Most Physicians Support Reporting Impaired Colleagues, But Many Do Not Report

Laurie Barclay, MD

July 13, 2010

July 13, 2010 — Most physicians endorse a commitment to report impaired or incompetent colleagues in their medical practice, but when faced with this situation, many do not report, according to the results of a study published in the July 14 issue of the Journal of the American Medical Association.

"Peer monitoring and reporting are the primary mechanisms for identifying physicians who are impaired or otherwise incompetent to practice, but data suggest that the rate of such reporting is lower than it should be," write Catherine M. DesRoches, PhD, from Massachusetts General Hospital in Boston, and colleagues.

Using a nationally representative survey of 2938 eligible physicians practicing in the United States in 2009, the investigators aimed to explore physicians' beliefs, preparedness, and actual experiences regarding their colleagues who were impaired or incompetent to practice medicine. The survey included anesthesiologists, cardiologists, family practitioners, general surgeons, internists, pediatricians, and psychiatrists. Overall response rate was 64.4% (n = 1891).

Of those physicians who completed the survey, 64% (n = 1120) endorsed the professional commitment to report significantly impaired physicians or those who are otherwise incompetent to practice, 69% (n = 1208) reported feeling prepared to deal effectively with impaired colleagues in their medical practice, and 64% (n = 1126) reported feeling prepared to deal effectively with incompetent colleagues.

Of 309 physicians (17%) with direct personal knowledge of a colleague in their hospital, group, or practice who was incompetent to practice medicine, 67% (n = 204) reported this colleague to the appropriate authority. Physicians working in hospitals or medical schools were most likely to report, and underrepresented minorities and graduates of non-US medical schools were less likely to report.

Believing that someone else was addressing the problem was the reason most often cited for not reporting (19%; n = 58). Also cited were the belief that nothing would happen because of their report (15%; n = 46) and fear of retribution (12%; n = 36).

"Overall, physicians support the professional commitment to report all instances of impaired or incompetent colleagues in their medical practice to a relevant authority; however, when faced with these situations, many do not report," the study authors write.

Limitations of this study include reliance on voluntary disclosure of failure to report, possible nonresponse bias, and inability to verify the respondents' beliefs about their colleagues' impairment or incompetence.

"All health care professionals, from administrative leaders to those providing clinical care, must understand the urgency of preventing impaired or incompetent colleagues from injuring patients and the need to help these physicians confront and resolve their problems," the study authors conclude.

"The system of reporting must facilitate, rather than impede, this process. Reliance on the current process results in patients being exposed to unacceptable levels of risk and in impaired and incompetent physicians possibly not receiving the help they need."

In an accompanying editorial, Matthew K. Wynia, MD, MPH, from the Institute for Ethics, American Medical Association, in Chicago, Illinois, agrees with the need for improving the current system of physician self-regulation.

"Calls for more education, improved socialization into the norms and obligations of professionalism, and better protections for whistle-blowers should be heeded," Dr. Wynia writes. "Yet the study by DesRoches et al is also a reminder that physicians are always seeking to perfect the complex web of interactive processes used for quality assurance in medicine. That, too, is in the nature of medical professionalism."

The study was supported by the Institute on Medicine as a Profession. The study authors and Dr. Wynia have disclosed no relevant financial relationships.

JAMA. 2010;304:187-193, 210-211.