Specialty‑level patterns of professionalism concerns in academic health systems: a multi‑system analysis with heat map visualizations
Heather A Davidson, William Martinez, Thomas W Doub, Cynthia A Baldwin, Henry Domenico, William O Cooper, Gerald B HicksonAbstract
Purpose
Unprofessional behavior in healthcare settings can undermine teamwork, communication, and patient outcomes. Although prior studies have shown that professionalism concerns are disproportionately concentrated among a subset of individual clinicians, less is known about specialty-level patterns. The purpose of this study was to examine whether professionalism concerns, measured using the Patient Advocacy Reporting System (PARS) risk categories, cluster at the specialty-group level within and across academic health systems (AHSs).
Method
This retrospective, cross-sectional study used PARS risk categories, derived from deidentified unsolicited patient complaint data collected between March 1, 2014, and November 30, 2019. The study population consisted of 23,789 physicians representing 52 specialty groups and practicing across 19 Academic Health Systems (AHS) from multiple geographic areas regions of the United States. Physicians were categorized into high, intermediate, or low PARS risk categories. Inferential analyses used Pearson's chi-square tests to compare proportions of physicians within each risk category across specialties within the same AHS and within specialties across AHSs. Heat maps were created to visually summarize risk-category distributions.
Results
Across the 19 AHSs, an average of 1.5% (n = 341) of physicians were classified as high PARS risk and 8.6% (n = 2149) as intermediate PARS risk, with substantial site-level variation. Statistically significant differences in PARS risk-category distributions across specialties were observed within 16 of 19 AHS (P<.001). Among the 23 specialties represented at all 19 AHSs, 69.6% (16/23) demonstrated significant (P<.05) between-system differences in risk-category distributions.
Conclusions
The findings suggests that professionalism concerns may cluster at the specialty- group level both within and across AHSs. Routine specialty-level review, guided by statistical comparisons and complemented by heat map visualizations, may help leaders identify specialty groups and organizational contexts that warrant further evaluation to support professionalism and teamwork.