Eyeworld

and who do they complain about? March 2018 • Ophthalmology Business 13 drive them to undertake workloads for which they are not adequately trained or for which there is little institutional support," the authors wrote. Although mid-career physi- cians may feel obliged to see more patients, they also may get com- plaints that they are not spending enough time with patients and that quality of care is lower. As for late-career ophthalmolo- gists, this group has "survived" the challenges through time, while those who received more complaints or had other challenges had likely left the organization. Some healthcare experts or patients may raise con- cerns about age-related cognitive and motor skill decline in older physi- cians, but this particularly study did not find this to be true. "Why late-ca- reer physicians may be associated with fewer complaints remains to be explored," the authors wrote. Pearls, perspectives for early-career physicians One issue that may not be addressed as often is the age bias that younger physicians face, said Jeffrey Y.H. Chung, MD, in private practice, Gaithersburg, Maryland, and board member, Prevention of Blindness Society of Metropolitan Washington. He gave the example of a younger physician passionately trying to con- vince a patient to get a sight-saving surgery. Even though the physician has the right idea medically, he or she may be perceived as abrasive by a patient. Over time, after receiving negative feedback from patients, that usually leads physicians to back off a Overall, 42% of ophthalmolo- gists received at least one unsolicited patient complaint. Behind the numbers There may be a few reasons that younger ophthalmologists have more complaints, the authors wrote. "Ear- ly-career physicians may be associat- ed with less time to first complaint and overall more unsolicited patient complaints owing to the challenge of mastering new clinical systems and how to best provide excellent attend- ing-level care largely on their own," they wrote. Several other factors may stack against younger physicians, they add- ed. They may have less experienced support staff and nurses, and they may receive a larger number of "dif- ficult" patients referred by mid- and late-career ophthalmologists. They also may not have sufficient training to handle unsolvable medical situa- tions or emotionally difficult conver- sations, the study authors observed. "Our finding that younger physi- cians had less time to first complaint and a greater risk for unsolicited patient complaints is consistent with findings that malpractice claim rates are highest in the first 10 years of practice and peak when physicians are in their 40s," the study authors wrote. Although mid-career physicians had longer times to complaints than younger colleagues, they still had more complaints than seasoned peers. "Despite greater experience and know-how, mid-career physi- cians' unsolicited patient complaints may arise from greater external challenges, including personal, fam- ily, or financial problems that may were classified under six main categories: 1) care and treatment, 2) communication, 3) access and availability, 4) concern for patient and family, 5) safety of environment, 6) and billing. The findings Researchers found that ophthalmol- ogists age 70 or older had the longest mean time to their first complaint, and they had the lowest complaint rate. There were 0.71 complaints per 1,000 follow-up days compared with 2.02 for those 41 to 50 years old and 1.88 for those 31 to 40 years old. The physicians in the two youngest age bands—31 to 40 and 41 to 50 years old—had a significantly shorter time to first complaint com- pared with their older peers. Neuro-ophthalmology was associated with a statistically signif- icant higher adjusted hazard ratio for time to first complaint compared with comprehensive ophthalmolo- gy; participants at regional medical centers also received complaints more quickly than those at academic medical centers. The most common type of com- plaint was about care and treatment, such as diagnosis, recommendations, and medications. The second most common complaint type was a con- cern about accessibility and avail- ability, followed by communication concerns. Within ophthalmology, there were no complaints about safe- ty of environment. There were proportionally fewer complaints about a perceived lack of humanistic concern for patients or family. The type of complaints received did not vary much among the age bands. continued on page 14

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