An AAPL member since 2014, Dr. Matthew Mazurek shares his broad experience in managing physicians, including those who struggle with professionalism.
Q Society (and patients) elevate the position of physicians, and physicians need to meet that expectation. In your experience, is there a specific type of non-professional physician behavior that is the most difficult to manage?
A Managing passive-aggressive behaviors is a particular challenge due to the nature of the behavior itself. For example, colleagues who are notorious for not returning texts, emails, or phone calls, or for not completing charts in a timely manner, can easily create dozens of excuses for their behavior — the most clichéd and often- used being, “I’m really busy.” These physicians may or may not be aware of the impact this behavior has on their colleagues, the organization, or their patients.
The negative impact on morale from this type of behavior is insidious and can lead to a toxic environment among disengaged staff. For these colleagues, I often have an informal conversation about their behavior and the necessity for corrective action. If this fails to change their behavior, a more formal approach may be necessary.
The organization’s rules and regulations or medical staff bylaws often clearly state expectations for completing charts, arriving on time, responding to pages, and so forth. Otherwise outstanding physicians can derail their careers through poor communication and what is often perceived as a lack of respect for others through this type of behavior.
Q Do you think ethics and professionalism are innate or can they be learned?
A Albert Camus said “A man without ethics is a wild beast loosed upon this world.” This is an interesting quote, and I think it helps define the difference between ethics and morals. It is easy to fall into the trap of thinking morals and ethics are the same. They are not. Morals are our beliefs of right and wrong and ethics are morals in action when there may not be a clear right or wrong decision or action. Behaving ethically and relying on ethics to solve difficult problems can be learned.
Professionalism, too, can be learned, and in 2017, the Association of American Medical Colleges published a 163- page document that included more than two dozen peer-reviewed research articles on professionalism education in medical schools and residency programs.1
A lot of our medical training involves learning through observation and modeling behaviors, and interestingly, through listening to and sharing stories and narratives.2 Most of us can recall excellent attendings or colleagues whom we admire, and there are specific reasons these physicians made an impression. Modeling their behaviors allows us to learn professionalism as we progress through our training.
Additionally, those of us who choose leadership positions can refine our professionalism training through formal educational programs like AAPL offers.
Q Physicians learn by case studies. Can you describe a particular scenario where your physician leadership was challenged? What was the problem and what was the remedy?
A Conflict resolution and management presents, along with managing disruptive physician behavior, a significant challenge for physician leaders. When I was chief of staff, two surgeons wanted equal access to a hybrid OR. Due to demand from other service lines, it was not possible to allocate time equally. Interestingly, one of the surgeons requesting equal time wanted access to the hybrid OR only because it had a state-of-the-art, real-time video system with monitors throughout the room.
The only solution to the problem was a six-figure outlay of capital to build out a similar video system in another OR. The other surgeon thought this was a waste of resources.
It was clear to me from the beginning that the conflict was not only about resource access — it was a personal conflict between the two surgeons. To resolve this, I invited each surgeon to make a case for or against the capital spend in front of our surgical executive committee and made it clear the decision would be made by committee vote after discussion.
Ultimately, we decided to invest in the video system for the other OR after considering the benefits of having the video system in two ORs. Decisions by committee provided objective input from multiple perspectives and did not place me in a position of making a unilateral decision with the potential to damage a professional relationship with one of the surgeons.
Q How do you maintain equity in working with physicians — for example, managing a high revenue producing surgeon vs. a primary care physician?
A I think maintaining equity among all members of the medical staff is essential. The elephant in the room is obvious. Proceduralists, not just surgeons, earn significantly more income both personally and for the organization. Healthcare leaders are not going to change this reality, and C-suite leaders, CMOs, and presidents of the medical staff have a responsibility to be objective and as fair as possible when managing any concern or issue with any physician, regardless of specialty.
This means no one gets preferential treatment or more “air time” at meetings. If a primary care physician and a surgeon, for example, are both accused of insulting staff, both physicians must be held accountable for their actions with similar consequences. Organizations cannot afford to create an environment with a double standard for expectations. Allowing a double standard is a liability and in the long term, can cost an organization time and money through increased turnover or lower staff morale.
Lastly, listening is the most powerful tool a leader can use to build relationships and trust. This is why I think it is essential for C- suite executives and CMOs to carve out time to meet individually with all leaders and department chairs from every department on a monthly basis. These one- on- one meetings build relationships and trust over time.
As leaders, our effectiveness in creating change and moving an organization forward is only possible with transparent, honest relationships.
Q What are the first three things you do when you encounter a situation with a physician with disruptive behavior?
A First, I remain objective, fair, and gather facts — curious, not judgmental. There is always a story from all sides involved — the witnesses, the attributed physician, and the other party, be it a staff member, colleague, or patient.
Second, I categorize the behavior type and note whether this is a physician who has had prior issues. Repeat offenders are not a surprise, but these physicians can elicit your own emotional response — often frustration — which you must internally manage. A new incident or complaint against a physician who has never had issues before is a red flag, however. Personal problems or substance use may be a factor. This is not always the case, but it must be considered.
Third, I schedule a meeting as soon as possible, either one- on- one or with the professional behavior committee if necessary.
It is important to adhere to a standardized process and follow the medical staff bylaws, so I always document all communication with the attributed physician. In the meeting format, I designate a colleague to take notes and submit the notes to the committee for review and acceptance. Just as our medical records are legal documents, the content of the discussions and meetings, too, are legal documents.
My three rules for internally managing my own response have helped guide me through the years: be objective and fair, understand it is not personal, and remain consistent.
- Sklar DP. Professionalism in Medicine and Medical Education, Volume II: Foundational Research and Key Writings, 2010-2016. Acad Med. 2017;1.
- Quaintance JL, Arnold L, Thompson S. (2010). What Students Learn About Professionalism From Faculty Stories: An “Appreciative Inquiry” Approach. Acad Med. 85, 1:7–12.