Physician peer review must balance safety and fairness

Medicine is one of the few professions in which a colleague may understand exactly how difficult the journey has been and simultaneously possess enormous influence over whether another physician is permitted to continue that journey.

Becoming a physician requires years of education, medical school, residency, examinations, credentialing, sacrifice, and continual professional development. For surgeons, the pathway often includes additional fellowship training and years spent developing technical judgment that cannot be acquired from textbooks alone. Yet after decades invested in becoming a clinician, a physician’s reputation, privileges, and ability to practice can sometimes be placed at risk remarkably quickly. This creates an important question for our profession: How do we protect patients from genuinely incompetent or unethical physicians while ensuring that professional oversight does not become a vehicle for interpersonal conflict, competition, retaliation, or subjective judgment?

Published medical literature has documented bullying, undermining behavior, harassment, incivility, and disruptive conduct throughout health care. These problems are not unique to surgery. They have been described across specialties and health care organizations, affecting physicians, nurses, trainees, and other professionals. Research also suggests that dysfunctional professional relationships can adversely affect teamwork, communication, physician well-being, and ultimately patient safety.

Patient safety must always come first

This discussion should never be interpreted as an argument against physician accountability. If a surgeon or physician is incompetent, repeatedly practices below accepted standards, behaves unethically, or places patients in danger, there is no excuse for ignoring that conduct. Physicians have a professional obligation to protect patients and appropriately report legitimate concerns.

But accountability must work in both directions. The same ethical framework that requires physicians to report dangerous conduct also requires allegations to be evaluated fairly and objectively. Professional concerns should never be fabricated, exaggerated, selectively applied, or used maliciously against another physician.

An allegation is a reason to investigate. It should not automatically become the conclusion.

When professional disagreement becomes personal

Medicine naturally produces disagreement. Surgeons may disagree about operative indications, techniques, implants, complication management, emerging technology, or whether a difficult outcome represents an unavoidable complication or a deviation from accepted care. Physicians from different specialties may reasonably interpret the same clinical situation differently. Difference of opinion is not necessarily incompetence.

Likewise, questioning a policy, advocating strongly for a patient, challenging an administrative decision, developing an innovative technique, or disagreeing with another physician should not automatically be characterized as disruptive behavior. The distinction between legitimate accountability and professional undermining is therefore critical. When concerns arise, the central question should not be, “Who made the allegation?” It should be, “What does the evidence demonstrate?”

Objective evidence should outweigh subjective opinion

Questions about physician competence should rely as heavily as possible on measurable evidence:

• Medical records and operative documentation
• Accepted standards of care and published evidence
• Clinical outcomes and complication rates in appropriate context
• Comparable cases involving similarly situated physicians
• Independent specialist review
• Opinions from experts genuinely qualified in the procedure or specialty being evaluated

This becomes particularly important when qualified experts disagree. If independent specialists reviewing the same records reach conclusions supporting the physician’s clinical judgment, those opinions deserve meaningful consideration. A subjective characterization from another physician should not automatically outweigh objective clinical evidence merely because that physician occupies a leadership position.

Similarly, the specialty and expertise of the reviewer matter. Medicine has become extraordinarily specialized. A physician may be highly accomplished in one discipline while lacking the technical experience necessary to determine whether a complex procedure in another subspecialty met accepted standards. Independent expert review can therefore serve as an important safeguard for both patients and physicians.

The hidden cost of physician-on-physician conflict

Professional hostility affects more than the physicians involved. Research has associated disruptive behavior and incivility with poorer teamwork, decreased job satisfaction, impaired communication, and weaker patient-safety culture. Experimental research has even demonstrated that exposure to rudeness can impair the performance of health care teams. That means physician-to-physician hostility can itself become a patient-safety issue.

A culture in which physicians fear colleagues may discourage communication. A culture in which legitimate concerns are ignored is equally dangerous. Neither extreme serves patients. Health care organizations therefore need systems in which physicians can raise genuine concerns without fear while simultaneously protecting colleagues from unsupported accusations, inconsistent standards, or subjective decision-making.

Remember the investment behind the white coat

Every physician evaluating another physician should remember what stands behind the name on the credentialing file:

• Years of education
• Medical school
• Residency
• Fellowship for many specialists
• Board examinations
• Thousands of patient encounters
• For surgeons, thousands of hours developing procedural judgment and technical skill

None of this creates immunity from accountability. Twenty years of experience cannot excuse unsafe medicine. But neither should twenty years of responsible practice be disregarded casually. A professional career should not turn on personality, popularity, rivalry, rumor, or one subjective interpretation when objective clinical evidence is available.

A better standard

The goal should not be to make physician discipline more difficult. The goal should be to make it more objective, consistent, and credible.

When serious concerns arise, institutions should ask:

• What actually happened?
• What does the medical record demonstrate?
• What is the applicable standard of care?
• What do appropriately qualified independent experts conclude?
• Are comparable physicians being evaluated under comparable standards?

• If the evidence demonstrates incompetence, appropriate action should follow.
• If it demonstrates a correctable deficiency, education, remediation, monitoring, or proctoring may be appropriate.
• If qualified physicians reasonably disagree, the process should recognize that clinical complexity rather than automatically transforming disagreement into misconduct.

Physicians do not owe one another immunity from criticism. They owe one another fairness.

We understand better than almost anyone what it takes to earn the privilege of caring for patients. That shared experience should make physicians more careful, not less, when exercising power capable of changing another physician’s career.

Patient safety requires courage to speak when something is genuinely wrong. Professional integrity requires equal courage to insist that allegations be tested against evidence.

The best system is neither protective of physicians nor punitive toward physicians. It is protective of patients, due process, objectivity, and truth.

Babajide Ogunseinde is a Harvard-trained, ABPS board-certified orthopedic spine surgeon, innovator, author, and physician leader with more than fifteen years of experience and over 8,000 spine procedures. He practices as an independent spine consultant. A summa cum laude graduate of Virginia Commonwealth University and valedictorian of Howard University College of Medicine, he completed his orthopedic surgery residency and his spine fellowship at Harvard.

Ogunseinde pioneered the FDA-cleared posteromedial-to-lateral (PML) technique for sacroiliac joint fusion and founded the PML Mastery digital app. He holds a health care leadership certification from Stanford University and is an MBA and Certified Physician Executive candidate. He serves as an ABPS oral board examiner and codirector of its leadership program, and he is a new Distinguished Fellow of the North American Spine Society and an editorial reviewer for the Journal of Spine Surgery.

His scholarship spans sacroiliac joint dysfunction, minimally invasive spine surgery, outcomes in high-BMI patients, and orthopedic trauma, with work appearing in the Journal of Clinical Spine Surgery, the Journal of Spine Surgery, the Journal of Surgical Case Reports, and the Journal of Pediatric Orthopedics. He is the author of four books spanning surgical innovation, sacroiliac joint disease, faith, leadership, weight loss, and preventive health: Faith and Purpose: The PML Story; SI Joint Dysfunction: The Truth Shall Set You Free; Messages From Our Father: Father’s Wisdom; and The Coach Before the Scalpel: A Surgeon and a Coach’s Guide to Preventing Obesity, Chronic Back Pain, and the Surgery You Never Needed. He is a 2026 Global Recognition Award recipient and an international invited speaker.

His books and PML resources are available at ogunseindepml.com, and he shares updates on LinkedIn, Instagram, and YouTube.