Physicians don't always report impaired or incompetent colleagues

Most physicians agree they have an ethical obligation to report impaired or incompetent colleagues, but many don't always do so, according to a new study.

Researchers performed a survey of 2,938 physicians practicing in the fields of anesthesiology, cardiology, family practice, general surgery, internal medicine, pediatrics and psychiatry. The response rate was 64.4%. Respondents were asked whether they agreed or disagreed that physicians should always report impaired or incompetent colleagues. They were also asked whether they were prepared to deal with such colleagues and whether they had been aware of and subsequently reported an impaired or incompetent colleague in the past three years. Those who reported knowing of an impaired or incompetent colleague were asked if they had ever not reported unprofessional behavior for certain reasons, such as believing someone else was handling the problem or that the physician in question would be too harshly disciplined as a result of the reporting. The survey results appear in the July 14 Journal of the American Medical Association.

Overall, 1,120 physicians (64%) agreed that the tenets of their profession obligated them to report impaired or incompetent colleagues. Still, only 69% (n=1,208) were prepared to deal with impaired colleagues and 64% (n=1,126) were prepared to deal with incompetent colleagues. Of the 309 physicians (17%) who personally knew an incompetent colleague, 67% (n=204) said that they had reported him or her. Physicians who were underrepresented minorities, who did not graduate from a U.S. medical school and who lived in an area where malpractice claim numbers were high were less likely to report, while those working in hospitals or medical schools rather than group or small practices were more likely to report. Physicians were most likely to cite a belief that "someone else was taking care of the problem" as the reason for failing to report. Other common reasons included believing that reporting would have no effect and fearing that it would lead to retribution.

The study results may have been affected by nonresponse bias, and physicians may have been wrong about their colleagues' job performance. However, the authors concluded that based on their survey results, self-regulation does not guarantee accurate reporting of impaired or incompetent physicians. External regulation by such bodies as professional societies should be strengthened, they suggested, and reporting systems must guarantee reporting physicians' anonymity and provide feedback once the reported problem is addressed.

The author of an accompanying editorial pointed out that the study results could alternatively be viewed more positively, since most physicians did agree that they had an obligation to report impaired or incompetent colleagues. He also noted that "today there are multiple complementary methods, developed by the profession, to monitor competence and detect impairment," such as performance measurement, CME requirements, and maintenance of certification programs. The editorialist agreed that some physicians do not report colleagues when they should, and that the existing reporting system should be improved. However, he wrote, the current study "is also a reminder that physicians are always seeking to perfect the complex web of interactive processes used for quality assurance in medicine."