Bias/Conflict of Interest in Peer Review

Peer review for doctors is a valuable process because it promotes accountability, maintains high standards of patient care, and encourages continuous professional improvement. When peer reviewers have personal, professional, or financial interests in the outcome, they may not be able to remain objective. These conflicts of interest can undermine the fairness of the process and weaken confidence in the results. When bias is present, peer review risks shifting away from its legitimate purpose of advancing positive patient outcomes. Identifying and addressing bias helps preserve the fairness and credibility of peer review. Here are some signs of bias or conflict of interest in peer review, and what to do about them. 

About Peer Review

The purpose of peer review is to improve patient care by identifying gaps in performance, correcting unsafe or substandard practices, and reinforcing accepted clinical standards. It is also used to support physician accountability and encourage ongoing professional improvement. When done correctly, peer review protects patients, strengthens clinical quality, and maintains trust in the medical staff process.

Legitimate peer review is a structured, evidence-based process used to evaluate clinical practice and professional performance fairly and consistently. It focuses on objective measures such as adherence to clinical guidelines, quality of care, documentation accuracy, and patient outcomes, rather than personal opinions or relationships. Decisions should be based on verified facts and relevant medical standards.

Sham peer review, on the other hand, occurs when the peer review process is misused for improper purposes. Rather than addressing legitimate concerns about a physician’s competence, clinical judgment, or conduct, it is used to target an individual for retaliation, personal conflict, economic competition, or coercion within the organization.

What Is a Conflict of Interest?

People involved in peer review are expected to remain neutral and objective, but bias is a natural part of human thinking and can never be fully eliminated. It is important, therefore, not to simply ascertain whether bias exists, but whether it begins to influence judgment in a way that affects the fairness or accuracy of the review. This is where conflicts of interest become important, as they can signal when personal or professional factors may interfere with independent decision-making. A conflict of interest exists when an individual’s personal, financial, professional, or other interests could compromise—or appear to compromise—their ability to exercise independent judgment.

Personal Interests 

Personal relationships or interests may also create conflicts of interest in peer review proceedings.

These may include:

• Close friendships with the practitioner under review
• Personal animosity with the practitioner under review
• Family or household relationships
• Prior disputes or ongoing personal conflicts
• Mentorship or supervisory relationships
• Other non-financial motivations that could influence judgment or perceived impartiality

Financial Interests

Financial arrangements unrelated to direct competition may also create conflicts.

These may include:

• Ownership interests in affiliated entities
• Compensation arrangements tied to organizational decisions
• Consulting relationships
• Equity interests
• Potential financial gains resulting from the practitioner’s removal or restriction

Professional Interests

Professional relationships and career-related considerations may also create conflicts of interest in peer review proceedings.

These may include:

• Current or prior supervisory relationships with the practitioner under review
• Competition for positions, leadership roles, or clinical privileges
• Collaboration on research, publications, or clinical programs
• Shared departmental or organizational responsibilities that may affect objectivity
• Potential impacts on reputation, advancement, or professional standing

Quick Overview of the Peer Review Process

The peer review process typically begins with a peer review committee assessing the seriousness of an identified concern regarding a physician’s clinical performance or conduct. If the issue poses a potential risk to patient safety, the committee may recommend a temporary suspension or restriction of clinical privileges while the investigation is ongoing. The committee then conducts a thorough review of all relevant materials, including patient records, internal reports, and opinions from external medical experts, before issuing a formal recommendation. If the recommendation includes adverse actions such as restriction, modification, suspension, or revocation of privileges, the physician must be given formal written notice outlining the proposed action and procedural rights. The physician may then request a Fair Hearing, during which they can present evidence, cross-examine witnesses, and be represented by counsel before an impartial panel of physicians. After the hearing, the panel issues a recommendation that is ultimately reviewed and decided upon by the hospital’s governing board.

The physician is entitled to due process. Due process in peer review ensures that physicians are treated fairly through structured and impartial procedures before any adverse action is taken. It requires that the physician receive clear notice of the concerns or allegations being raised and the reasons behind them. The physician must also be given a meaningful opportunity to respond and present evidence. Finally, he or she must be heard before an unbiased decision-maker.

I Think There Is Bias–What Can I Do About It?

Individuals who identify a conflict of interest are expected to promptly disclose it and recuse themselves from participation in any related deliberations or decision-making to preserve the integrity of the process. Unfortunately, not everyone does. Having a peer review attorney is critical for identifying and evaluating potential conflicts of interest that may not be immediately apparent to those involved in the process. Counsel can help assess whether a conflict rises to the level requiring recusal and ensure that it is properly documented and communicated to the appropriate parties. This guidance helps ensure that individuals with conflicts are appropriately excluded from participating.

Contact a Peer Review Attorney 

Bias and conflict-of-interest allegations pose significant challenges in peer-review proceedings. When these concerns arise, they must be carefully evaluated to determine their impact on the outcome. This includes reviewing the specific facts, identifying any relationships or interests that may be relevant, and assessing whether those factors could reasonably have influenced the decision-making process. Seeking guidance from a peer review attorney can help ensure that the process is handled fairly and in accordance with applicable standards. A peer review attorney can also help clarify whether the concerns rise to the level of a true conflict of interest and advise on appropriate steps to address or correct any procedural issues. Contact our office today.