Complaints of unprofessional behavior about a physician coworker were not uncommon in a 5-year retrospective cohort study, with surgeons most likely to be on the receiving end of those complaints.
Among more than 35,000 physicians, 9.1% received one or more reports of unprofessional behavior from coworkers from January 2018 to December 2022, reported William Cooper, MD, MPH, of the Center for Patient and Professional Advocacy (CPPA) at Vanderbilt University Medical Center in Nashville, Tennessee, and co-authors in JAMA Network Open.
The results mean that “the vast majority behave perfectly professionally,” Cooper said, referring to complaints received through the 193 hospitals participating in the CPPA’s Coworker Concern Observation Reporting System (CORS).
As a specialty, surgeons (13.8%) had the highest share of physicians reported by a coworker, although the “vast majority” were not reported at all, Cooper stressed. Next most commonly subject to complaints were nonsurgeon proceduralists (12%) and emergency medicine physicians (10.9%).
Nonsurgeon nonproceduralists, such as hospitalists and critical care physicians, were less likely to be named when compared with all other specialties combined (5.6% vs 12.8%, respectively, P<0.001). And pediatric-focused nonsurgeon nonproceduralists were even less likely to be linked to a CORS report than were other nonsurgeon nonproceduralists (3.6% vs 6%, P<0.001). Pediatric focus didn’t correlate significantly with unprofessional behavior complaints among emergency medicine physicians, nonsurgeon proceduralists, or surgeons.
Unprofessional behaviors reported by patients and coworkers have been linked to increased risk for patient complications and malpractice claims. Repeat offenders “are also likely to have a deleterious impact on culture and team performance,” Cooper and team noted.
The most common of the four types of reports made were related to clear and respectful communication, followed by professional responsibility. The least common reports were those around medical care and professional integrity.
An example of disrespectful communication might be a person who states, “Do you hate your job? Because you do it so badly,” Cooper told MedPage Today. An example of a professional responsibility complaint might include a scenario where another clinician reminds a physician of a certain safety protocol and the physician willfully ignores the reminder, he said.
In exploring the reasons for the differences across specialties, Cooper and his team hypothesized that stressful practice environments may play a role. Surgeons’ work is often “high stakes,” he said. A surgeon’s work also requires a degree of interdependence that can increase the potential for frustration by the surgeon or other members, Cooper and team wrote.
“It is also possible that personality characteristics of surgeons, nurses, and other clinicians who deliver care in perioperative settings differ from clinicians who provide care in other settings,” the authors added.
As for why pediatric-focused physicians seem to fare so well, Cooper, who is a pediatrician, suggested that having the skills required to interact with children and families might lend itself to interacting with coworkers in a way that leads to fewer reports. “It could also be that all the individuals who practice in that space may have different ways of interacting,” he added.
Studies have demonstrated that physicians with unprofessional behaviors often have difficulty with personal relationships and other well-being concerns, Cooper said. His group had also previously found that physicians who have cognitive impairment are more likely to display these unprofessional behaviors.
The goal of these studies is to be able to leverage the data to understand the context for these interactions in ways that can guide leaders to improve professionalism, team function, and ensure the best care possible for patients, he added.
For the 1% of physicians with multiple reports, healthcare organizations can hold individuals accountable by communicating to them how they differ from their peers. While that may seem a “soft, gentle correction,” Cooper said, “it turns out, it really works.”
And for the “small number” who don’t respond to course-correction, Cooper said, organizations can use focused professional evaluation to provide support and help mitigate the inappropriate behaviors.
The study population included 35,120 physicians, of whom 52.1% were nonsurgeon nonproceduralists, 23.4% were surgeons, 19.2% were nonsurgeon proceduralists, and 5.3% were emergency medicine physicians.
The largest share of physicians in the study practiced in the Midwest. The second largest share overall practiced in the Northeast, while the second largest share of emergency medicine physicians practiced in the West.
More physicians practiced in academic settings than community settings, and 13.4% practiced in pediatric settings. The group with the smallest share of pediatric-focused physicians was surgeons, at 5.5%.
One limitation of the study was the possibility that some physicians who engaged in unprofessional behavior weren’t reported due to fear of retaliation.
Cooper said he and his team plan to explore the results of “course-correction” among physicians reported for unprofessional behavior and “how we can help them be the best version of themselves.”
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Disclosures
Cooper disclosed no relevant relationships with industry. Coauthors disclosed relationships with Medtronic Speaker’ Bureau, USC Keck, the IHI, and the International Regulatory Expert Advisory Group to the Australian Health Practitioner Regulation Agency.
Primary Source
JAMA Network Open
Source Reference: Cooper WO, et al “Physician specialty differences in unprofessional behaviors observed and reported by coworkers” JAMA Netw Open 2024; DOI: 10.1001/jamanetworkopen.2024.15331.
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