Critical decision points in the management of impaired doctors: the New South Wales Medical Board program

Kay A Wilhelm and Alison M Reid
Med J Aust 2004; 181 (7): 372-375.


  • The New South Wales Medical Board has developed the Impaired Registrants Program to deal with impaired registrants (doctors and medical students) in a constructive and non-disciplinary manner; the program is now well established.

  • The Program enables the Board to protect the public, while maintaining doctors in practice whenever possible.

  • Disorders that commonly lead to referral of impaired doctors include alcohol and drug misuse, major depression, bipolar disorder, cognitive impairment and, less commonly, psychotic and personality disorders and anorexia nervosa.

  • Pathways in the program are individualised according to the impact of the specific disorder, the registrant’s career stage, stage of involvement in the program, insight and motivation.

  • Critical points in the program include entry, easing of conditions, breach of conditions, return to work after suspension, and exit from the program.

  • Decision-making at these points takes into account the nature of the impairment, compliance, professional and personal support available and the registrant’s insight and motivation.

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  • Kay A Wilhelm1
  • Alison M Reid2

  • 1 Liaison Psychiatry, St Vincent’s Hospital, Sydney, NSW.
  • 2 NSW Medical Board, Sydney, NSW.


  • 1. Warhaft N. The Victorian Doctors Health Program: the first 3 years. Med J Aust 2004; 181: 376-379.
  • 2. Wilhelm K, Diamond M, Williams A. Prevention and treatment of impairment in doctors. Adv Psychiatr Treatment 1997; 3: 267-274.
  • 3. Breen K. Doctors who self-administer drugs of dependence. Med J Aust 1998; 169: 404-405. <MJA full text>
  • 4. Birch D, Ashton H, Kamali F. Alcohol, drinking, illicit drug use, and stress in junior house officers in north-east England. Lancet 1998; 352: 785-786.
  • 5. Kaufmann M. Physician substance abuse and addiction: recognition, intervention, and recovery. Ont Med Rev 2002; 69 (9): 43-47.
  • 6. Kaufmann M. Treating doctors well: the experience of Ontario’s Physician Health Program. Royal Australian and New Zealand College of Psychiatrists’ Annual Congress; 2003; Hobart, Tasmania.
  • 7. McLellan T, Lewis D, O’Brien C, Kleber H. Drug dependence, a chronic medical illness. Implications for treatment, insurance, and outcomes evaluation. JAMA 2000; 284: 1689-1695.
  • 8. Vaillant GE, Sobowale NC, McArthur C. Some psychologic vulnerabilities of physicians. N Engl J Med 1972; 287: 372-375.
  • 9. Hickie I, Scott E. Late-onset depressive disorders: a preventable variant of cerebrovascular disease? Psychol Med 1998; 8: 1007-1113.
  • 10. Zubenko GS, Zubenko WN, McPherson S, et al. A collaborative study of the emergence and clinical features of the major depressive syndrome of Alzheimer’s disease. Am J Psychiatry 2003; 160: 857-866.
  • 11. Weissman MM, Bland RC, Canino GJ, et al. Cross-national epidemiology of major depression and bipolar disorder. JAMA 1996; 276: 293-299.
  • 12. Wilhelm KA, Lapsley H. Disruptive doctors. Unprofessional interpersonal behaviour in doctors. Med J Aust 2000; 173: 384-386. <MJA full text>
  • 13. Peisah C, Wilhelm K. The impaired ageing doctor. Intern Med J 2002; 32: 457-459.
  • 14. Birchwood M, McGorry P, Jackson H. Early intervention in schizophrenia. Br J Psychiatry 1997; 170: 2-5.


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