1 in 3 Physicians Balk at Reporting Incompetent Colleagues

"Our findings cast serious doubt on the ability of medicine to self regulate with regard to impaired or incompetent physicians," said study co-author Catherine DesRoches, DrPh, of the Mongan Institute at the Massachusetts General Hospital, Boston. "Since physicians themselves are the primary mechanism for detecting such colleagues, understanding their beliefs and experiences surrounding this issue is essential. This is clearly an area where the profession of medicine needs to be concerned."

The 1999 Institute of Medicine report, To Err Is Human, and various media accounts have heightened public awareness of egregious physician behaviors, such as surgeons leaving midway through an operation or performing wrong-site surgery. But the rate of reporting by physicians appeared to be 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.

For the survey, a sample of nearly 3,500 eligible physicians practicing in the United States in 2009 in anesthesiology, cardiology, family practice, general surgery, internal medicine, pediatrics, and psychiatry were contacted. Overall, nearly 1,900 responded. Only 64% of the respondents agreed that physicians should always report impaired or incompetent colleagues. About 70% of respondents indicated feeling prepared to deal with an impaired colleague, and 64% felt prepared to deal with an incompetent colleague in their practice.

Pediatricians appeared to be the least likely to report feeling prepared to deal with impaired or incompetent colleagues, while psychiatrists and anesthesiologists said they felt most prepared. Direct, personal knowledge of an impaired or incompetent physician during the past three years was indicated by 17% of respondents, but only 67% of those with such knowledge actually had gone ahead to report those colleagues.

Overall, the study underscores the need for the medical profession to better educate its members on their reporting duties to ensure safe and competent patient care, said John Fromson, MD, associate director of Postgraduate Medical Education, MGH Psychiatry, and also report co author.

"Those obligations include referring colleagues to physician health programs that can guide and monitor their recovery from substance use and mental disorders, Fromson said.

Among those who would not report a colleague, the most frequently cited reason was the anticipation that someone else would report or take care of the problem, as indicated by 19% of those surveyed. This was followed by the belief that nothing would ever happen even if a report was made—cited by 15%—and a fear of retribution, noted by 12%.

Other reasons associated with not reporting the impaired or incompetent physician were having that physician belong to one or two person practices or being a member of an underrepresented minority or a graduate of a foreign medical school. Respondents who came from a state with high, medium, or low rates of malpractice claims were not linked with a failure to report.

The American Medical Association's Code of Ethics requires colleagues to report those of whom they suspect are unable to practice medicine safely because of impairment or incompetence. Additional efforts on the part of medical societies, specialty and accrediting organizations, and hospitals are needed to reinforce the responsibilities of the medical community and to prepare physicians to deal with these difficult situations, the researchers said.