A recent cohort study investigated the disparity in unprofessional behavior reports among physicians across various specialties, as perceived by their coworkers. Involving 35,120 physicians, the study discovered that 9.1% had at least one report from a coworker describing unprofessional behavior.
Key Findings
Surgeons were the most frequently reported group, with 13.8% having at least one report, whereasnonsurgeonnonproceduralists had the lowest rate at 5.6%. Emergency medicine physicians and nonsurgeon proceduralists exhibited unprofessional behavior at rates of 10.9% and 12%, respectively. Physicians specializing in pediatrics were notably less likely to receive reports compared to their nonpediatric counterparts, especially among nonsurgeonnonproceduralists (3.6% vs. 6.0%).
The primary types of unprofessional behavior reported were issues with clear and respectful communication, followed by lapses in professional responsibility, competent medical care, and integrity.
Study Design
This retrospective cohort study, published in JAMA Network Open, utilized data from the Coworker Concern Observation Reporting System (CORS), administered by the Vanderbilt Center for Patient and Professional Advocacy, covering January 2018 to December 2022. Reports were categorized into clear and respectful communication, professional responsibility, competent medical care, and integrity. The study employed logistic regression to calculate the odds of any CORS report, adjusting for specialty, region, academic practice status, and pediatric specialty status.
The cohort included 18,288 nonsurgeonnonproceduralists, 1,876 emergency medicine physicians, 6,743 nonsurgeon proceduralists, and 8,213 surgeons. Notably, surgeons had the smallest proportion of pediatric-focused practitioners (5.5%). The largest proportion of the cohort practiced in academic settings, reflecting the distribution of CORS sites.
Detailed Results
Out of the 35,120 physicians in the cohort, 3,179 (9.1%) had at least one CORS report. The incidence of reports varied significantly by specialty: nonsurgeonnonproceduralists (5.6%), emergency medicine physicians (10.9%), nonsurgeon proceduralists (12.0%), and surgeons (13.8%). Nonsurgeonnonproceduralists were significantly less likely to be reported compared to all other specialties combined (5.6% vs. 12.8%).
Pediatric-focused physicians were less likely to receive a CORS report than nonpediatric-focused physicians (6.8% vs. 9.4%). Specifically, pediatric-focused nonsurgeonnonproceduralists had fewer reports compared to their nonpediatric counterparts (3.6% vs. 6.0%).
In a multivariable logistic regression model, controlling for physician and practice site characteristics, all specialty types had significantly higher odds of receiving at least one coworker concern report compared to nonsurgeonnonproceduralists. The adjusted odds ratios (OR) were: emergency medicine physicians (adjusted OR, 1.91; 95% CI, 1.63-2.24), nonsurgeon proceduralists (adjusted OR, 2.34; 95% CI, 2.12-2.57), and surgeons (adjusted OR, 2.75; 95% CI, 2.51-3.01) (P < .001). Pediatric-focused physicians were significantly less likely to have a coworker concern report than those with a nonpediatric focus (adjusted OR, 0.69; 95% CI, 0.61-0.78; P < .001).
The predominant types of CORS reports across all specialties involved issues with clear and respectful communication, followed by professional responsibility. Reports concerning professional integrity were the least common.
Implications
“Because unprofessional behaviors are associated with patient complications, malpractice claims, and well-being concerns, monitoring concerning behavior and especially those physicians with repeated reports provides important opportunities for physicians and leaders to support professionalism, which increases the chance of health care organizations meeting their clinical, cultural, and other performance goals,” the study researchers concluded.
A complete list of disclosures from the researchers is available in the study.
