Urgent message: Physicians are expected to be leaders in the urgent care practice, but they are also human and prone to inappropriate behavior. It’s thus critical for urgent care operators to establish processes for investigating, documenting, and responding to allegations of physician misconduct.
Alan A. Ayers, MBA, MAcc is Chief Executive Officer of Velocity Urgent Care and is Practice Management Editor of The Journal of Urgent Care Medicine.
On any given day, there is no single person in an urgent care operation as influential as the physician. The physician, sometimes alongside an office manager, sets the tone for how staff performs their duties, how they relate to patients, and how they communicate and work with colleagues. The physician is the product being sold, the nexus for all processes, the ultimate authority sought, and the one who garners respect from higher education and an income that can be 10 times that of front-line staff. Given their skills and social standing, physicians are counted among the leaders of any practice and thus are expected to set an example of collegiality and professionalism at all times.
Conversely, it’s also due to their status and influence that physician misconduct, when it occasionally rears its ugly head, can be so damaging to a practice. So, what does physician misconduct look like? Some examples (and links to further reading) include:
- Verbal tirades directed towards staff and patients
- Bullying and intimidation
- Physical aggression (including slamming doors, tossing equipment, snatching objects from a colleague’s hand, etc.)
- Inappropriate sexual innuendo, comments, and behavior
- Passive-aggressive behavior (failing to return calls, pages, and texts)
The list could on, but it’s the consequences of such behavior that are most damaging: erosion of trust, lowered morale, poor patient service, heightened stress among staff, staff turnover, lowered productivity, malpractice lawsuits, and clinical errors that could harm patients.
Whether physician misconduct is a result of a usually professional provider going through some personal crisis or simply due to the provider being a bad apple, left unchecked the ripple effect of such behaviors can bring a center to its knees. Put simply, physician misconduct is not only a threat to your practice, but a delicate issue fraught with potential landmines. Hence, following are a few key actions your center should take when dealing with a troublesome physician.
At some point, your practice may need to take decisive action against a misbehaving physician. As the action will likely be based upon the terms spelled out in the physician’s employment agreement, it’s critical to thoroughly document each instance of questionable or bad behavior. Overlooking incidents and giving “second chances” without documenting those instances can weaken your ability to enforce the employment agreement later. Lack of documentation can also expose a practice to a claim for wrongful termination, even if employment is otherwise “at will.” Ensure that all policies and procedures are clearly spelled out, are unambiguous, and are signed off on by the physician.
Put Personal Feeling Aside
One of the primary reasons misbehaving physicians are allowed to continue their behavior is their personal and professional relationships with staff. In many cases, the physicians have formed friendships that go beyond the center, which makes it difficult for staff to report their bad behavior. In other cases, the offending physician is profitable to the bottom line, such that their absence could mean a serious hit to revenues. In either case, personal feelings must be set aside, and prescriptive action must begin. Failure to act or insufficiency of response not only exposes the center to great legal risk, but it forfeits the opportunity to potentially salvage the situation had it been addressed earlier.
Be Prepared for Pushback
Keep in mind that when you move to discipline or terminate a physician, their license, reputation, and livelihood are at stake. So, don’t be surprised if you get pushback in the form of, say, the physician “lawyering up” and going on the offensive. Basically, things may start to get costly and messy in terms of legal expense. Additionally, the provider understands that they could wind up in the National Practitioner’s Data Bank, which will cast them in a negative light to payers and prospective employees, and could cause them problems with getting credentialed later. Indeed, it could become such an ugly fight that the physician might go as far as soliciting regulatory bodies and accusing the practice of breach of contract, anticompetitive practices, and fraud, for example. Regardless, it is your duty to stick your guns and protect your medical staff, patients, and business from the misconduct of the physician. Forge ahead, and be sure to consult your legal counsel on the best way to navigate the situation.
In short, addressing physician misconduct can be a sticky situation fraught with peril for all parties involved. Even in cases where you have personal empathy for a colleague going through a tough time, you still must be rigorous in your documentation and corrective action. The hope is to salvage the professional relationship when possible, of course, but if it’s not possible, following and enforcing the physician employee agreement to the letter places your center in the best position to move forward with minimal legal consequence.