Physician Behavioral Issues
We are finding an increasing number of medical practices that are struggling to deal with
physicians with behavioral issues. It is difficult to know whether there are an increasing number
of physicians with these problems or others are just becoming less tolerant. Whichever it is, the
situations are being compounded by the many stresses with which all physicians have to deal.
It is very difficult for most physicians to confront another physician over such matters as
unacceptable behavior. Physicians hold their colleagues right to practice as each individual
deems appropriate within the parameters of community standards as almost sacred. Add to this,
physician’s reluctance to hurt one another feelings through a confrontation.
Another aspect that often plays into the equation is finances. No one is anxious to ruffle the
feathers of a partner that is contributing to paying the overhead of the practice. An interesting
phenomenon is that a large number of the physicians exhibiting bad behavior are the high
producers in practices.
So how does a practice go about solving this sticky problem?
The first step is for a practice to set the standards, expectations and governance around physician
behavior. The best time to this is before issues arise, but it is never too late to lay this important
foundation.
The first is to agree on the Core Values for the practice. What are those things that a practice
holds as the fundamentals on which they base decisions and actions? Such things as Quality
Patient Care, Respect For All Individuals, Team Work, Balanced Lives, Honesty, and Doing
What Is Right. Once these values are clearly understood and agreed upon, it becomes much
easier to recognize behavior that strays from what is acceptable. For instance, if a practice has a
physician that routinely shows up late at the office, does not complete their charts and sloughs
off when on call they are disruptive to everyone. When other physicians are asked why do you
come to work on time, complete your charts each day and always appropriately handle your oncall work, the response is likely to be, it’s not fair to the patients, staff and my colleagues to do
otherwise. What they are saying is that my values guide the way I act. The poor behavior of
physician is often just the symptoms; the real issue is that they do not share the same Core Value.
The next important piece of the foundation is governance. A group needs to decide who is
responsible for dealing with physician behavioral issues. Far too often it falls to the practice
manager. In only the rarest of organizations would it be appropriate for the manager to have this
role. It is simply not appropriate for an employee to deal with the behavior of one of their
bosses. The responsibility should be assigned to the lead physician of the practice – the group
president or managing partner. The ultimate responsibility lies with the governing body – the
Board of Directors, Shareholders or Partners.
The third leg of the foundation is clearly delineating expectations around how physicians should
conduct themselves. A good way to do that is through a Code of Conduct or a document that
lays out examples of expected behavior and unacceptable behavior (see Exhibit 1). The
corporate documents or partnership agreements should reference these examples and give the
governing body the authority to act appropriately toward an individual that does not meet the
standards.
What are the approaches to dealing with physicians with behavior problem?
The most important considerations are 1) always think of the physician as an employee for these
purposes; and 2) rely on the formal governance structure that you have put in place. Regardless
of the approach, these two items are essential for success.
There are several techniques and the proper way to handle any specific situation will depend on
the past behavior, personality, motivations, personal life, age, relationships and other factors. In
spite of the mitigating factors the person with the delegated responsibility for dealing with
physician behavioral issues must confront the physician as an employee and clearly tell them that
his or her behavior has been deemed as inappropriate. The lead physician should have the
unanimous support of the governing body – either by explicit delegation of authority by virtue of
the position or by meeting to discuss the situation before the physician is confronted. The
meeting with the physician is not a discussion or debate; it is to inform the misbehaving
physician that their conduct is not acceptable. It is very important that the physician understand
that the spokesperson is speaking for the whole group.
If it is difficult for the practice or the individual physician to fully understand what the
underlying problem is that is causing the poor behavior or if the physician denies the problem,
Vanderbilt Medical Center offers a Comprehensive Assessment Program for Professionals. The
program offers:
• Psychological Testing and Reports
• Psychiatric Evaluation
• Psychosocial History (may include interviews with family members)
• History and Physical, where indicated
• Blood Work and Drug Testing, when indicated
• Collateral Information – with client permission other interested parties maybe
interviewed
• Follow-up Sessions
• Comprehensive Report for Client & Practice
The practice should present the individual with a specific action plan. Some of the options to
consider placing in the plan would include:
• Be evaluated by Vanderbilt
• Come under the care of a psychologist
• Get charts caught up by a specific date
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Stop doing surgery
Attend anger management course
Apologize to surgical team
Follow the prescribed action plan
Physicians Health Program
Fundamentally, the situation could be handled as any other employee discipline issue following a
set step by step program such as:
• Counsel
• Warn
• Discipline
o Fine
o Suspend
o Require outside counseling
o Direct activities – cannot see patients until charts are completed, work on
weekends to catch up, etc
• Terminate
Other approaches include requiring the individuals with behavioral issues to work with a
professional job coach. These are trained and credentialed professionals that spend regular time
helping the physician change the behavior. It must be remembered that the physician very likely
has learned this behavior over a long period of time and it is going to take considerable effort to
alter their behavior. Additionally, some individuals may require psychological or psychiatric
counseling.
The practice should have a plan to monitor the progress or lack thereof. The individual should
be given regular feedback. Probably the most important part of the plan should be that the
repercussions for failure to adhere to the plan should be clearly defined.
A final very important consideration is the financial impact on the practice and the individual of
dealing with a physician behavior problem. The physician’s professional competence will be
threaten through this process so the question becomes, does adding a financial burden on top that
aid in bringing about a positive outcome? The practice should consider being willing to support
the physician financially by protecting their income while they seek help and paying for all the
evaluations and treatment. Compassion should prevail with the clear rationalization that it will
likely cost the practice more money to recruit, replace and build a new physician’s practice than
it will to rehabilitate a current physician.
SVMIC’s Medical Practice Services department is staffed with professional consultants that can
assist your practice through this difficult process. The help provided by these individuals is
provided as a benefit of your SVMIC policy for no additional cost.
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