10/11/2011 11:22 EDT | Updated 12/11/2011 05:12 EST

One-fifth of doctor discipline cases involve repeat offenders, research finds

TORONTO - One-fifth of doctor disciplinary cases in the last decade involved repeat offenders, suggesting a need for greater monitoring, researchers at Toronto's St. Michael's Hospital have concluded.

The researchers looked at the cases of doctors who were disciplined by their provincial medical licensing bodies between 2000 and 2009. Of the 606 cases in total, they found that 92 per cent of those doctors were men and that a majority were family physicians who had been practising for a long time.

Research from the United States suggests that women communicate more effectively with patients, which leads to a lower rate of malpractice claims, the study authors said.

The findings were published Tuesday in the journal Open Medicine.

Research Dr. Chaim Bell said the number of doctors disciplined each year only represents about one per cent of all physicians in Canada.

"That's one of the things that really jumped out at me, that it really isn't that common at all," he said. "It's a very low proportion of doctors that are disciplined."

But of the doctors who are disciplined, there are many repeat offenders, the research found. Fifty-one doctors committed 64 repeat offences, or 19 per cent of the total offences. Seven of the doctors had been disciplined three times and two had been disciplined four times.

Provincial licensing authorities are devoting "significant" resources to disciplining those doctors, the study authors said.

"Previous research in the United States corroborates the finding that a substantial fraction of previously disciplined physicians are subsequently disciplined at rates far higher than physicians with no discipline history," they wrote.

"This indicates a possible need for greater monitoring of disciplined physicians and/or less reliance upon rehabilitative sanctions such as disciplinary action to promote and sustain positive change in behaviour."

The most common violation was sexual misconduct, which accounted for 20 per cent of the cases. Those offences, as well as standard of care issues and unprofessional conduct made up more than half of the violations.

The three most frequent penalties were fines, suspensions and formal reprimands. Six per cent of disciplined physicians had their licences revoked.

That rose slightly to 10 per cent when looking at the repeatedly disciplined doctors. The most common penalty for repeat offenders was a fine.

Information was not uniformly available from all the provinces — and not at all publicly available from the territories.

"The standardization of provincial reporting along with the creation of a national database of physician offenders would facilitate more comparable public reporting as well as further research and educational initiatives," the study authors said.

The authors also noted they could find no "meaningful national data" on percentages of complaints that led to disciplinary action.