Participation in unprofessional behaviors among hospitalists: a multicenter study.

BACKGROUND Unprofessional behaviors undermine the hospital learning environment and quality of patient care. OBJECTIVE To quantify perceptions of, and participation in, unprofessional behaviors among hospitalists. DESIGN Observational survey study. SETTING Three academic health centers. SUBJECTS Hospitalists. MEASUREMENTS Observation, participation in, and perceptions of unprofessional behaviors. RESULTS Response rate was 76% (77/101). Nearly all behaviors were perceived as unprofessional ("unprofessional" or "somewhat unprofessional" on the Likert scale). Participation in egregious behaviors (ie, falsifying records) was low (<5%). The most frequent behaviors reported were having personal conversations in patient corridors (67.1%), ordering a test as "urgent" to expedite care (62.3%), and making fun of other physicians (40.3%). Four factors accounted for 76% of survey variance: (1) making fun of others; (2) learning environment (eg, texting during conferences); (3) workload management (eg, celebrating a blocked-admission); and (4) time pressure (eg, signing out work early). Hospitalists with less clinical time (<50% full-time equivalents [FTE]) were more likely to report making fun of others (β = 0.94 [95% CI 0.32-1.56], P = 0.004). Younger hospitalists (β = 0.87 [95% CI 0.07-1.67], P = 0.034) and those with administrative time (β = 0.61 [95% CI 0.11-1.10], P = 0.017) were more likely to report participating in workload management behaviors. Hospitalists who work night shifts were more likely to report participating in time-pressure behaviors (β = 0.67 [95% CI 0.17-1.17], P = 0.010). Workload management and learning environment varied by site. CONCLUSION While hospitalist participation in unprofessional behaviors is low, job characteristics (clinical, administrative, nights), age, and site were associated with different types of unprofessional behavior that may affect the learning environment and patient care.