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Fitness For Duty

A Pulmonary/CC fellow who does not feel fit for duty should consult with their current program director or Employee Health.  Additionally, a supervisor who has concerns regarding a fellow’s fitness for duty should also consult with the Program Director and/or Associate Dean for Graduate Medical Education.

Emotional exhaustion, sleep deprivation, depersonalization, perceived low personal accomplishment, doubt, guilt, family issues, compulsiveness, dissatisfied patients, and the psychology of postponement (things will get better when…) can impact the balance of body, mind, and spirit for successful fellowship practice.  

Physicians often have difficulty accepting help, due to the pressures of perfection that are often part of the intrinsic nature of high achievers.  Physicians-in-training might be unable or unwilling to recognize their own state of health. 

The Department of Medicine is keenly aware of and responsive to the serious consequences that fatigue and stress can have on fellows in any subspecialty.  In response to this, the Department has set forth the following guidelines:

  1. Faculty and fellows must first be attuned to and accepting of the signs and results of excess fatigue, stress, and possible impairment. 
  2. Faculty and fellows are required annually either to attend a presentation or to complete online training on the possible influence of fatigue and stress. 
  3. Fellows should be permitted to be comfortable in expressing unrest in a confidential manner, without fear of being made to feel inadequate. 
  4. Colleagues, including administrators, nurses, auxiliary staff, and other physicians, must monitor and question appearances of extreme exhaustion or stress, especially following extended time on service.
  5. Associates should be vigilant of fellows’ behavioral or attitudinal changes, as these could signal physician impairment (substance or alcohol abuse).
  6. Fellows ought to acknowledge that family, marital, personal, or financial problems might adversely impact their performance.  Positive as well as negative life-altering events, such as a birth, job change, death, divorce, or sudden accident should be taken into consideration.
  7. Faculty advisors and mentors discuss stress issues during semi-annual evaluations with fellows.  Concerns are noted. 
  8. Mistakes in judgment or treatment concerning patient care can have lasting effects on fellows, and can exacerbate existing depression.  Patient downturns or death can deplete fellows’ confidence, temporarily or permanently.
  9. Programs should have contingency plans for rescheduling assignments in the event fellows have to be excused to seek treatment. 
  10. Faculty and fellows are reminded that Employee Health Services offers counseling and assistance, pursuant to GME MC-HR Policy No. 500.

During the three years of the Pulmonary and Critical Care Fellowship there might be a time where the fellow may experience fatigue, sleepiness, anxiety, and/or depression.  If any of the fellows are having a hard time coping with any of these, whether it is at work or home, the Program Director has an open door policy and will provide necessary resources to the fellow and their family.  Also, SUNY Upstate Medical University has available to any employee and their family, the Employee Assistance Program located at Room 510 Jacobsen Hall.  They can be reached at (315) 464-4260/464-5760.  Signs of fatigue and the effects of performance are available on the SUNY Upstate Medical University Hospital blackboard site at www.upstate.edu/blackboard /courses/GME Education.  It is recommended that all pulmonary fellows review this website.

If at any time during a rotation a pulmonary fellow is feeling fatigued due to extended hours at the hospital performing patient care, they are to contact the Program Directors office and coverage will be arranged.  If they are unable to safely return home, transportation will be arranged for them.  It is essential to the fellow’s health that the Pulmonary and Critical Care fellow strictly adhere to the 80-hour work limit.

Tips for combating stress:  foster relationships, involve religion or spirituality, practice self-care physically and psychologically, derive new meaning for work, develop a new approach to life with insight, understanding, and core values.