Medical Boards Discipline Physicians Unevenly: New Study
Public Citizen recently released its annual report ranking of the effectiveness with which state medical boards discipline their physicians. The rankings are based on data released annually by the Federation of Sate Medical Boards (FSMB).
According to the nationwide data, in 2006, there were 2,916 serious disciplinary actions taken by state medical boards -- 10% fewer than the previous year. Mississippi scored the lowest rate of serious actions, with 1.4 physicians per 1,000 being disciplined, while Alaska was the most vigilant, with 7.3 serious actions per 1,000 physicians. The difference from lowest to highest was five-fold, a fact that researchers believe indicates dangerous variability in the safety of the nation's health care system. According to the report, state medical boards appear to be more likely to discipline dangerous physicians when:
• "They have adequate funding (all money from license fees going to fund board activities instead of going into the state treasury for general purposes);
• They have adequate staffing;
• They undertake proactive investigations rather than only responding to complaints;
• They use all available and reliable data from other sources such as Medicare and Medicaid sanctions, hospital sanctions and malpractice payouts;
• They have excellent leadership;
• They are independent from other parts of the state government, so that the board has the ability to develop its own budgets and regulations; and
• A reasonable legal framework exists for disciplining doctors (the 'preponderance of the evidence' rather than 'beyond reasonable doubt' or 'clear and convincing evidence' as the legal standard for discipline)."
In 2006, Public Citizen cited another study, which indicated that 67% of insurance fraud convictions among physicians, and 36% of controlled substance abuse convictions were associated with non-serious disciplinary action by state boards -- evidence that regulatory groups tend to under-discipline physicians who break the law, and that raw data such as a tally of serious disciplinary actions may not clearly illustrate the scope of impropriety among the nation's doctors.
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