Professionalism in Medicine: Results of a National Survey of Physicians

4 December 2007 | Volume 147 Issue 11 | Pages 795-802

Background: The prospect of improving care through increasing professionalism has been gaining momentum among physician organizations. Although there have been efforts to define and promote professionalism, few data are available on physician attitudes toward and conformance with professional norms.

Objective: To ascertain the extent to which practicing physicians agree with and act consistently with norms of professionalism.

Design: National survey using a stratified random sample.

Setting: Medical care in the United States.

Participants: 3504 practicing physicians in internal medicine, family practice, pediatrics, surgery, anesthesiology, and cardiology.

Measurements: Attitudes and behaviors were assessed by using indicators for each domain of professionalism developed by the American College of Physicians and the American Board of Internal Medicine. Of the eligible sampled physicians, 1662 responded, yielding a 58% weighted response rate (adjusting for noneligible physicians).

Results: Ninety percent or more of the respondents agreed with specific statements about principles of fair distribution of finite resources, improving access to and quality of care, managing conflicts of interest, and professional self-regulation. Twenty-four percent disagreed that periodic recertification was desirable. Physician behavior did not always reflect the standards they endorsed. For example, although 96% of respondents agreed that physicians should report impaired or incompetent colleagues to relevant authorities, 45% of respondents who encountered such colleagues had not reported them.

Limitations: Our measures of behavior did not capture all activities that may reflect on the norms in question. Furthermore, behaviors were self-reported, and the results may not be generalizable to physicians in specialties not included in the study.

Conclusion: Physicians agreed with standards of professional behavior promulgated by professional societies. Reported behavior, however, did not always conform to those norms.

Editors' Notes Context Whether practicing physicians conform to norms of professionalism is unknown. Contribution This survey of 3504 practicing physicians in the United States found that most physicians agreed with principles regarding fair distribution of resources, access to and quality of care, conflicts of interest, and self-regulation that were proposed by professional societies in 2002. Self-reported behaviors, however, showed that about one half did not follow self-regulation principles and that about one third would order unneeded magnetic resonance imaging for back pain in response to a patient's request. Implication Although physicians generally agree with proposed professional norms, they do not always follow all of them. —The Editors

 

Author and Article Information

From Massachusetts General Hospital, Institute for Health Policy, Boston, Massachusetts; School of Public Health, Yale University, New Haven, Connecticut; and University of Melbourne, Center for Medical Research, Royal Melbourne Hospital, Parkville, Victoria, Australia.

Acknowledgment: The authors acknowledge the contributions of Drs. Janice Ballou and Frank Potter for Mathematica Policy Research.

Grant Support: By a grant from the Institute on Medicine as a Profession.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Eric G. Campbell, PhD, Institute for Health Policy, 50 Staniford Street, 9th Floor, Boston, MA 02114; e-mail, ecampbell{at}partners.org.

Current Author Addresses: Drs. Campbell, Regan, Ferris, Rao, and Blumenthal: Massachusetts General Hospital, Institute for Health Policy, 50 Stanford Street, 9th Floor, Boston, MA 02114.

Dr. Gruen: University of Melbourne, 6th Floor, Center for Medical Research, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.

Dr. Cleary: Yale University, School of Public Health, 60 College Street, New Haven, CT 06513.

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