Study compares traits, discipline

A new study of California doctors identified physician characteristics associated with the likelihood of discipline by a state medical board.

Males were nearly three times as likely as females to be disciplined. Doctors who were not board-certified had about twice the risk of discipline as did board-certified physicians, according to the study in the March 22 Archives of Internal Medicine.

Obstetricians and gynecologists, family doctors, general physicians and psychiatrists were more likely than internists to be disciplined. Pediatricians and radiologists were less likely to face discipline.

Another study, in the March Academic Medicine, found that medical students who behaved unprofessionally were likely to display similar behavior after they became physicians.

Neal D. Kohatsu, MD, MPH, lead author of the Archives study, said more attention on quality care is partly responsible for greater interest by researchers in physician discipline.

In Dr. Kohatsu's study, researchers examined 890 physicians disciplined by the Medical Board of California from July 1, 1998 to June 30, 2001. They looked at risk of discipline associated with a physician's age, sex, board certification, international medical school education and specialty. The cases were compared with 2,981 nondisciplined physicians.

The study, "Characteristics Associated with Physician Discipline," found that international medical education was linked with an elevated risk for disciplinary action.

"Age is a factor, but the association is less strong," said Dr. Kohatsu, former medical director of the California board and now associate professor of epidemiology at the University of Iowa College of Public Health.

It was unclear if the elevated risk of discipline with advancing age was due to increased exposure to complaints over time or to other factors. Differences between male and female practice styles and patient interaction might account for the higher discipline risk for men. But Dr. Kohatsu said more research was needed.

"We need to look at why these differences exist. They are dramatic enough to deserve follow-up."