Professionalism in Medicine: Results of a National Survey of Physicians

BACKGROUND: The prospect of improving care through increasing professionalism has been gaining momentum among physician organizations. Although there have been efforts to define and promote professionalism, few data are available on physician attitudes toward and conformance with professional norms. OBJECTIVE: To ascertain the extent to which practicing physicians agree with and act consistently with norms of professionalism. DESIGN: National survey using a stratified random sample. SETTING: Medical care in the United States. PARTICIPANTS: 3504 practicing physicians in internal medicine, family practice, pediatrics, surgery, anesthesiology, and cardiology. MEASUREMENTS: Attitudes and behaviors were assessed by using indicators for each domain of professionalism developed by the American College of Physicians and the American Board of Internal Medicine. Of the eligible sampled physicians, 1662 responded, yielding a 58% weighted response rate (adjusting for noneligible physicians). RESULTS: Ninety percent or more of the respondents agreed with specific statements about principles of fair distribution of finite resources, improving access to and quality of care, managing conflicts of interest, and professional self-regulation. Twenty-four percent disagreed that periodic recertification was desirable. Physician behavior did not always reflect the standards they endorsed. For example, although 96% of respondents agreed that physicians should report impaired or incompetent colleagues to relevant authorities, 45% of respondents who encountered such colleagues had not reported them. LIMITATIONS: Our measures of behavior did not capture all activities that may reflect on the norms in question. Furthermore, behaviors were self-reported, and the results may not be generalizable to physicians in specialties not included in the study. CONCLUSION: Physicians agreed with standards of professional behavior promulgated by professional societies. Reported behavior, however, did not always conform to those norms.