What Brings Physicians to Disciplinary Review? A Further Subcategorization

摘要

Background: Medicine, like most professions, has the privilege and responsibility of self-regulation. Evidence about physician discipline comes largely from state medical boards' actions and reports. However, medical professional associations also participate in the review and, when necessary, discipline of physician behavior. This study analyzes a longitudinal series of cases brought to the American Medical Association (AMA) Council on Ethical and Judicial Affairs (CEJA) for review, providing a national view on what sorts of behaviors lead to disciplinary review. The study also presents a more detailed taxonomy of behaviors leading to disciplinary action, which is of particular importance for physician education. Methods: The study sample consisted of 5 years (2004-2008, inclusive) of disciplinary cases brought to the CEJA for initial and dispositive review, representing 298 cases and 293 individuals. Open coding in an iterative fashion led to a codebook of categories and subcategories of reasons for disciplinary review. Each case was then coded by two authors. Disagreements were discussed and reconciled as a group. Results: The two most common categories of behavior that led to disciplinary review were substance abuse disorders (28% of cases) and controlled-substance violations (27%). Negligence/incompetence (21%), criminal activity (20%), fraud/misrepresentation (19%), and boundary violations (12%) were also common reasons for which physicians were brought before the CEJA. Subcategories illustrate a range of behavior within categories; for instance, boundary-violation subcategories included romantic relationship with a patient, treating family members as patients, and having sexual contact with a patient. Conclusions: Physicians were reviewed by a professional medical disciplinary council for a variety of reasons. While the broad categories of alleged behavior are similar to those found in other studies, this study identified subcategories that demonstrate the complexity of actions that lead to physician disciplinary review. Physicians and physicians-in-training should be educated regarding this subcategorization in order to decrease the rate of discipline and improve patient care.