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Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023
| Contributor Information
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Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
Medicine is a profession that prides itself on a high standard of both ethical and professional behavior. Expectations for proper conduct by physicians commonly are applied not only at work but also in the community and on social media, even if some doctors chafe at the latter standard. For this report, Medscape asked US physicians how often and where they see other doctors behaving poorly, when their own conduct got out of line, and how misbehavior should be addressed.
In this report, gender is based on how physicians self-identified in our survey.
Some totals in this presentation do not equal 100% because of rounding.
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
For last year's report, 62% of all physicians said they had personally witnessed or experienced misbehavior by another doctor in any setting (at or away from work, or remote). That was up from 56% in our 2021 report. In surveying for this year's report, that overall misbehavior percentage dropped back to 55%.
Physicians should not be surprised by rising acts of poor behavior in their ranks, a Virginia neurologist told us. "Just like the military, professions act as a microcosm of society. As society grew more coarse, demanding, and confrontational, so have professionals including physicians."
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
In the 3 years we've asked doctors this question, they've been quite consistent in how often they'll admit to behaving poorly (either mistakenly or deliberately) during the prior year. There's something of a disconnect here; 55% of physicians said a peer had misbehaved, but only 14% acknowledged doing the same.
Drew Ramsey, MD, an assistant clinical professor of psychiatry at Columbia University in New York City, regards improvement in professional and personal behavior to be a career-long undertaking, akin to CME.
"It's easy to see the problem in other people. But if you're a physician in America, you're part of the problem, and you need to have the mindset of being part of the solution," he says.
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
One way to examine physician conduct is to ask how many doctors were noticed behaving properly. Another way is to ask about the number of instances of poor behavior. Typically, a physician has recalled seven instances over 5 years, or just over one incident per year on average, that involved a peer and occurred at work, outside the office, or on social media.
"Working as a physician is a privilege, not a right," a Maine pulmonologist argued." We need to earn it every day."
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
If physicians had witnessed or experienced any misbehavior by other doctors in the past 5 years, this chart shows the most recent incident. The percentages were each close to those in last year's report, so a consistent profile of when physicians step out of line at the office is emerging.
"As a mid-career psychiatrist, I think about where I fit in," Ramsey says after reviewing our list. "Ask yourself: When was the last time you were drunk in public, or even had more than two drinks in public? Have you recently dominated or bullied someone?"
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
As with the most recent incidents involving physician misbehavior at the office, the frequencies of bad deeds away from work were very similar to those in last year's report.
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
Once again, doctors most often opted to confront another physician directly about their misbehavior or to report the incident internally at work by name. In our three reports on this topic, physicians have shown extreme reluctance to take the matter to the state medical board.
"All of us in medicine remember moments when colleagues told us to do a better job," Ramsey says. "Good physicians take their behavior extremely seriously, especially those of us in clinical medicine. It's one of the wonderful things about the culture of medicine.
"Often, all patients have of us is our behavior and our word."
Regardless of how they push forward, doctors do often need to push, according to an American Medical Association opinion. It recommends that they report any incompetent or unethical behavior that might put patients at risk.
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
This is the third time our surveys have posed this question, and doctors have been remarkably consistent with their priorities. They favor internal responses to bad behavior (eg, a verbal warning, a sit-down with a manager, a disciplinary letter) over involving the state medical board or suspending the physician.
"Maybe this means we need other systems, that there isn't a middle ground between a heart-to-heart with a colleague and an official report with significant institutional and professional consequences," Ramsey says, adding formal peer support groups as an example of that middle ground.
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
When we asked doctors to guess the age of the physicians they saw or experienced behaving poorly (whether it be at or away from work or online), they more often described someone in their 40s or 50s. The same was true in last year's report.
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
In the 3 years we've asked this question, large margins of physicians have always pointed to male colleagues as the offender. Eight of 10 is as large as that majority has been over that time.
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
Physicians were asked whether they should face a higher standard of behavior than the general public does. Our survey question didn't specify whether that behavior was at or away from work, or online.
"Although we should be able to act freely in our private lives, we are held to a higher standard and we shouldn't bring down the public impression of our profession," an Illinois radiologist told us.
But not all physicians agreed. "Holding physicians to a higher standard than the rest of the population is an outdated principle that should no longer exist. They are not better or worse than anyone else," a California psychiatrist argued.
"Maybe we should shift the notion from 'higher' to 'different' standards," Ramsey says." There's no doubt that it's necessary for me as a physician to have a different standard of behavior than in the general public."
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
Over our last three reports on physician behavior, doctors have been likelier to say that society's standards for their behavior are too high away from the office compared with at work. They have been more likely to call those societal expectations appropriate for physicians' professional behavior than for how they act when they go home.
"I wish that the high standards of behavior expected by physicians also applied to politicians and other social influencers," a North Carolina internist lamented.
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
Doctors were just as inclined to pin unprofessional behavior in their profession on society's more lax expectations as on physician arrogance. Ditto for whether job stress or personal demons were a bigger culprit.
Bottom line: Physicians' opinions about underlying factors varied widely. But difficult patients and COVID hangovers were not popular fall guys for poor behavior.
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
Consistently, around 6 in 10 doctors have told us that yes, they should be able to behave as they think best in their personal lives without special repercussions, as long as they followed the law and were not acting in a professional capacity.
"We should remain professional in our professional lives, but I don't believe we should be held to a higher standard in our personal lives," a Michigan otolaryngologist told us.
"I really struggled with this question," Ramsey confesses. "Physicians hope for this…separation between their public and private lives, and from the very advent of social media, I have seen doctors get this wrong. You have one reputation, and what you do in your private life can rapidly become public more swiftly than ever before."
"'Public' and 'private' really have little meaning for me anymore," Ramsey continues.
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
Doctors are now less likely to agree that one physician's "poor" behavior can reflect unfavorably on all healthcare professionals than they were in our 2021 report (for which our survey asked about "inappropriate" behavior).
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
About 2 in 3 physicians told us they had not witnessed or experienced doctors who behaved inappropriately out in public being disciplined by their employer or a medical organization.
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
In the year since our last report, doctors more often said that they observed inappropriate behavior by fellow physicians at work (47% in our 2022 report). They less often said that the setting was remote technology (35% for social media in the 2022 report).
Put a different way, physicians were twice as likely to spot doctor misbehavior in the office than on a digital platform.
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
Bad behavior by doctors on social media was spotted less frequently by their peers over the prior year.
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
As in both of our prior reports, inappropriate commenting continues to be the leading type of physician misbehavior on social media seen by fellow doctors.
"I think we all have the freedom to behave as we see fit in our personal lives," a Texas internist said. "However, if you want to make it public and post it on social media, expect a reaction."
An Oklahoma pediatrician agreed. "Acting inappropriately in your personal life and posting about it opens anyone up to scrutiny. Keep your private life private, but do not behave in any illegal behavior regardless."
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
In this survey question, doctors who use social media regularly were asked on which platforms they had personally witnessed or experienced inappropriate behavior by fellow physicians.
Their responses once again underscored that physicians gravitate to older social media platforms that are heavy on commentary (Facebook over Twitter) or on photos (Instagram over TikTok).
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
Millennials (age 27-41) were more liberal on these questions about the image you present on social media than were Gen Xers (age 42-56) or boomers (age 57-75).
"Social media posts have a lot to do with relaxed cultural norms and standards of appropriate behavior," a Wisconsin internist observed.
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
Physicians remained adamantly against the idea of friending or following a patient on social media (90% of respondents answered this question "no" for our 2022 report).
Added a Connecticut oncologist, "Doctors shouldn't be contacting or following patients on social media. They shouldn't be socializing with patients at all, period."
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
Helping or Hurting Doctors' Reputation? Medscape Physician Behavior Report 2023
Jon McKenna | August 30, 2023 | Contributor Information
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