Monday, November 06, 2023

Most state medical boards are too inactive

 By Mathew Goldstein

Disciplining physicians who exhibit incompetence or whose conduct is illegal or abusive towards patients is a chief responsibility of the state medical boards. State licensing boards and health care entities, including professional societies, are required to report to the National Practitioner Data Bank (NPDB) certain adverse licensing and disciplinary actions taken against individual practitioners. Malpractice insurers and other payers are also required to report all malpractice payments made on behalf of individual practitioners. State level summary information that does not identify individuals is publicly available. 

Public Citizen’s Health Research Group calculated the rate of serious disciplinary actions per 1,000 physicians in each state per year averaged over three years 2019, 2020, and 2021. They defined “serious disciplinary actions” as those that had a clear impact on a physician’s ability to practice. They utilized the information on the Federation of State Medical Boards (FSMB) website ( census) to determine the total number of physicians in each state.

Michigan averaged 1.74 serious disciplinary actions per 1000 physicians.  Michigan’s rate is lower than the highest three rates for the years 2017-2019.  I agree with Public Citizen that the highest rate currently observed is unlikely to be the best that can be achieved nor is it likely to be adequate for protecting the public from dangerous physicians. Many states took no, or little, disciplinary action against physicians promoting disproven or unproven treatments for COVID-19. Public Citizen points out that “data from the NPDB show that by the end of 2021, 9,286 U.S. physicians have had five or more malpractice-payment reports since the NPDB began collecting such information in 1990. This is a malpractice record worse than 99% or more of all physicians who have practiced since then. Yet, dangerously and unacceptably, three-quarters (75%) of these 9,286 physicians have never had a medical board licensure action of any kind, serious or nonserious.” Also “almost half of physicians deemed worthy of discipline by their peers with whom they practice had no action taken by a licensing board.” We can nevertheless assign an A+ (100%) grade to the Michigan rate and grade the other states from that sub-optimal starting point. 

Maryland’s rate is 0.89 which ranks 25th among all states. That earns Maryland an F grade (51%) relative to Michigan’s rate.  Virginia’s rate is 1.02 which also earns an F grade (58%). Marylanders and Virginians, like the citizens of most states, should be concerned about the poor performance of state medical boards. 

Public Citizen notes: “For $2.50 per physician per year, boards can purchase “continuous query” from the NPDB for each licensee. the licensing boards of Florida, Massachusetts, Vermont, and Wyoming enrolled substantially all their licensees in continuous query. All of these states except Wyoming — a low population state for which a relatively few licensure actions could make a relatively large change in ranking position — were among the twenty highest ranked states.” Yet “In 2022 the licensing boards of 29 states had no physicians enrolled in the Data Bank’s continuous query service. Six of those 29 state boards made no single name queries to the Data Bank. Seven state boards only had between one and fifty physicians enrolled.” Those numbers are pathetic.

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