Issue: August 2010
August 01, 2010
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Survey finds two-thirds of physicians would report impaired colleague

Issue: August 2010
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According to a survey of 1,891 physicians in the Journal of the American Association (JAMA), only 64% of respondents agreed with the professional commitment to report fellow physicians who are insignificantly impaired or incompetent. Moreover, only 69% reported being prepared to effectively handle such individuals.

Overall, 17% of physicians had direct personal knowledge of a colleague who was incompetent; 67% reported the colleague to the relevant authority.

Even though many states have mandatory reporting statutes, “We were surprised that the number of physicians in support of the commitment statement and the reporting rate were not higher, because the idea of self-regulation is truly central to the profession’s professionalism,” principal investigator Catherine M. DesRoches, DrPH, told Orthopedics Today. “Physicians are considered sort of the classic profession. They regulate themselves; in turn, they have a variety of responsibilities.” Hence, “for there to be one-third of respondents not agreeing with the statement or reporting seems like a very high number to me.”

Education needed

The reason most cited for not reporting a colleague was the belief that someone else was taking care of the problem (20%). “This suggests the need for more physician education about their responsibility in this area,” DesRoches said.

The second most popular reason for not reporting a colleague was the belief that nothing would happen as a result of the report (16%). Fear of retribution (13%) was also noted. “This suggests the need for a greater strengthening of the confidentially of these reporting systems,” she said.

Among underrepresented minorities, only 47% with a direct knowledge reported the problem vs. 68% of non-underrepresented minorities. In addition, only 45% of graduates of international medical schools reported, compared to 73% of U.S. graduates.

Women physicians (68%) were more likely than men (61%) to completely believe it was their duty to report impaired or incompetent colleagues. However, women were less likely to feel prepared to deal with incompetent colleagues.

By practice

Physicians in private practice, solo or two-person, were less likely to agree with the statement as those practicing in a hospital or a clinic attached to a hospital.

In contrast, the investigators concluded that a physician’s particular malpractice environment was not that much of an influence as to whether he believed in reporting all instances of impaired or incompetent colleagues.

Anesthesiologists and psychiatrists were most likely to feel very or somewhat prepared to deal with impaired colleagues. “Among the anesthesiologists, this is an issue they have taken on,” said DesRoches. “Their specialty society provides a lot of education and awareness of this issue.” Pediatricians were least likely to feel very or somewhat prepared.

As for the need for increased self-regulation, “I think it depends on which side of the fence you are sitting on,” said DesRoches. “If you are in the profession of medicine, the percentage following through on their commitment to report is pretty good, well over a majority. But if you are a patient, you really want every physician to report. You want this number to be at 100%.”– by Bob Kronemyer

Editor’s note:

See the related commentary.

References:

  • DesRoches CM, Rao SR, Fromson JA, et al. Physicians’ perceptions, preparedness for reporting, and experiences related to impaired and incompetent colleagues. JAMA. 2010; 304(2): 187-193.

  • Catherine M. DesRoches, DrPH, Mongan Institute for Health Policy, Massachusetts General Hospital, 50 Staniford St., Suite 900, Boston, MA 02114; 617-724-6958; e-mail: cdesroches@partners.org.