adhere to this mandate. Group prac-
tices should strive to develop and
maintain an environment of profes-
sionalism that fosters collaboration
and high-quality care.
Facilities and practices alike
should develop a multifaceted
approach and process to deal with
this issue. The code of conduct
defines standards of behavior and
The code should be provided at
the time of initial employment
and at each reappointment, and
each staff member should sign on,
acknowledging acceptance and an
understanding of consequences
should they not adhere to the code.
Organizations must demand full
compliance with the code of conduct by all employees. It is also the
organization’s obligation to create
a non-retaliatory environment,
including creation of a confidential
reporting and monitoring system.
Anonymity for the reporting individual is crucial, and a process should
be developed for the charged
person to respond to the complaint.
The workplace should provide education and training and, importantly,
a clear resolution protocol.
While most agree that behaviors
such as intimidating, disruptive,
and sexually inappropriate conduct
are unprofessional and should
not be permitted, some organizations find it difficult to confront a
disruptive or inappropriate individual. Coworkers fear retaliation
or stigma as a “whistleblower.”
Often, disruptive behavior by a
revenue-generating physician is
tolerated due to fear of economic
consequences of confrontation or
because the subject is intimidating.
The cost of not curtailing miscon-
duct, however, is far greater to the
physician and the practice. Exceed-
ingly significant consequences
follow when a physician is found to
be disruptive. If an entity or practice
takes a privilege action against an
individual for disruptive behavior, it
may trigger reporting obligations to
the respective state medical board or
the National Practitioner Data Bank. 4
Time, Money, and
And there are other, personal
impacts. The physician may be
required to enroll in a professional
assistance program or anger
management courses; submit to
neuropsychiatric examinations and
assessments and urine screens
(as alcohol increases the risk of
inappropriate behavior); participate in mandated therapy; and
face privilege and/or license suspensions or limitations. All these
modalities have huge ramifications
in terms of time, money, and emotional resources.
The most deleterious effect to
the individual physician may be the
impact of a tarnished reputation,
especially in today’s Internet age.
Being labeled a disruptive physician
handicaps one’s ability to retain or
find a new job. In addition, there is
the proverbial target on one’s back
in the workplace once negative comments or actions become public.
The damage to the practice is
also significant. A disruptive or
sexually inappropriate physician
negatively impacts the work environment that the organization has
an obligation to maintain as safe
and free of harassment. The organization runs the risk of employee
and patient lawsuits if it does not
maintain a culture of safety and
adhere to established policies and
procedures (see “Reduce Stress to
Create a Safe Workplace”).
Practical avoidance tools that
physicians can use to minimize the
occurrence and risk of disruptive
F Self-realization: stop and look
at your quality of life. Are you
stressed out? If so, stop and do
something about it, because the
1. American Medical Association 2004. Physicians
and Disruptive Behavior. Policy Finder, July 2004.
2. Society for Human Resource Management.
2018. Harassment: What Is Meant by the
Term “Reasonable Person”? January 12, 2018.
Accessed December 6, 2018 at shrm.org/
3. The Joint Commission, 2008. Behaviors That
Undermine a Culture of Safety. Joint Commission
Sentinel Client Alert, 2008; Issue 40.
4. National Practitioner Data Bank. 2018. Chapter E:
consequences of being labeled
disruptive will only increase your
F Identify what frustrates you; put
a proactive reaction plan in place.
F Speak to supervisors, but not in
the heat of the moment.
F Don’t confront a coworker in
public. Instead, set aside a quiet
time for reasonable discussion of
F Seek therapy if needed.
F If the electronic medical record
(EMR) is a problem, consider a
F If scheduling is an issue, arrange
with the facility to address your
concerns productively instead of
reacting in the moment.
Yes, these physician/organiza-tion avoidance tools cost money,
but they generate great savings if
the desired interventions create a
stress-free, congenial work environment. Together, these actions
translate to a safe environment for
The practice of medicine has
changed, and in today’s #Me Too
era, physician behavior and group
practice and facility protocols must
change, too! The consequences are
too dire not to.
Debra W. Levine, Esq., is counsel in the
health law practice at Brach Eichler, a
law firm in Roseland, New Jersey. For
27 years, Levine was counsel to the New
Jersey State Board of Medical Examiners, where she advised the board on
disciplinary, investigative, and regulatory matters.