JAMA: Most physicians don't report incompetent colleagues

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A survey of physicians finds that while most support the professional commitment to report other physicians who they feel are incompetent or impaired, such as from alcohol or drug use, when faced with this situation, many did not follow through on making a report, according to a study in the July 14 issue of the Journal of the American Medical Association.

“Many states have mandatory reporting statutes, requiring physicians and other healthcare professionals to report to appropriate authorities those physicians whose ability to practice medicine is impaired by alcohol or drug use or by physical or mental illness,” the authors wrote. But data suggest that the rate of reporting by physicians is far lower than it should be, given the estimated numbers of physicians who become impaired or who are otherwise incompetent to practice at some point in their careers, according to background information in the article.

Catherine M. DesRoches, DrPH, of Massachusetts General Hospital in Boston, and colleagues conducted a study to assess physicians’ beliefs, preparedness and actual experiences related to colleagues who are impaired or incompetent to practice medicine. The researchers gathered data from a nationally representative survey of 2,938 eligible physicians practicing in the U. S. in 2009 in anesthesiology, cardiology, family practice, general surgery, internal medicine, pediatrics and psychiatry. Overall, 1,891 physicians responded.

Physicians were questioned regarding their beliefs about and preparedness for reporting and experiences with colleagues who practice medicine while impaired or who are incompetent in their medical practice.

Among the findings of the survey, DesRoches and colleagues found that 64 percent of surveyed physicians agreed with the professional commitment to report physicians who are significantly impaired or otherwise incompetent to practice. Overall, 69 percent of physicians said they were very or somewhat prepared to deal with impaired colleagues; 64 percent of physicians overall reported being prepared to deal with colleagues who were incompetent in their medical practice, and preparedness varied by specialty and professional age.

However, only 17 percent of physicians reported having direct personal knowledge of an impaired or incompetent physician colleague in their hospital, group or practice in the last three years; and 67 percent of these physicians reported that individual to a hospital, clinic, professional society or other relevant authority.

According to the researchers, underrepresented minority physicians were significantly less likely than other physicians to report, as were international medical graduates compared with graduates of U.S. medical schools. Physicians working in hospitals or medical schools were more likely to report than physicians working in small practices, the researchers found.

The most frequently cited reasons for not reporting an impaired or incompetent colleague included the belief that someone else was taking care of the problem; the belief that nothing would happen as a result of the report; fear of retribution; the belief that reporting was not their responsibility; or that the physician would be excessively punished, DesRoches and colleagues wrote.

“These national data regarding physicians’ beliefs, preparedness and actual experiences related to impaired and incompetent colleagues raise important questions about the ability of medicine to self-regulate,” the authors concluded. “More than one-third of physicians do not completely support the fundamental belief that physicians should report colleagues who are impaired or incompetent in their medical practice. This finding is troubling, because peer monitoring and reporting are the prime mechanisms for identifying physicians whose knowledge, skills or attitudes are compromised.”