Physician incompetency found under-reported by colleagues

DesRoches, CM. JAMA. 2010;304:187-193.

Peer monitoring and reporting of incompetent medical practice by physicians was found lacking in a new study published in the Journal of the American Medical Association.

The study consisted of a nationally representative survey of 2,938 eligible physicians practicing anesthesiology, cardiology, family practice, general surgery, internal medicine, pediatrics and psychiatry in the United States in 2009. Overall, the physician response rate was 64.4% (n=1,891).

Of the surveyed physicians, 64% agreed with the professional commitment to report physicians who are notably impaired or otherwise incompetent. Sixty-nine percent (n=1,208) of physicians reported being very or somewhat prepared to deal with impaired colleagues in their medical practice, and 64% (n=1126) reported being very or somewhat prepared to deal with incompetent colleagues. For the 17% (n=309) of physicians who had personal knowledge of an incompetent physician colleague, 67% (n=204) reported this colleague to the relevant authority.

According to researchers, the most frequently cited reason for taking no action was the belief that someone else was taking care of the problem (19%), followed by the belief that nothing would happen as a result of the report (15%) and fear of retribution (12%).

These findings, they wrote, “suggest that a large number of practicing physicians do not support the current process of self-regulation; it is underused and appears to have several major shortcomings, including a perceived lack of anonymity and efficacy. 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 results of this study were not a surprise to me. Physicians in general have been reluctant to police themselves—throughout their career they have been taught to be autonomous and not to rely on others. Because of this, they find it difficult to coach as well as to insure that others among their ranks are meeting all standards. Too often they feel "that is his or her problem and not mine" so I will remain quiet—someone else will probably take care of it.

–W. Douglas Weaver, MD
Head, division of cardiovascular medicine,
Darin Chair of Cardiology, Co-director, Heart and Vascular Institute

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