Peer Review for Physicians

Physicians are powerful members of society. They earn our respect for their commitment to extensive education, their willingness to intervene in matters of life and death, and their compassion for those who suffer. Such power comes with responsibility for social accountability, and physicians face plenty of that as well. Licensing and certification agencies, federal and state regulators and reimbursement agencies, patients, and their legal representatives all are standing in line to hold physicians accountable to professional standards of performance. 

But within the intimacy of business relationships in medical practices, accountability is a little more difficult to define and maintain. Many groups would like to believe that the external accountability is more than enough, but the fact of the matter is that the external agents have little or nothing to say about internal dynamics. Yet internal relationships are of front-line importance to achieving consistently excellent medical care in every medical group practice, and even in solo practices. Physicians need to be open to feedback from those who know them best, and who are in the best position to offer constructive criticism. Peer review is one of the best tools for professional growth.

But peer review is difficult. It challenges the organizational culture of conflict avoidance and puts trust on the line. Tactful honesty is a wonderful goal for all relationships, but difficult to achieve in almost every relationship. But when quality of patient care is on the line, tactful honesty is worth the effort.

I have experimented with peer review tactics in a variety of medical practices, and would offer the following suggestions: 

1. Make peer review a routine, just as employee evaluations would be. Let every potential recruit know at the outset that peer review is expected, and that it helps every physician develop their individual potential.

2. Keep peer review simple. I like a three-question format for feedback.

1. What special talents are worthy of praise?

2. What qualities might limit medical effectiveness?

3. What goals should be considered for personal development?

3. If scheduled peer-to-peer conversations are too uncomfortable, start out with an independent facilitator. Ask each physician to offer encouragement and feedback about every other physician in the group to an outside consultant. Have the consultant assemble the confidential information for each participant, then provide it in a confidential memo to each intended recipient.

4. By definition, peer review should involve all physicians in a group. If one person is designated to lead the effort, (s)he should not act alone, but with full input from the reviewee’s peers. The leader should also be subject to the same kind of review as every other physician in the group.

Peer review can significantly strengthen both the medical quality and the relationships within a medical group. It sets the stage for transparency that inevitably leads to personal and corporate growth. It can become a vehicle for early identification of potential problems, and a forum for building each other up. The benefits for patients may go unnoticed, but they are present nonetheless. The benefits for the group dynamic are likely to be more palpable, with growing trust, open communication, and greater cross-referrals. Peer review can be a significant part of the glue that holds a group together, and a tactic for practice development.

About the Author: Ken Hekman is a medical management consultant based out of Holland, MI. For more information or consultation go to www.hekmangroup.com or email Ken@hekmangroup.com.