Physician Intervention Services

Discreet. Confidential. Effective.

Research done by Vanderbilt University Medical Center showed that 9% of physicians accounted for 50% of unsolicited patient complaints — and over 50% of malpractice dollars paid out over the study period.

Do you have a disruptive physician on your staff? Someone who intimidates, bullies or demeans co-workers and patients, has verbal outbursts, throws items at others or makes physical threats? A physician who engages in inappropriate sexual behavior or retaliates against those who make complaints?

Physicians exhibiting disruptive behavior can be extremely costly in terms of lost time, productivity and staff morale. Unchecked, they potentially threaten the safety of your patients and staff, diminish the reputation of your institution — and increase your exposure to malpractice suits.

It’s often hard to know what to do and how to do it — particularly in the early stages when an inappropriate behavior is noticed but not deemed critical. Yet the need for early and effective intervention has never been greater.

  • In order to keep JCAHO accreditation, every hospital now must have a system in place for recognizing and effectively dealing with disruptive physicians — whether they’re on staff or simply have privileges.
  • In order to minimize the risk of adverse events and malpractice suits, medical groups must have the awareness and skill set to intervene effectively when a colleague or employee first begins behaving unprofessionally.
  • Organizations that identify and deal with disruptive behaviors and performance problems at the earliest stages can not only save a considerable amount of time and money — but also mitigate risk.

How Physician Intervention Services Can Help

We’re behavioral experts you can consult whenever you have a physician who may be underperforming, creating difficult work situations or putting patients at risk. We’ll assign a case manager to assist you in identifying specific concerns related to the physician's behavior, determining the appropriate level of response, and in developing a plan to approach the physician with your concerns.

Escalating Levels of Intervention

An Individualized, Step-By-Step Approach

Our Physician Intervention Services offer a research-based, step-by-step approach to confronting disruptive behaviors and performance issues.

The rate of suicide among physicians is 40% higher for male physicians and 227% higher for female physicians than among the general population.

Step 1

Objective Situation Analysis

When a physician-related issue is referred to us, our first step is to conduct an objective, data-driven analysis of the physician’s behavior. As part of this analysis, we may also interview staff members and other observers to determine baseline behavior or performance patterns and identify the core reason for the disruptive behavior or performance issue.

Research shows that when physicians exhibit disruptive behaviors, or are having performance issues, there may be one or more factors in play that affect doctors to a greater extent than the general population. Those factors include:

  • Depression
  • Alcohol and drug abuse
  • Relationship issues
  • Physical illnesses
  • Day-to-day stressors
  • Inherent personality characteristics

In working with physicians and healthcare organizations, we strive to:

  • Minimize lost productivity and prevent damage to patients, staff and institutions
  • Maintain confidentiality to the full extent allowed by law, addressing reporting and licensure considerations as required
  • Make referrals, when necessary, to the psychiatrists and other behavioral and mental health professionals in our nationwide network who are experienced in working with physicians and also best qualified to address the issue at hand
  • Formulate plans designed to work in concert with existing organizational policies and identify gaps in existing policies

Step 2

Determining an Appropriate Level of Intervention

Our goal is to help you address problems at the earliest possible stage. We tailor our services to meet the needs of the individual and the organization. Our approach is positive and compassionate rather than punitive — with an emphasis on support and accountability.

We look at your immediate needs, internal resources and preferences before developing a strategy. For example:

  • Do you have someone on staff with the experience and comfort level to perform an informal intervention — or would you like us to coach and mentor you through the process?
  • For more serious interventions, do you want to handle them internally — or rely more on our staff, which has the experience to handle those issues discreetly and effectively?

Based on more than 30 years of working with medical professionals, and on research and studies by Vanderbilt Medical Center and others, we offer four escalating levels of intervention services:

Level 1 — Informal Intervention

Recommended for single incidents where there are no legal or patient safety issues associated with the unprofessional behavior exhibited.

VITAL WorkLife staff will coach and provide support to a peer or staff member before and after an informal conversation with the troubled physician.

The expectation is that the physician will self-correct — although VITAL WorkLife staff can be made available as a resource.

Level 2 — Awareness Intervention

Used in situations where disruptive behavior recurs. While still largely informal, the Awareness Intervention includes a confidential written directive from the organization.

The physician receives a document outlining the organization’s expectations for change and a plan for monitoring improvement.

VITAL WorkLife staff may provide coaching to management, meet one-on-one with the physician, help draft a letter or some combination of those activities.

Level 3 — Authority Intervention

Used when disruptive behavior continues or escalates, or a single serious incident occurs, the Authority Intervention begins with a physician interview performed by a multidisciplinary team of medical, mental and behavioral health providers.

After conducting the interview and identifying the factors that may underlie or contribute to the physician's disruptive behavior at work, we:

  • Develop a plan for successful behavior change
  • Share these recommendations with both the physician and referring employer
  • Coordinate any necessary referrals for specialized care to a nearby provider in our network
  • Monitor success of referrals and behavior change
  • Develop a core team of in-house and VITAL WorkLife personnel to serve as a source of support and accountability.

All Authority Interventions include a confidential written directive, setting forth expected actions and improvements with potential consequences for noncompliance.

Level 4 — Disciplinary Intervention

Used when an escalation or continuation of previous patterns of behavior occurs, or because of a single incident with serious implications surrounding patient and staff safety and quality, the Disciplinary Intervention typically involves:

  • Formal multi-disciplinary assessment of the physician, as with Level 3
  • An involuntary plan to resolve identified issues — such as attending an anger management course, participating in a chemical dependency program or seeking treatment for psychological concerns.
  • Threat of termination for non-compliance
  • Monitoring to ensure progress and compliance.

The Disciplinary Intervention may also include reporting to legal or licensure entities and restriction or termination of privileges.

Step 3

Monitoring and Follow Up

VITAL WorkLife provides support for every stage and type of intervention. Our end-to-end solution includes coaching and support, written documentation and performance plans, as well as short- and long-term monitoring and follow up. When we make referrals to specialized service providers, we provide coordination and oversight to ensure that progress is being made