Substance use disorders & professionalism FAQ
Can I still study if I have a substance use disorder?
Yes. Having a substance abuse problem (either active or in remission) in and of itself does not prohibit an individual from continuing school responsibilities. Seeking help voluntarily does not mean studies must be put on hold or a leave of absence is required. Students are always encouraged to seek help for a substance use disorder before it leads to unprofessional behaviour. Students seeking help will be treated with confidentiality and any subsequent recovery plan may be highly self-directed.
The MD Program seeks to provide support for student well-being and success. Should the MD Program become involved (e.g. through reporting of a professionalism lapse or via academic concerns), every effort will be made to maintain student enrolment and progress in the program and reasonable accommodations will be explored. As Ontario undergraduate medical students are not members of the College of Physicians and Surgeons of Ontario (CPSO), the CPSO does not regulate complaints regarding medical student behaviour and performance during medical school. It will however consider breaches of good character under section 2 of the regulation during application to residency.
Can I still practice as a licensed resident/physician if I have a substance use disorder?
Once students complete their undergraduate training, they must register with their province of residency’s College of Physicians and Surgeons. In Ontario, to obtain a certificate of registration, first-time applicants must complete the Postgraduate Education Application Form. On this form, there are questions concerning whether applicants are currently abusing, dependent on or addicted to alcohol or a drug; whether they have ever abused/been dependent or addicted to alcohol or a drug in the past; and finally whether they have been treated for the abuse/dependence or addiction. If applicants answer yes to any of these questions, the CPSO would still consider issuing a certificate of registration, but, under direction of the Registration committee, could stipulate a condition that the applicant meet with the OMA’s Physician Health Program for an assessment. To date, no application has ever been declined due to self-declaration of substance abuse or addiction.
Once registered with the CPSO, practicing physicians are required to complete an annual questionnaire to maintain their membership status. The annual renewal form contains a question which focuses on whether physicians have an addiction or substance use problem, newly identified in the past year, for which they are not currently enrolled in the OMA’s Physician Health Program.
What happens if I seek professional help?
Office of Health Professions Student Affairs (OHPSA)
A personal counsellor will meet with the student to conduct an initial assessment and decide if follow-up should be done at OHPSA or through external health care services. No formal contract is developed with OHPSA. OHPSA abides by a strict confidentiality agreement that outlines the limited conditions warranting a breach of confidentiality. These conditions include the need to disclose information to prevent serious risk of harm to self or others.
Physician Health Program (PHP)
A student self-presenting to the PHP can be served on a voluntary basis. In some cases, the student and the PHP may enter into a mutually agreed upon monitoring agreement (i.e. a contract) which outlines treatment and recovery steps to be taken, and circumstances and contingencies regarding breach of the contract. Monitoring by PHP includes having your file followed by a case manager and ensuring access to appropriate community resources. PHP will also facilitate access to resources whether or not a student is being officially monitored. If a student or physician decides to practice outside of Ontario, the PHP will transfer the monitoring responsibilities to the local provincial body as possible.
Where one acknowledges substance abuse and agrees to engage with the PHP, including being monitored, the PHP will not automatically breach confidentiality or disclose any information to the UME office. However, certain conditions may be agreed upon in the voluntary monitoring agreement which may include reporting as a condition should the contract be broken.
Private health care consultation
Medical practitioners are expected to remain professional and maintain confidentiality. As set out in the CPSO’s Mandatory and Permissive Reporting Policy, the CPSO expects physicians to take appropriate and timely action when they have reasonable grounds to believe that another physician or health care professional is incapacitated. This duty is grounded in professionalism, and the objective is to ensure patient safety.
What happens if someone reports me at school?
If unprofessional or problem behaviour is identified and reported to the MD Program, all cases are handled on a case-by-case basis and are followed up by the Course Director, the Preclerkship Director, or the Clerkship Director, as applicable. The Preclerkship or Clerkship Director may determine that the lapses are sufficiently serious to require remediation. For information on the remediation process, including the role of the Board of Examiners, see the Student Handbook.
The remediation process generally involves a series of meetings with the Faculty Lead, Ethics and Professionalism together with another senior Faculty member. The objective of the process is to ensure that the student has insight into the professionalism lapses and has developed strategies to prevent future lapses. In the case of substance abuse, these strategies will likely include continuing preventive supports (such as counselling). The student must pass the remediation in order to graduate.
Information regarding student professionalism concerns is maintained in confidence throughout the process, while further information is gathered, and next steps are determined. Behavioural lapses, however, may be reported to the Board of Examiners. Ultimately, the main goal is to provide support for the student to continue their education successfully and healthily.
The CPSO is not involved in complaints regarding undergraduate medical student behaviour and performance. However, the CPSO may consider events regarding behaviour and performance during time of application, where relevant.
What happens if someone reports me in the workplace (as a resident or licensed physician)?
Each workplace (i.e. hospital, community practice, etc.) has their own policy on dealing with workplace complaints. There are mandatory reporting obligations that apply in certain employment settings when there are reasonable grounds to believe that a regulated health professional is incapacitated. It should be emphasized that the CPSO only gets involved when CPSO members (residents and physicians) are involved in a complaint; this does not include medical students. Should the CPSO receive a complaint or report regarding physician incapacity through a third party (e.g. employer, patient, etc.), the CPSO will open an investigation which may result in direct follow up with the physician and/or eventual monitoring through the PHP. An investigation includes gathering facts and consulting with health professionals and patients directly involved with the complaint. Once the CPSO becomes directly involved due to problem behaviour (i.e. if a physician chooses not to voluntarily seek help and workplace safety is impaired) physicians no longer have the right to recover privately, on their own terms, and become accountable for follow-up.
Ultimately, the CPSO seeks to ensure patient safety, to ensure the physician receives treatment and care, and to keep the physician in practice.
What are the limits to privacy and confidentiality?
In cases where students or physicians self-present for help to OHPSA, the OMA’s Physician Health Program, or other support persons, privacy and confidentiality is strictly kept unless it is determined there is an immediate and serious risk of harm to self or others.
Can I be kicked out of the profession?
Students are supported and every effort is made to maintain enrolment in the MD Program. Specific measures and accommodations are made on a case-by-case basis, with both patient safety, student wellness and recovery as the focus.
To date there has never been a case where the CPSO has revoked a physician’s license due to a substance use disorder alone. However, if there are other multiple and severe lapses in professionalism or the physician is uncooperative in receiving help, the CPSO can suspend or revoke a physician’s license. Revocation or suspension is a last resort and every effort is made to keep the physician in practice.
At what point does drug/alcohol use become a problem? What is acceptable and what is not?
Identifying that you or a peer is at risk for a substance abuse issue or addiction can be challenging. It is often difficult to differentiate social from problem use. More information and tools to help identify problem behaviour may be found on the resource page for substance use and disorders.
Can a substance abuse problem affect my CaRMS application/match?
No. The CaRMS match is independent and uninformed by the MD Program, the PHP, or the CPSO regarding any student’s personal health problems.