less than 1% of the workforce—prompt concerns about their performance every year, sufficient to warrant the need for outside help, indicates an analysis of 11 years of data, published in BMJ Quality & Safety.
But doctors in the late stages of their career are six times more likely to be referred for remedial help, the figures show.
The findings are based on a detailed analysis of referrals of NHS doctors by employing organisations— and in 3% of cases, the doctors themselves—to the National Clinical Assessment Service (NCAS) between April 2001, when NCAS was set up in England, and March 2012.
Unlike the professional regulator, the General Medical Council, NCAS does not seek to determine whether doctors are fit to practise, but to find out if they are able to do the job(s) they are employed to do.
Over the 11 years, 6179 doctors from all specialties and types of employment were referred to NCAS, and while the annual rate fluctuated to some extent in the first few years after NCAS was set up, the annual rate worked out at five referrals per 1000 working doctors.
Based on eight years of data (5271 doctors), to exclude the fluctuations of the first three start-up years, the figures consistently showed that doctors who qualified overseas and male doctors were more than twice as likely to be referred to the service.
And doctors in the late stages of their career were almost six times as likely to be referred as those in the early stages.
The specialties prompting the highest rates of concern were psychiatry and obstetrics and gynaecology.
Doctors working in these specialties were more than 3.5 times as likely to be referred as those working in the specialties with the lowest referral rates—public health, cancer, and general medicine.
"Top level" concerns included clinical difficulties, such as poor diagnostic and treatment decisions; governance/safety issues; behavioural problems, such as aggression; misconduct, such as financial irregularities and inappropriate sexual behaviour; health problems, including drug and alcohol misuse; work environment, such as inability to cope with work pressures; and personal issues, such as marital break-down and bereavement.
The figures indicated that the type of top level concern varied with age among the 3467 doctors for whom information on the type of concern was available.
Clinical difficulties were significantly more common among doctors in mid and late career than those at the start of their careers, while misconduct issues were significantly more common in early career than in mid or late career.
The authors confirm that their findings back those of other studies, but caution against overly simplistic explanations. The arguments advanced for the gender divide in referrals—that women are better at apologising or are better communicators—was not entirely consistent with their findings, for example.
Misconduct was more common among men, but behavioural issues were more common among women, the figures showed.
And while the real possibility of racial discrimination needs to be borne in mind for doctors who qualify overseas, non-white doctors who qualify in the UK do not seem to be at greater risk of referral, the figures indicate.
But nearly a third of doctors referred to NCAS had a health problem, which is often a strong reason for poor performance, say the authors. "Greater attention must be paid by organisations towards the mental wellbeing of their staff," they urge.
Explore further: Study raises questions over discrimination in GP exam
More information: Identification of poor performance in a national medical workforce over 11 years: an observational study, Online First, DOI: 10.1136/bmjqs-2013-002054
Medical Xpress on facebook
Related Stories
Study raises questions over discrimination in GP exam
Sep 27, 2013
Concerns over discrimination in the UK general practitioner examination are raised in a study by The University of Manchester published on bmj.com today.
Why do doctors abuse prescription drugs? 'Self-medication' is key reason
Oct 04, 2013
Doctors who abuse prescription drugs often do so for "self-medication"—whether for physical or emotional pain or stress relief, reports a study in the October Journal of Addiction Medicine, the official journal of the Am ...
Overseas doctors more likely to face serious GMC action
Apr 06, 2011
General Medical Council (GMC) decisions about doctors who qualified outside the UK are more likely to have far reaching consequences (high impact decisions), finds research published in the British Medical Journal today.
Half of all patient complaints in Australia are about three percent of doctors
Apr 10, 2013
Half of all formal patient complaints made in Australia to health ombudsmen concern just 3% of the country's doctors, with 1% accounting for a quarter of all complaints, finds research published online in BMJ Quality & Sa ...
Are there too many women in medicine?
Nov 30, 2011
In the UK, women doctors are set to outnumber their male counterparts by 2017. The press has dubbed the rise "worrying" and "bad for medicine" but in an editorial published by Student BMJ today, Maham Khan asks is medici ...
Recommended for you
Death rates higher among middle aged and elderly when economy is booming
1 seconds ago
Death rates among middle aged and older people are higher when the economy is growing than when it's heading for recession, reveals a long term analysis of the economic cycles of developed countries, published online in the ...
Design and software problems plague health exchanges
1 hour ago
(HealthDay)—Problems signing up for health insurance through HealthCare.gov, the federal website serving health exchanges in 36 states, are the result of design and software problems, The Wall Street Jo ...
Meals for more seniors could save some states money
2 hours ago
Home-delivered meals bring not only food to seniors but also the opportunity to remain in their homes. A new study by Brown University public health researchers projects that if every U.S. state in the lower ...
Study tracks factors linked to creation of accountable care organizations
2 hours ago
Regions of the U.S. where doctors and hospitals are consolidated into large networks are more likely to have accountable care organizations, medical practice structures intended to improve medical care and cut costs, according ...
Incentives help Mass. General's physicians organization reach quality-improvement goals
2 hours ago
A program offering modest financial incentives to salaried Massachusetts General Hospital-affiliated physicians who achieve specific quality improvement targets has helped the organization meet goals related to the adoption ...
Delayed aging is better investment than cancer, heart disease
2 hours ago
On the heels of an announcement from Google that the company's next startup, Calico, will tackle the science of aging, a new study shows that research to delay aging and the infirmities of old age would have ...
User comments
© Medical Xpress 2011-2013, Phys.org network
less than 1% of the workforce—prompt concerns about their performance every year, sufficient to warrant the need for outside help, indicates an analysis of 11 years of data, published in BMJ Quality & Safety.
But doctors in the late stages of their career are six times more likely to be referred for remedial help, the figures show.
The findings are based on a detailed analysis of referrals of NHS doctors by employing organisations— and in 3% of cases, the doctors themselves—to the National Clinical Assessment Service (NCAS) between April 2001, when NCAS was set up in England, and March 2012.
Unlike the professional regulator, the General Medical Council, NCAS does not seek to determine whether doctors are fit to practise, but to find out if they are able to do the job(s) they are employed to do.
Over the 11 years, 6179 doctors from all specialties and types of employment were referred to NCAS, and while the annual rate fluctuated to some extent in the first few years after NCAS was set up, the annual rate worked out at five referrals per 1000 working doctors.
Based on eight years of data (5271 doctors), to exclude the fluctuations of the first three start-up years, the figures consistently showed that doctors who qualified overseas and male doctors were more than twice as likely to be referred to the service.
And doctors in the late stages of their career were almost six times as likely to be referred as those in the early stages.
The specialties prompting the highest rates of concern were psychiatry and obstetrics and gynaecology.
Doctors working in these specialties were more than 3.5 times as likely to be referred as those working in the specialties with the lowest referral rates—public health, cancer, and general medicine.
"Top level" concerns included clinical difficulties, such as poor diagnostic and treatment decisions; governance/safety issues; behavioural problems, such as aggression; misconduct, such as financial irregularities and inappropriate sexual behaviour; health problems, including drug and alcohol misuse; work environment, such as inability to cope with work pressures; and personal issues, such as marital break-down and bereavement.
The figures indicated that the type of top level concern varied with age among the 3467 doctors for whom information on the type of concern was available.
Clinical difficulties were significantly more common among doctors in mid and late career than those at the start of their careers, while misconduct issues were significantly more common in early career than in mid or late career.
The authors confirm that their findings back those of other studies, but caution against overly simplistic explanations. The arguments advanced for the gender divide in referrals—that women are better at apologising or are better communicators—was not entirely consistent with their findings, for example.
Misconduct was more common among men, but behavioural issues were more common among women, the figures showed.
And while the real possibility of racial discrimination needs to be borne in mind for doctors who qualify overseas, non-white doctors who qualify in the UK do not seem to be at greater risk of referral, the figures indicate.
But nearly a third of doctors referred to NCAS had a health problem, which is often a strong reason for poor performance, say the authors. "Greater attention must be paid by organisations towards the mental wellbeing of their staff," they urge.
Explore further: Study raises questions over discrimination in GP exam
More information: Identification of poor performance in a national medical workforce over 11 years: an observational study, Online First, DOI: 10.1136/bmjqs-2013-002054
Medical Xpress on facebook
Related Stories
Study raises questions over discrimination in GP exam
Sep 27, 2013
Concerns over discrimination in the UK general practitioner examination are raised in a study by The University of Manchester published on bmj.com today.
Why do doctors abuse prescription drugs? 'Self-medication' is key reason
Oct 04, 2013
Doctors who abuse prescription drugs often do so for "self-medication"—whether for physical or emotional pain or stress relief, reports a study in the October Journal of Addiction Medicine, the official journal of the Am ...
Overseas doctors more likely to face serious GMC action
Apr 06, 2011
General Medical Council (GMC) decisions about doctors who qualified outside the UK are more likely to have far reaching consequences (high impact decisions), finds research published in the British Medical Journal today.
Half of all patient complaints in Australia are about three percent of doctors
Apr 10, 2013
Half of all formal patient complaints made in Australia to health ombudsmen concern just 3% of the country's doctors, with 1% accounting for a quarter of all complaints, finds research published online in BMJ Quality & Sa ...
Are there too many women in medicine?
Nov 30, 2011
In the UK, women doctors are set to outnumber their male counterparts by 2017. The press has dubbed the rise "worrying" and "bad for medicine" but in an editorial published by Student BMJ today, Maham Khan asks is medici ...
Recommended for you
Death rates higher among middle aged and elderly when economy is booming
1 seconds ago
Death rates among middle aged and older people are higher when the economy is growing than when it's heading for recession, reveals a long term analysis of the economic cycles of developed countries, published online in the ...
Design and software problems plague health exchanges
1 hour ago
(HealthDay)—Problems signing up for health insurance through HealthCare.gov, the federal website serving health exchanges in 36 states, are the result of design and software problems, The Wall Street Jo ...
Meals for more seniors could save some states money
2 hours ago
Home-delivered meals bring not only food to seniors but also the opportunity to remain in their homes. A new study by Brown University public health researchers projects that if every U.S. state in the lower ...
Study tracks factors linked to creation of accountable care organizations
2 hours ago
Regions of the U.S. where doctors and hospitals are consolidated into large networks are more likely to have accountable care organizations, medical practice structures intended to improve medical care and cut costs, according ...
Incentives help Mass. General's physicians organization reach quality-improvement goals
2 hours ago
A program offering modest financial incentives to salaried Massachusetts General Hospital-affiliated physicians who achieve specific quality improvement targets has helped the organization meet goals related to the adoption ...
Delayed aging is better investment than cancer, heart disease
2 hours ago
On the heels of an announcement from Google that the company's next startup, Calico, will tackle the science of aging, a new study shows that research to delay aging and the infirmities of old age would have ...
User comments
© Medical Xpress 2011-2013, Phys.org network
0 comments:
Post a Comment