You're referring to my impaired physician comment? I wasn't trolling at all. I might have exaggerated a bit, and I could be wrong and there's more to these evals than I'm aware of, but I find it hard to believe that impaired physician evals are nearly as hard as we are led to believe (mainly by a small handful of academic gurus who have cultivated a big-time mystique around their own work and reputations.) I know because I do some occupational evals myself - granted not with physicians, but other professionals. I meet with the patients on their turf, and I produce a report. Hence, I really could do it in my garage if I wanted. There's a learning curve, but it's no worse than any other learning curve in psychiatry. So why people would think you have to be some academic big wig to do the evals, I don't know. Being a big wig helps with marketing, obviously, but isn't a prerequisite for doing the evals, or doing them well. And by the way, occupational evals are not always the same as fitness for duty evals. It's not exactly the turf of forensic psychiatry either.
What makes occupational evals hard is that the patients can be demanding, you have to be accurate and defend your conclusions (so none of the usual psychiatrist hand-waving) and of course, there can be a question of public safety. What makes it easy is, there is almost no corner you can't document yourself out of. At least, so far, I haven't found one. There's no treatment relationship! How hard can it be?? As long as you understand that your job is to attempt to quantify risk, and as long as you acknowledge that any attempt at quantifying risk in psychiatry is always a mere guess, how can you go wrong? In the case of impaired physicians (which granted, I don't do) - you, as a psychiatrist would not be issuing that medical license, right? It's the state board that will be accountable. If you identify a risk - for example, that a surgeon is likely to relapse on alcohol, say - then I would think you just have to document how likely you think this is, and why. But you don't have to mitigate that risk, and you don't have to treat it. I think this makes it much easier than dealing with almost anything else in psychiatry, where you actually have to DO something.
I think it would be similar with sex offender evals, and I have sometimes thought about trying to do some of those. They pay well, no one wants to do them, and the answer is always the same at some level - "yes there is a risk this offender will reoffend. It cannot be precisely quantified." I know I'm oversimplifying it, but you see my point? I'm also sure someone is going to respond to this saying, sex offender evals are the turf of forensic psychiatry - but in large parts of the country, there are simply not enough forensic psychiatrists to do sex offender evals. They're being done - by someone.
There are certainly going to be difficult impaired physician cases, and cases that are more appropriate for certain subspecialists, but all I was getting at was that you don't need to be ensconced in an illustrious academic fiefdom with residents and junior faculty fawning over you in order to DO evals like that.
