A recent cohort study explored differences by specialty in the proportion of physicians identified in safety event reports submitted by coworkers describing unprofessional behaviors. The study included 35,120 physicians and found that 9.1% had at least 1 report from a coworker describing unprofessional behavior.

Key Findings

Surgeons were the most likely to receive a coworker report, with 13.8% having at least 1 report, while nonsurgeon nonproceduralists had the lowest percentage at 5.6%, according to study results. Emergency medicine physicians and nonsurgeon proceduralists had a 10.9% and 12% report rate for unprofessional behavior, respectively. Pediatric-focused physicians were significantly less likely to receive reports compared with nonpediatric-focused physicians, particularly among nonsurgeon nonproceduralists (3.6% vs. 6.0%, respectively).

The study also found the most common types of unprofessional behavior reported involved issues with clear and respectful communication, followed by professional responsibility, competent medical care, and integrity.

Study Design

Published in JAMA Network Open, the retrospective cohort study used data from the Coworker Concern Observation Reporting System (CORS), managed by the Vanderbilt Center for Patient and Professional Advocacy, from January 2018 to December 2022. Reports were categorized into clear and respectful communication, professional responsibility, competent medical care, and integrity. Logistic regression was used to calculate the odds of any CORS report, adjusting for specialty, region, academic practice status, and pediatric specialty status.

The cohort consisted of 18,288 nonsurgeon nonproceduralists, 1,876 emergency medicine physicians, 6,743 nonsurgeon proceduralists, and 8,213 surgeons. Surgeons had the smallest proportion of physicians with a pediatric-focused practice (5.5%). Physicians practicing in academic settings represented the largest proportion of the cohort, which reflects the distribution of CORS sites.

Detailed Results

Of the 35,120 physicians in the cohort, 3,179 (9.1%) had at least 1 CORS report. The proportion of physicians named in at least one report varied significantly by specialty: nonsurgeon nonproceduralists (5.6%), emergency medicine physicians (10.9%), nonsurgeon proceduralists (12.0%), and surgeons (13.8%). Nonsurgeon nonproceduralists were significantly less likely to be named in a CORS report compared to other specialties combined (5.6% vs 12.8%).

Pediatric-focused physicians were significantly less likely to receive a CORS report than their nonpediatric-focused counterparts (6.8% vs 9.4%). Pediatric-focused nonsurgeon nonproceduralists had a lower rate of CORS reports than nonpediatric-focused nonsurgeon nonproceduralists (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 nonsurgeon nonproceduralists, including 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).1 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 most common types of CORS reports for all physician specialties involved clear and respectful communication, followed by professional responsibility. The least common type of CORS report involved professional integrity.

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," concluded study researchers.

A full list of disclosures from the researchers are available in the study.