimately cause harm to those to whom we have sworn “to do no harm”.

We…that’s us.  You and me.  Medical students, residents, attending physicians.  None of us are immune.

  • What defines an “impaired” physician?
  • How do we recognize impairment and under-performance in our colleagues, and in ourselves?
  • How do we distinguish impairment from incompetence?
  • What are the risk factors for physician impairment?  For burn-out?
  • What is the burden of physician impairment in our community? Our military? Our society at large?
  • How can we promote physician health at all levels (medical school, residency, and beyond)?

Impairment in healthcare professionals occurs at all levels, including both trainees and seasoned clinicians.  We want to get this often stigmatized and hidden issue out in the open, in hopes of being better able to recognize, address and prevent it.  This session is devoted to you, to me, to our fellow healthcare team members, to our loved ones, and most certainly, to our patients.


1. Read “Dealing with the Impaired Physician” (AAFP link above) and read/listen to at least 2 other sources above prior to the panel session/small group. Review the other sources provided as time allows.  Feel free to bring your own references (journal articles, etc) relating to physician health or impairment.

2. Reflect on personal experiences either during medical school (or prior if applicable) when you or a friend or colleague may have been impaired in any way; this might even include a time where you felt “burned out” and were at risk of under-performing.  Consider your reactions (toward yourself or an impaired friend or colleague); how did your reactions affect how you or others addressed the situation?

3. Using any artistic modality (painting/sketch/drawing, poetry, prose, short story, photography, sculpture, music, dance, etc. — be creative and do what you love!), create a reflective work that relates to your personal experience of impairment and/or well-being.  Ideally, this should be something that was particularly relevant to you during the clerkship year.  This work can be a symbol of the struggle you faced, or something that brought you relief, or something that encourages resilience.

4. Bring your creation to the small group; be prepared to discuss what your reflective piece means to you.


  • Dr. Martin Rusinowitz  is a Senior Medical Officer in the FDA’s Controlled Substance Staff.  He also serves as Medical Director of the Maryland Professional Rehabilitation Program, and is a former chair of the Maryland Physician Health Committee, both within the Maryland State Medical Society (Med Chi).  He is a Board Certified neurologist and had been in private practice in the Bethesda/Rockville area for more than 25 years.



By the end of the small group session on “Physician Impairment and Well-being”, students will demonstrate the ability to:

  1. Understand the definition of “impairment” as it pertains to healthcare professional; recognize risk factors and warning signs of impairment.
  2. Reflect on experiences in which they or their peers/supervisors/others may have been impaired, or were at risk of impairment, in the professional realm.  Analyze how their reactions and personal context affected how they thought about or addressed impairment in themselves or others.
  3. Explore avenues for addressing impairment and for confronting a peer or supervisor who may be impaired.
  4. Reflect on the issue of “burn-out” amongst physicians, residents and medical students.  Resolve to maintain awareness of personal well-being and the well-being of colleagues.
aafp-capital-rgb2_1024x512bDealing with the Impaired Physician
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YouTubeThe Impaired Physician Dr. Richard Gunderman, a pediatric radiologist, presents an overview of physician impairment.
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Shame! Self-stigmatisation as an obstacle to sick doctors returning to work: a qualitative study Shame, invincibility, self-stigmatization...a fascinating study of the difficult and complicated process of returning to work for impaired physicians.
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emrap-iconSuicide Risk in Physicians This 26-minute podcast explores the burden of medical trainee/physician suicide and discusses barriers physician face in seeking help.
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Washington-PostWhy Doctor's Kill Themselves
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Measuring a doctor's performance: personality, health and well-being This editorial discusses the individual and system complexities affecting physician performance and calls for improved remediation processes within the British health system.
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How one program achieved resident wellness, work-life balance An overview of a general surgery training program's response (Balance in Life program) after one of its graduates committed suicide.
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When Art Talks: Expressions of Clinician Well-Being This exhibition, organized by the National Academy of Medicine's Action Collaborative on Clinician Well-Being and Resilience, showcases art created by clinicians, students, patients and loved ones, and represents their views clinician burnout and well-being.
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Session originally created by: Francesca Cimino | Uniformed Services University | Curriculum Director, Reflective Practice | Family Medicine