Background: Communication, teamwork, and conflict navigation amongst physician colleagues are core competencies. Yet, how these core elements of professional behavior are enacted in practice remains poorly characterized, and interpersonal interactions continue to be a central source of workplace conflict. While this has been described in the nursing literature, physicians’ experience of conflict with other physician colleagues remains poorly characterized. The goal of this study was to gain a more nuanced understanding of interphysician conflict and to provide foundational guidance for how communities can support best practices regarding communication.
Methods: Using a constructivist grounded theory approach, the authors explored the perceptions of interpersonal interactions of emergency medicine (EM) and internal medicine (IM) clinicians, using conversations regarding hospital admissions as a critical interface between members of these two disciplines. The authors used a purposive sampling approach to recruit participants, and included EM residents and attending physicians and IM attending physicians who serve in the triage hospitalist role. Two authors conducted hour-long, semi-structured interviews over Zoom. The two primary investigators then coded the transcripts according to Charmaz’s three stages of coding: initial, focused and theoretical. Investigators used a constant comparative and integrative analysis to refine the interview guide, and interviews continued until thematic sufficiency was reached.
Results: The authors interviewed 18 participants for this study, including 9 IM faculty, 9 EM providers (4 faculty, 5 residents). Participants identified primers, modifiers, consequences, and solutions to interphysican conflict. They described how preconceived perceptions of their colleagues’ specialty and misalignments in expectations around clinical care primed the learning environment for conflict. EM and IM providers emphasized the role word choices in creating mutual feelings of being undervalued, disempowered, and having their clinical judgement questioned. Personal and professional consequences occurred secondary to this conflict, such as stress, burnout, job dissatisfaction, self doubt, questioning their choice of medical specialty, and concerningly they expressed these encounters reinforced bias and stereotyping amongst specialties. Finally, providers suggested strategies to repair conflictual interactions and improve communication. They noted that focusing on honesty, empathy, teaching, and active team formation could be used to resolve or avoid conflict.
Conclusions: Our data suggests that interpersonal conflict between physicians is a pervasive issue. Participants describe that these encounters impact both their professional and personal wellness, which aligns with the broader workplace conflict literature. Interspecialty ‘othering,’ and pre-existing biases and stereotypes prime the workplace for these conflictual interactions. They also serve as a lens to interpret misaligned expectations and difference of opinion as error, clinical incompetence, and work avoidance, which further propagate conflict. Empathy, honesty, and mutual teaching are important strategies to combat stereotyping and othering, and may help mitigate the deleterious consequences of interphysican conflict.