Psychopathy
Psychopathy is present in all professions. In The Wisdom of Psychopaths: What Saints, Spies, and Serial Killers Can Teach Us About Success, Kevin Dutton provides a side-by-side list of professions with the highest (CEO tops the list) and lowest (care-aid) percentage of psychopaths. Interestingly surgeons come in at #5 among the professions with the highest percentage of psychopathy while doctors (in general) are listed among the lowest.
Although by no means a scientific study, Psycopaths, by their very nature, seek power and it would make sense that a psychopath among us might pick surgery over pediatrics or pathology as they are drawn to power, prestige, and control. Be this as it may the incidence of psycopathy or psychopathic traits in doctors of any specialty is low. Statistics indicate that no more than 1% of men in general exhibit psychopathic traits. In Women these characteristics are far less.
Due to irresponsible behavior and a tendency to ignore or violate social conventions and rules, psychopaths frequently find themselves engaged in conduct involving the criminal justice system or involved in other disciplinary action. Juvenile delinquency, arrests, school suspensions and misconduct related issues are barriers that preclude professional careers for many and, with around 15% of the prison population estimated to be psychopathic, incarceration and recidivism are common final pathways. Because of this tendency it would be highly unlikely for most sociopaths to follow a standard professional career pathway involving academic rigor and normal professional and societal expectations, because impulsive irresponsible actions commonly blocks it. This would predict a probably much lower prevalence of psycopathy in physicians compared to the general population.
That being said, such self imposed removal from a potential career is the sole product of getting caught for misconduct and being held accountable for it. Psychopaths possess several traits that make this difficult. With a talent for “reading people” and identifying their weak spots and vulnerabilities they are able to get people to see what they want them to see. Psychopaths often exude charm, confidence and charisma. They can lie effortlessly and are very convincing..
The natural history of psychopathy involves risky behavior and the ability to get away with it or out of it. The consequences of this depend on if and when it occurs. It is entirely conceivable that some may live their entire lives undetected. With a need for stimulation and a proneness to boredom the psychopath is particularly prone to drug abuse and addiction and twice as likely as the general population to be diagnosed.
Psycopathy involves a path of risky behavior as well as the potential for being held accountable for it. At any age the behavior that brings they psychopath to the attention of the criminal justice system is often drug or alcohol related. The natural history of the average psychopath reveals an overrepresentation in prison with a 15x greater risk in general. Any statistics on psycopathy in a population is based on psychometric evaluations retrospectively in specific populations. Being arrested or getting caught for something does not reveal the pathology or the correlation. You have to look for it.
And nothing is known of subpopulations of psychopaths and the impact of intelligence, education, profession and other factors and how they relate to outcomes and consequences over time. Egocentricity and a sense of entitlement drives they do not adapt to the environment but try to make the environment adapt to them. Without empathy and lacking remorse the goal is always self-serving and a question of what they can get out of it.
Many judges, as an alternative to incarceration, have been requiring people arrested for drug and alcohol related offenses to attend AA meetings and provide proof of participation. As misguided as this is on other levels it is also dangerous. Given a choice between incarceration and attending AA the majority of any population, including those with psychopathic traits, would choose the latter. And as in any situation they would use it to see what they could get out of it. Masters of manipulation and impression management in a room full of potential victims. The reports of rape and theft coming out is no surprise. It is in all likelihood much worse.
And in reality psychopaths exist in every profession, including medicine.
What is the natural history and final common pathway of M.D. psychopaths? Where do these shape-shifters end up?
In his book Without Conscience, Dr. Robert Hare notes “If we can’t spot them, we are doomed to be their victims, both as individuals and as a society. ” Dr. Clive Boddy in Corporate Psychopaths observes that unethical leaders create unethical followers, which in turn create unethical companies and society suffers as a result.” And if you look at the FSPHP branch of the ASAM that is exactly what you will find. less than 1/% of the population are psychopaths but they represent more that 10% of those in prisons. What is the natural history of the physician psychopath? You do the math.
A 2010 study, Corporate Psychopathy: Talking the Walk, found that 3 to 6 percent of corporate employees may be responsible for the majority of ethical breaches in corporations, with corporate psychopathy tending to be concentrated at the higher levels of organizations.
This group here, Like-minded Docs, is largely responsible for what happens to any doctor referred to a state PHP because all of the medical directors of the “PHP-approved” assessment and treatment centers can be found right here.
So too can Bob Dupont and Greg Skipper who have introduced the non-FDA approved drug and alcohol LDTs. Stuart Gitlow, President of ASAM is also on the list.
This group is essentially in control of doctors and determines their fates and the percentage of psychopathy here is much much more than the 3-6% found at Enron.
Some of these doctors have done horrible things that most doctors would never do under any circumstances (steal IV pain relieving drugs from dying cancer patients I.V. bags, selling the ‘date-rape” drug to DEA agents).
On this list are multiple felons and a fair number of double felons who got their licenses back by saying they were not responsible for what they did. They were helpless over drugs or alcohol and have now been saved by the good graces of 12-step spirituality.
And with that the medical boards gave them power without accountability. There is no regulation, oversight, answerability or need to justify their actions. It is a free for all and this list is a gold-mine for anyone studying organized psychopathy.
Physician Health Programs are a funnel for the sociopath and without restraint they are only growing.
This is what John Nash described would happen without counter-forces to keep their numbers low.
In his book Without Conscience, Dr. Robert Hare notes “If we can’t spot them, we are doomed to be their victims, both as individuals and as a society. ” Dr. Clive Boddy in Corporate Psychopaths observes that unethical leaders create unethical followers, which in turn create unethical companies and society suffers as a result.” And if you look at the FSPHP branch of the ASAM that is exactly what you will find. It is the perfect funnel for such personalities in our profession–relicensed by claiming the salvation card and an externalization of all blame. “I didn’t do it it was my disease.” In this manner felons, double felons, swindlers and pedophiles have not only gotten their medical licenses back but PUT IN CHARGE of evaluating other doctors in a 
Disrupted Physician 