The Texas A&M KSTAR Fitness for Duty Evaluation,1.0 Rob Steele, MD Director – KSTAR Programs Texas A&M Health Science Center, College of Medicine

Objectives Describe why KSTAR created the program Review the process used to develop it Demonstrate the core and optional components of the program Outline the process from intake to reporting Address some of the questions that came out of the process Thoughts for future development

Why did we create the KSTAR Fitness for Duty Program? Representatives of the Texas Medical Board (TMB) ask us to create an objective evaluation of physician health From time to time, the board has had difficulty getting sufficient/detailed information from physicians whose physical/mental abilities are in question The objectivity of a physician’s health care provider can come into question (especially if a friend/colleague of the provider)

Building the Evaluation KSTAR Committee (assessors and directors) convened several times to determine potential components of the evaluation and refine a process – anticipating this something we might do from time to time It was also determined that first evaluation center would be in Round Rock, TX, due to availability of resources there, and because of it’s proximity to Austin (and its airport!)

Domains to be evaluated Overall physical health Mental health/cognition Special sensory abilities (vision, hearing) Motor strength, fine motor skills, coordination

First of foremost… It was determined that we would take an individualized approach to this examination.

Usual Components of the Evaluation A detailed physical exam including a full neurologic exam Cognitive screening (with MicroCog) Vision and hearing testing Occupational therapy evaluation – standardized Depression/Anxiety screening

Added when deemed necessary Psychiatric evaluation Full neuropsychological evaluation Customized simulation available at Texas A&M’s medical school campus at Round Rock Simulation of specific procedures Drug testing (?)

Process: Intake When initial contact is made, basic information is obtained. KSTAR staff schedules separate intake calls with the referring source and the health care provider to be assessed (calls are done by a physician medical director) When the concerns are defined, the medical director individualizes the evaluation by putting together the components that are most likely to answer the question(s) at hand

Application The physician to be evaluated applies to the program The physician describes his/her take on why they are to be evaluated Basic demographic information Training Work location Past history of performance difficulties Scope of practice Procedures done Hours worked/number of patient’s seen Permission for release of information is obtained

Testing Site: Round Rock, TX

Evaluation is Scheduled Baylor/Scott&White Clinic in Round Rock, TX (just north of Austin, TX) Physical exam, vision screening, and depression/depression screening is done by a board-certified internal medicine physician Hearing screening is done in the same clinic in the occupational medicine department MicroCog is also administered by staff at the internist’s office Occupational therapy standard evaluation is done in the same building, too

One-Day Evaluation Evaluation starts at 9 AM and ends around 2 PM Allows physician to fly in and out the same day (though we recommend arriving the day before) There is an board certified occupational physician who is available for back-up if needed (works next to the internist)

Building the Report Individual reports are submitted to the KSTAR medical director for the evaluation The medical director summarizes the pertinent findings of the individual components of the evaluation, making suggestions regarding ability to practice, any limitations, and additional evaluations if they are deemed necessary (example: a full neuropsychiatric evaluation if the MicroCog interpretation deems this necessary) Report is released in 3-4 weeks

Follow-Up KSTAR contacts the physician evaluated and the referring entity to see if there are any questions/concerns We encourage both parties to contact us whenever they have questions

Some things to consider as we moved toward version 2.0: Important to define how much testing you are going to do: KSTAR decided no lab testing, but will recommend it in follow-up if needed. We do have an agreement in place to do drug testing as needed – should we do it on everyone? How much liability are we taking on? Is this administrative, medical practice, or both? Do we need to be concerned about this evaluation being interpreted as a disability examination? Should this evaluation be individualized, or should there be a standard battery of testing for everyone?

More things to consider Should a full neuropsychiatric and/or psychiatric evaluation be done on everyone? Is there are role for multi-source feedback, and if so, should it be done selectively or on everyone? Should there be standard labs or other medical studies done in addition to what we already do?

Experience to Date Our first evaluation came from out of state, flying in and out the same day The physician being evaluated completed an exit interview and did not find the evaluation threatening or otherwise obtrusive The reports submitted were summarized by the KSTAR medical director and placed into a final report (raw data was not handed over) He was able to continue his practice of gastroenterology without any suggested restrictions or limitations

QUESTIONS? KSTAR Office OR Around the Corner…