Peer Review Monthly: Why is peer review hard to do?

It is not surprising that physicians might be reluctant to perform peer review. Few, if any, other industries have a system in which potential competitors or colleagues without direct supervisory authority are asked to determine the competency of their coworkers, often without any compensation for their time.

Participating in peer review presents at least three challenges for physicians:

• It can have a negative influence on physicians’ relationships with their colleagues
• It takes up precious time, which today often negatively affects physicians’ income
• Physicians are concerned that the evaluation could become public information through the legal system due to the erosion of discoverability protection in some states

So why should physicians on a hospital medical staff want to do peer review? In the current organized medical staff model, there are three main reasons:

• The medical staff has the privilege of self-governance and physicians are responsible for holding each other accountable for quality
• The board depends on medical staff leaders to perform peer review
• If physician leaders don’t accept this responsibility, society will find other means

Unfortunately, a hospital does not have an option when it comes to evaluating physician competency. Failure to do so could lead to loss of accreditation and Medicare payments, which can affect the hospital’s reputation and bottom line. It also exposes the hospital to legal action, including negligent credentialing and negligent peer review.

Even if those consequences didn’t exist, the medical staff has an obligation to ensure that physicians who exercise clinical privileges are competent to do so. Otherwise, everyone is at greater risk: the community, the organization, referring or consulting physicians, and even practicing physicians who often are willing to improve if there is information to indicate the need.

So how have medical staffs addressed physicians' reluctance to do peer review?  Through The Greeley Company’s work helping medical staffs across the country redesign their peer review programs, we have identified these strategies as effective ways to address these challenges:

• Create a positive culture of mutual accountability to minimize the effect peer review has on physician’s collegial relationships
• Design more efficient approaches to minimize the amount of time physicians spend on peer review
• Develop and follow good policies and practices to ensure your peer review information remains legally protected

Peer review will always have challenges, but our experiences have show there are many dedicated physician leaders across the country who have successfully helped their medical staffs overcome them.  

Robert Marder, MD, CMSL
Vice president
The Greeley Company