Original Investigation
Public Health
June 6, 2024
Physician Specialty Differences in Unprofessional Behaviors Observed and Reported by Coworkers
William O. Cooper, Gerald B. Hickson, Roger R. Dmochowski, et al
JAMA Netw Open. 2024;7(6):e2415331. doi:10.1001/jamanetworkopen.2024.15331
Question Are there differences by specialty in the proportion of physicians who are identified in safety event reports submitted by coworkers describing unprofessional behaviors?
Findings In this cohort study of 35 120 physicians, 9.1% had at least 1 report from a coworker describing unprofessional behavior. Surgeons were most likely to receive a coworker report, and physicians with a pediatric focus were the least likely to receive a report of unprofessional behavior.
Meaning Understanding more about the distribution and patterns of unprofessional behaviors in health care that interfere with individual and team performance can support coworker well-being and the ability to deliver safe high-quality care.
Abstract
Importance Because unprofessional behaviors are associated with patient complications, malpractice claims, and well-being concerns, monitoring concerns requiring investigation and individuals identified in multiple reports may provide important opportunities for health care leaders to support all team members.
Objective To examine the distribution of physicians by specialty who demonstrate unprofessional behaviors measured through safety reports submitted by coworkers.
Design, Setting, and Participants This retrospective cohort study was conducted among physicians who practiced at the 193 hospitals in the Coworker Concern Observation Reporting System (CORS), administered by the Vanderbilt Center for Patient and Professional Advocacy. Data were collected from January 2018 to December 2022.
Exposure Submitted reports concerning communication, professional responsibility, medical care, and professional integrity.
Main Outcomes and Measures Physicians’ total number and categories of CORS reports. The proportion of physicians in each specialty (nonsurgeon nonproceduralists, emergency medicine physicians, nonsurgeon proceduralists, and surgeons) who received at least 1 report and who qualified for intervention were calculated; logistic regression was used to calculate the odds of any CORS report.
Results The cohort included 35 120 physicians: 18 288 (52.1%) nonsurgeon nonproceduralists, 1876 (5.3%) emergency medicine physicians, 6743 (19.2%) nonsurgeon proceduralists, and 8213 (23.4%) surgeons. There were 3179 physicians (9.1%) with at least 1 CORS report. Nonsurgeon nonproceduralists had the lowest percentage of physicians with at least 1 report (1032 [5.6%]), followed by emergency medicine (204 [10.9%]), nonsurgeon proceduralists (809 [12.0%]), and surgeons (1134 [13.8%]). Nonsurgeon nonproceduralists were less likely to be named in a CORS report than other specialties (5.6% vs 12.8% for other specialties combined; difference in percentages, −7.1 percentage points; 95% CI, −7.7 to −6.5 percentage points; P < .001). Pediatric-focused nonsurgeon nonproceduralists (2897 physicians) were significantly less likely to be associated with a CORS report than nonpediatric nonsurgeon nonproceduralists (15 391 physicians) (105 [3.6%] vs 927 [6.0%]; difference in percentages, −2.4 percentage points, 95% CI, −3.2 to −1.6 percentage points; P < .001). Pediatric-focused emergency medicine physicians, nonsurgeon proceduralists, and surgeons had no significant differences in reporting compared with nonpediatric-focused physicians.
Conclusions and Relevance In this cohort study, less than 10% of physicians ever received a coworker report with a concern about unprofessional behavior. Monitoring reports of unprofessional behaviors provides important opportunities for health care organizations to identify and intervene as needed to support team members.
