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Fitness For Duty (FFD) Evaluation

Fitness For Duty

What is the Fitness for Duty Program?

The Fitness for Duty Program is an integrative, individualized, multi-faceted assessment of a physician's fitness for occupational functioning with the goal of determining whether an individual physician is fit to perform his or her tasks without risk to patients, self, or others.

There are many health conditions which can have a deleterious impact on clinical performance and personal health and wellbeing. Some of the more common conditions include:

  • Musculoskeletal injury or disease leading to specific motor and task-related disability;
  • Cardiovascular diseases;
  • Neurological events or progressive neurodegenerative conditions which lead to motor and/or cognitive deficits;
  • Psychiatric syndromes causing behavioral issues or fluctuations in emotional stability;
  • Substance abuse which may manifest as declining quality of clinical care, problems with reliability and punctuality, or other aspects of professional conduct;
  • Age-related conditions such as cognitive decline or decrements in physical or mental stamina.

After the FFD application is received, PACE will communicate with the referring organization and will request the following information: reason for referral, timeline of events, an outline of the physician's work duties, any other relevant documentation from the physician's personnel file, and when applicable a copy of the physician's personal medical records.

Following the FFD Evaluation, the client organization will receive a detailed written report, which includes specific findings from each component of the assessment as well as an integrative summary which designates one of the outcomes (clearly fit, fit for duty with accommodation, unfit) described below. The report is the result of a collegial team effort, combining the unique skills, knowledge, and experience of the UC San Diego PACE Program faculty and staff. Additionally, referral and guidance to appropriate resources will be provided, when possible, and PACE will remain available for additional follow-up questions.

Should impairment be found, the program will identify which duties of his or her job the physician would be able to safely continue performing independently - if any - and whether or not accommodations could be made that would enable the physician to safely perform some or all the other job duties. The results of the various components are thoroughly reviewed, carefully considered, and laboriously discussed by experienced PACE faculty and staff in one or more dedicated conference sessions.
Possible results of the Fitness Evaluation include:

  • Clearly fit for all aspects of duty
    • No presence of illness exists that interferes with the physician's ability to safely perform the duties of his or her job.
    • Presence of illness exists but currently does not interfere with the physician's ability to safely perform the duties of his or her job.
    • Re-evaluation may be recommended depending on the prognosis of present illness(es).
    • Specific information will be provided that outlines the reasons why the physician is currently able to perform all of the duties of his or her job.
  • Fit for some duties, but not for others (Fit with accommodation(s))
    • Presence of illness exists that interferes with the physician's ability to safely perform some, but not all of his or her duties.
    • The specific limitations for each functional area of concern will be described.
    • Recommendations will be provided for possible methods of accommodation.
    • Re-evaluation may be recommended depending on the prognosis of present illness(es).
  • Unfit for duty
    • Presence of illness exists that interferes with the physician's ability to safely perform most or all of the duties of his or her job.
    • The physician presents a significant risk to patients, self, and others.
    • It is unlikely that any reasonable accommodations could be made that would allow the physician to practice safely.
    • Re-evaluation may be recommended depending on the prognosis of present illness(es).
    • Information related to the rationale for the determination of being unfit for safe practice will be included.


The components of the Fitness Evaluation are customized to the individual physician, his/her job description, and the clinical environment, and may include:

For physicians who have exhibited changes in their work performance likely secondary to a health condition, but who have not previously received an appropriate clinical evaluation or diagnosis, the Fitness Evaluation will include a judicious, thorough clinical evaluation performed by UCSD School of Medicine primary care and specialist physicians, as appropriate for the clinical situation. Laboratory tests, toxicology screening, and imaging studies may be included when warranted.

Depending on the physician's presentation, specialists with expertise in the relevant medical area will participate in the assessment program. Some typical, commonly-encountered examples of specialty areas include Neurology, Cardiology, Physical Medicine & Rehabilitation, and Psychiatry. To hone the evaluation to the highest level of accuracy and specificity, subspecialists are selected for their expertise within each of these fields. In this way, the correct diagnosis, prognosis, and translation of clinical symptoms into functional assessment are attained.

In some cases, a psychiatric evaluation may be warranted to objectively determine if psychiatric issues are affecting a physician's ability to practice. Depending on the physician's reason for referral, the assessment may also include an addiction evaluation.

Disruptive behavior may be the result of a health condition affecting a physician's communication and interpersonal skills. Evaluation of a physician's specific behavioral issues may be explored if indicated.

When indicated, neuropsychological testing is used to give detailed information regarding cognitive performance including executive function, memory, language, visuospatial data as well as intelligence. The central purpose of the neuropsychological evaluation is not to determine whether the physician meets a certain diagnosis but rather whether he or she is able to function effectively as a physician, and in a manner conducive to public safety. UCSD's Division of Neuropsychology ranks as a world leader in experience with regard to neuropsychological testing of physicians.

For occupational roles that require the ability to perform procedures which can be observed and evaluated via skills-based assessment, resources and faculty from UCSD's state-of-the-art Simulation Center will be included. This component of the Fitness Evaluation provides a valuable hands-on evaluation of skills and serves the dual purpose of being a powerful educational tool.

Fitness for Duty Frequently Asked Questions

Print and complete the PDF application for a Fitness for Duty Evaluation, and email, fax or mail it to us.

Once received, our staff will email you some additional forms that will need to be completed prior to scheduling your screening.

We begin designing and scheduling your individualized assessment after receiving your application, your deposit of $8,000 and requested documents (ex. CV, hospital privileges, etc.). We generally schedule 4-6 weeks out from then.

Evaluations are scheduled Mondays-Fridays and are based on your availability and our faculty availability.

Time to complete the Fitness for Duty Evaluation varies, but most are completed in 1-3 days. Some aspects of the evaluation can be done remotely, however, most of the evaluation will take place in person at various locations in San Diego.

The final report is typically completed 4 weeks after the in-person screening, and approximately 8-10 weeks from the receipt of application.

The cost to enroll in the Fitness for Duty Evaluation is $8,000. The full cost varies depending on your needs and area of specialization. The amount due over your deposit towards the remaining balance is billed in a final invoice due before you come in for the assessment.