Disruptive physicians: Don't let the bullies win

Physician leaders most often cite disruptive physicians as their top challenge. In fact, the number of complaints from physician leaders and hospital administrators about disruptive physicians could convince you that the healthcare industry is undergoing an epidemic of disruptive physician behavior. Most often, it is only one or a few physicians at the hospital who create a negative and demeaning image that affects how the rest of the medical staff is perceived.

Why do physicians allow this to continue? Disruptive physicians threatens recruitment and retention, and it undermines respect for the medical profession. In addition, this behavior demonstrates the organized medical staff's inability "to police its own"—leading to snickers about how well physicians hold one other accountable in peer review. Allowing disruptive physicians to continue their behavior because they are a "heavy hitter" or a "big admitter" may be the most damaging move.

If we are afraid to confront a disruptive physician about behavior we would not tolerate in any other professional setting because we are afraid he or she will take his or her business across town, we are succumbing to the threats of a bully. Nobody likes to be pushed around by a bully. Yet no physician will stand up to a bully if they know the CEO and the board will back down at the threat of losing substantial business. When this happens, other physicians will roll their eyes or make disparaging remarks about how the CEO or the board only worry about the "holy dollar." It leaves physician leaders frustrated and demoralized, and negatively affects the relationship between the medical staff, administration, and the board.

Hospitals face daunting financial realities that force administrators to make difficult choices. However, we are in the midst of a dramatic change that is redefining acceptable physician behavior. Behavior that was tolerated in the past will no longer be tolerated. And like most bullies, when this happens, they usually back down. It is rare that a physician actually follows through with a threat to pull patients out of a hospital solely because they are called to account for their disruptive behavior.

Physician leaders must ensure they have a clear physician behavior policy or other clearly articulated expectations. Most importantly, these expectations must be enforced. Physician leaders should work closely with their CEO and board to anticipate any potential threats about pulling patients to a different facility. If a physician makes such a threat, the CEO and the board need to ignore the threat. Once physician leaders have the full support of the CEO and the board, they can stand up to the bully. If this is done clearly, professionally, and collegially, the medical staff will stand up and cheer because nobody likes a bully.