Abstract
BackgroundOutcomes of processes questioning a physician’s ability to practise —e.g. disciplinary or regulatory— may strongly impact their career and provided care. However, it is unclear what factors relate systematically to such outcomes.MethodsIn this cross-sectional study, we investigate this via multivariate, step-wise, statistical modelling of all 1049 physicians referred for regulatory adjudication at the UK medical tribunal, from June 2012 to May 2017, within a population of 310,659. In order of increasing seriousness, outcomes were: no impairment (of ability to practise), impairment, suspension (of right to practise), or erasure (its loss). This gave adjusted odds ratios (OR) for: age, race, sex, whether physicians first qualified domestically or internationally, area of practice (e.g. GP, specialist), source of initial referral, allegation type, whether physicians attended their outcome hearing, and whether they were legally represented for it.ResultsThere was no systematic association between the seriousness of outcomes and the age, race, sex, domestic/international qualification, or the area of practice of physicians (ORs p≥0.05), except for specialists who tended to receive outcomes milder than suspension or erasure. Crucially, an apparent relationship of outcomes to age (Kruskal-Wallis, p=0.009) or domestic/international qualification (χ2,p=0.014) disappeared once controlling for hearing attendance (ORs p≥0.05). Both non-attendance and lack of legal representation were consistently related to more serious outcomes (ORs [95% confidence intervals], 5.28 [3.89, 7.18] and 1.87 [1.34, 2.60], respectively, p<0.001).ConclusionsAll else equal, personal characteristics or first qualification place were unrelated to the seriousness of regulatory outcomes in the UK. Instead, engagement (attendance and legal representation), allegation type, and referral source were importantly associated to outcomes. All this may generalize to other countries and professions.
Highlights
Outcomes of processes questioning a physician’s ability to practise —e.g. disciplinary or regulatory— may strongly impact their career and provided care
Are regulatory sanctions related to personal characteristics of physicians such as age, race, or sex? This question is of wide interest globally [1,2,3,4,5,6,7], especially for the domains of policy-making, education, employment, and liability insurance; because such characteristics, and whether physicians qualified domestically or internationally, figure centrally in live migration and equality issues [8,9,10,11,12,13]
Engagement-related variables bore the strongest associations with the seriousness of outcomes Only about half of the physicians for whom legal representation was known, obtained it (Table 1)
Summary
Outcomes of processes questioning a physician’s ability to practise —e.g. disciplinary or regulatory— may strongly impact their career and provided care. It is unclear what factors relate systematically to such outcomes. Motivated by an earlier small-scale exploration [26], this is the first study to control for variables related to the engagement of physicians with a process assessing issues alleged about their practice — here attendance at hearings and legal representation; revealing them as critical correlates of outcomes. We show that variables related to engagement with regulatory processes and case-type may need to be more of a focus than personal characteristics. We hypothesize that similar patterns may underlie outcome differences in systems around the world dealing with complaints, legal claims, regulatory, or disciplinary actions
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