More than one-third of physicians don't think they're responsible for reporting colleagues who are impaired or incompetent, according to a study published on July 14 in the Journal of the American Medical Association.
The finding is troubling, according to researchers at Massachusetts General Hospital who wrote the JAMA article, because peer monitoring and reporting are the prime mechanisms for identifying physicians whose knowledge, skills or attitudes are compromised. Physicians are required by the AMA Code of Ethics to report colleagues whom they suspect are unable to practice medicine safely because of impairment or incompetence.
The lead investigator for the study, Catherine DesRoches, a survey scientist at the Mongan Institute for Health Policy, said what surprised her most was that the share of physicians who agreed that reporting was their professional responsibility (64 percent) wasn't higher. "This is a basic tenet of medical professionalism," she told FierceHealthcare.
The most commonly cited reasons for keeping mum included the belief that someone else was doing something about the problem (19 percent), the belief that nothing would happen as a result of the report (15 percent), fear of retribution (12 percent), the belief that reporting was not the physician's responsibility (10 percent), or fear that the physician would be punished too severely (9 percent).
Seventeen percent of physicians reported having first-hand knowledge of an impaired or incompetent physician in their hospital, group, or practice in the last three years. But only two-thirds of those physicians reported that physician to a hospital, clinic, professional society or other authority.
"This is a very difficult issue," DesRoches said. "We're talking about people who are having to turn in their colleague. I think they have legitimate worries about doing it." Since the study was published, she has been receiving emails from physicians telling her stories about what they've observed at their organizations.
Those who were less likely to report another physician were underrepresented minority physicians, international medical graduates, and physicians working in small practices.
While 64 percent of surveyed physicians agreed they had a professional commitment to report physicians who are significantly impaired or otherwise incompetent to practice, results varied by type of doctor. Females (68 percent) were somewhat more likely than males (61 percent) to agree that physicians should take on a watchdog role and report impaired/incompetent colleagues. Among specialties, anesthesiologists (76 percent) and psychiatrists (76 percent) said they would be very or somewhat prepared to deal with impaired colleagues. Cardiologists (63 percent) and pediatricians (59 percent) were somewhat less likely.
The malpractice environment is closely linked with beliefs about reporting, the study notes. Physicians who practice in areas with low numbers of malpractice claims were significantly more likely than those practicing in areas with medium or high numbers to completely agree that physicians should report all instances of impaired of incompetent colleagues.
Physicians with less than 10 years' experience, and those with 30 or more, were more likely to report than those with 10 to 29 years' experience.
The type of practice organization also was a factor in reporting. Seventy-six percent of physicians practicing in hospitals and 77 percent of those in universities or medical schools who knew of an impaired/incompetent colleague reported that person to the relevant authority. But only 44 percent of physicians with such knowledge did the same. Physicians in hospitals or medical schools are more likely to report than those who work in small practices.
Focus groups conducted to lay the groundwork for the survey may shed some light on how physicians handle such difficult situations. Physicians told DesRoches that they just don’t send their patients to doctors who seem impaired or incompetent.
To learn more:
- read the JAMA abstract
- read the NPR blog
- read the Washington Post blog
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