More than one-third of U.S. physicians responding to a 2009 nationwide survey did not agree that physicians should always report colleagues who are significantly impaired or otherwise incompetent to practice. Led by Catherine M. DesRoches, DrPH, from the Mongan Institute for Health Policy, this report published in the July 14, 2010 Journal of the American Medical Association also notes that substantial numbers of physicians feel unprepared to report or otherwise deal with impaired or incompetent colleagues.

"Our findings cast serious doubt on the ability of medicine to self-regulate with regard to impaired or incompetent physicians," says Dr. DesRoches. "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." Many states and professional organizations, such as the American Medical Association, require physicians and other health professionals to report colleagues whose ability to practice medicine is impaired. In spite of increased attention to and concern about medical errors in professional circles and in the media, studies have shown that fewer impaired physicians are being reported than would be expected.
The analyses reported here focused on physicians' beliefs about the obligation to report, their preparedness to report, and their experiences with and actions taken when confronted with impaired or incompetent colleagues. The data came from responses to a nationally-representative survey of physicians practicing in 2009, which asked about a range of attitudes and beliefs addressing different domains of medical professionalism. The survey was sent to 3,500 physicians, 500 in each of the following specialties: internal medicine, family practice, pediatrics, cardiology, general surgery, psychiatry and anesthesia. For the domain addressing professional self-regulation, participants were asked to rate their agreement that "physicians should report all instances of significantly impaired or incompetent colleagues." The survey also asked how prepared respondents felt to deal with such a colleague and whether they had direct knowledge of an impaired or incompetent colleague in the past three years. Those with such knowledge were asked whether they had reported the most recent incident and also if, within that three-year period, particular reasons were associated with a failure to report.
 

Respondents returned almost 1,900 surveys, and only 64% 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 were the least likely to report feeling prepared to deal with impaired or incompetent colleagues, while psychiatrists and anesthesiologists 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 reported the colleague.
According to John A. Fromson, MD, associate director of Postgraduate Medical Education, MGH Psychiatry, and a co-author of the report, the findings “underscore the need for the medical profession to educate its members on their reporting obligations to ensure safe and competent care to patients. Those obligations include referring colleagues to physician health programs that can guide and monitor their recovery from substance use and mental disorders.”
 

The most frequently cited reason for not reporting was the expectation that someone else would report, indicated by 19%, followed by the belief that nothing would happen because of the report, cited by 15%, and a fear of retribution, 12%. Among factors associated with not reporting were belonging to one- or two-person practices and being a member of an underrepresented minority or a graduate of a foreign medical school. Whether respondents came from a state with high, medium or low rate of malpractice claims was not associated with failure to report.
"Our results imply that the current system of reporting is functionally inadequate; many physicians are afraid to access it or believe that reporting will not be effective," noted Eric G. Campbell, PhD, MIHP’s research director and senior author of the JAMA report. "Improvements to the system need to include helping physicians understand their professional responsibility to report impaired and incompetent colleagues, enhancing protections for reporting physicians and providing confidential feedback about outcomes." This work was supported by a grant from the Institute on Medicine as a Profession.

DesRoches CM, Rao SR, Fromson JA, Birnbaum RJ, Iezzoni L, Vogeli C, Campbell EG.  Physicians' Perceptions, Preparedness for Reporting, and Experiences Related to Impaired and Incompetent Colleagues  JAMA. 2010;304(2):187-193.