title: Characteristics of Internal Medicine Physicians Disciplined by Professional Colleges in Canada.
abstract: Physician misconduct is of serious concern to patient safety and quality of care. Currently, there are limited data on disciplinary proceedings involving internal medicine (IM) physicians.The aim of this study was to investigate the number and nature of disciplinary cases among IM physicians compared with those of other disciplined physicians.Our retrospective study reviewed information from all provincial Colleges of Physicians and Surgeons (CPS) and compiled a database of all disciplined physicians from 2000 to 2013 in Canada. Disciplinary rate differences (RDs) were calculated for IM physicians and compared with other physicians.From 2000 to 2013, overall disciplinary rates were low (9.6 cases per 10,000 physician years). There were 899 disciplinary cases, 49 of which involved 45 different IM physicians. IM physicians comprised 10.8% of all disciplined physicians and were disciplined at a lower rate than non-IM physicians, incurring 5.18 fewer cases per 10,000 physician years than other physicians (95% confidence interval [CI] 3.62-6.73; P < 0.001). They were significantly less likely to be disciplined for: unprofessional conduct (RD 1.16; CI 0.45-1.87; P = 0.001); unlicensed activity (RD 0.78; CI 0.37-1.19; P < 0.001); standard of care issues (RD 1.37; CI 0.49-2.26; P = 0.002); sexual misconduct (RD 1.65; CI 0.90-2.40; P < 0.001); miscellaneous (RD 0.80; CI 0.11-1.50; P = 0.020); mental illness (RD 0.06; CI 0.01-0.12; P = 0.025); inappropriate prescribing (RD 0.74; CI 0.15-1.33; P = 0.010); and criminal conviction (RD 0.33; CI 0.00-0.65; P = 0.048). No significant differences were found with respect to unclear violations, fraudulent behavior/prevarication, or offenses involving drugs/alcohol (all RDs less than 0.32). IM physicians were also less likely to incur the following penalties: voluntary license surrender (RD 0.53; CI 0.37-0.69; P < 0.001); suspension (RD 2.39; CI 1.26-3.51; P < 0.001); retraining/assessment (RD 1.58; CI 0.77-2.39; P < 0.001); restriction (RD 1.60; CI 0.74-2.46; P < 0.001); other (RD 0.52; CI 0.07-0.97; P = 0.030); formal reprimand (RD 2.78; CI 1.77-3.79; P < 0.001); or fine (RD 3.28; CI 1.89-4.67; P < 0.001). No significant differences were found with respect to revocation or mandated counseling/rehabilitation (all RDs less than 0.46).Generally, disciplinary rates among physicians were low. Compared with other physicians, IM physicians have significantly lower disciplinary rates overall and are less likely to incur the majority of disciplinary offenses and penalties.
authors.affiliation: From the Department of Medicine, University Health Network (JJL); Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (AQA); Institute of Human Nutrition, Columbia University College of Physicians and Surgeons, New York, New York (HRG); Department of Biostatistics, Dalla Lana School of Public Health (JJM); Department of Medicine (CMB); Institute for Health Policy Management and Evaluation, University of Toronto (CMB); and Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada (CMB).
authors.forename: Jessica J
authors.initials: JJ
authors.lastname: Liu
authors.forename: Asim Q
authors.initials: AQ
authors.lastname: Alam
authors.forename: Hanna R
authors.initials: HR
authors.lastname: Goldberg
authors.forename: John Justin
authors.initials: JJ
authors.lastname: Matelski
authors.forename: Chaim M
authors.initials: CM
authors.lastname: Bell
mesh_terms: D002170:Canada; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data*; D008297:Male; D028743:Professional Misconduct / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012955:Societies, Medical