Doesn’t work well with others: Disruptive MDs can cost millions

Disruptive physician behavior in a typical 400-bed hospital can lead to annual costs of more than $1 million, and correcting these behaviors represents a source of potential savings for a provider, according to an article published in the September issue of Academic Radiology.

“Reducing disruptive physician behavior in academic health care systems is a potential funding stream with the added benefits of improved patient safety, reduced medical errors and improved medical student/resident education,” wrote James V. Rawson, MD, of Georgia Regents University, Augusta, and colleagues. The authors first presented their findings on disruptive behavior at the Association of University Radiologists’ annual meeting in 2012.

A number of behaviors can be disruptive in a hospital environment, some aggressive and others more passive-aggressive. Examples of the former include profane language, throwing objects and refusal to follow policies. More passive, but still disruptive, behaviors include lack of participation in discussions, tardiness or falling asleep during lectures.

Rawson and colleagues also pointed out that, over the course of their careers, approximately 10 to 12 percent of physicians will develop a substance use disorder, a rate similar to that of the general population.

Citing a 2011 QuantiaMD survey, the authors wrote that 70 percent of the survey’s 840 physician respondents reported disruptive physician behaviors occurred at least monthly, with 10 percent reporting daily disruptive behaviors.

Costs related to disruptive physician behaviors are driven by staff turnover, medical errors and preventable complications, explained Rawson and colleagues. Approximately 12 percent of staff members leave hospitals due to disruptive behavior, and turnover has been estimated to cost up to two times the salary paid for the position that needs to be refilled. A study in JAMA revealed that 7 percent of medication errors are due to dysfunctional physician behavior and the annual cost of these events alone is $480,000 for a typical 400-bed hospital.

“The most significant indirect cost is the failure to create a culture of safety and highly functional teams in a health care environment,” wrote Rawson and colleagues. “Medical errors account for 30 percent of national health care expenditures and 10 percent to 15 percent of a typical hospital's operating budget; at least half of medical errors are considered preventable.”

To combat disruptive behavior, the Joint Commission has recommended hospitals establish a formal code of conduct and create processes for reporting and managing these disruptions.