Disciplinary actions against physicians dropped 10.3% last year, according to the Federation of State Medical Boards. An analysis of the federations data by Public Citizens Health Research Group showed Mississippis state medical board is the least effective at disciplining doctors and Alaskas is the best.
The 2007 edition of the federations Summary of Board Actions, its annual state-by-state compilation of statistics on disciplinary actions taken against physicians and other healthcare professionals in the previous year, was released in April. Public Citizen released its analysis in early June.
We cant assume there is a constant level of misbehavior among physicians, says James Thompson, M.D., president and chief executive officer of the federation, which counted 5,574 disciplinary actions taken against physicians by state boards last yearcompared with 6,213 in 2005, 6,265 in 2004 and 5,230 in 2003. In general, the value of this (report) to the public is the reassurance that their state medical board is doing their due diligence.
Public Citizens Health Research Groups annual state rankings are based on a three-year average of serious disciplinary actionsdefined as license revocations, surrenders, suspensions and probations/restrictionstaken in each state as compiled by the federation. A serious-actions-per-thousand-doctors rate is then calculated using American Medical Association figures on a states physician workforce. The Mississippi State Board of Medical Licensure issued only 1.41 serious actions per 1,000 doctors compared with the Alaska State Medical Boards rate of 7.3. Just ahead of Mississippi were: South Carolina and Minnesota, both with 1.45; South Dakota, 1.52; and Nevada, 1.68. Just behind Alaska were: Kentucky, 7.1; Wyoming, 6.37; Ohio, 6.01; Oklahoma, 5.54; and Missouri, 5.43.
A tiny fraction of physicians are doing an enormous amount of harm, says Sidney Wolfe, M.D., director of Public Citizens Health Research Group. Five percent of physicians account for 50% of malpractice payouts.
Public Citizens ranking came out several weeks later than usual this year because the AMA for the first time included federally employed physicians in its workforce state-by-state totals. As a result, Public Citizen had to recalculate the results of previous rankings to provide an accurate comparison to this years ratings. Wolfe, whom Modern Physician and Modern Healthcare readers recently ranked 30th on a list of the Most Powerful Physician Executives in Healthcare, says after the recalculation, 37 states remained the same, while six states moved up one position and six states moved down one.
According to the Public Citizen report, only 2.46% of physicians are federal employees and they are disproportionately represented in Alaska, the District of Columbia, Hawaii and Maryland.
While Public Citizen only counts the serious actions, the federations statistics also include measures such as fines or reprimands, and policy changes in large states can have an impact on the grand total. For example, the Florida Board of Medicines total actions fell to 546 from 901, a 39.4% decrease.
In an e-mail, the Florida board noted two reasons for the drop. One involved a six-month extension for license applicants to complete a continuing education requirement. According to the e-mail, some new applicants were taking advantage of the extension, and were cited for being late with completing education requirements. So in July 2006 the extensions were removed. Also, the board adopted a policy of not including first-time citations in the totals it provided to the federation.
But that would not explain why disciplinary actions resulting in the loss of license or license privilege fell to 88 from 137, nearly 36%. On the other hand, actions taken by the Florida Board of Osteopathic Medicine rose to 51 actions taken in 2006 compared with 32 in 2005, or 59.4%, but it was not enough to offset the Florida Board of Medicines decline.
In California, the federation reported that actions taken dropped to 547 in 2006 compared with 624 in 2005, or 12.3%.
The reduction was linked to staff cutbacks. Given that we lost 19 of 110 investigators in 2002 and 2003, and have experienced recruitment issues, the small decrease in some of our enforcement actions since 2002 is not surprising, says Candis Cohen, public information officer for the Medical Board of California, in an e-mail. We have restored four positions to date, she said in the e-mail, and in 2006 implemented a new program, vertical enforcement, which brings prosecutors from the attorney generals office in at the ground level to work with our investigators.
In addition to the summary of disciplinary actions, the federation also released a report, State of the States: Physician Regulation 2007, that highlighted state efforts to crack down on rogue pharmacies, and touted the federations national alert service that notifies boards about physicians licensed in their state who have been sanctioned by another state. The importance of this service, according to the federation, is that 88% of the physicians disciplined in 2006 had licenses to practice in more than one state.
In years past, it would have been possible for a physician who lost a license or was disciplined in one state to move and hang his shingle in another, and it would have been months, years or never before the public was notified, Thompson says.
Although the federation distances itself from the Public Citizen rankings of state medical boards, Thompson says: We cannot or will not deter Public Citizen from developing its report that is based on the data found in the federation report. Public Citizens rankings are often characterized as an apples-to-oranges comparison, and unfair to state boards that lack the resources to investigate complaints quickly and thoroughly.
Wolfe, however, says thats exactly the point, noting that in any given year there can be a sevenfold to eightfold difference between the state boards taking the most actions and those taking the fewest. As a trade association for state medical boards, Wolfe says, the federation doesnt want to spank its members, so it takes pains to avoid anything that can draw unflattering comparisons between the most- and least-active boards.
If you put out the information in a way that sharply displays the contrast between the best and the worst, the states that havent done well can go to their legislature and get more support, Wolfe says.
Wolfe cited Arizona as example of a state that had used its No. 38 ranking in 1998 as ammunition to get the state Legislature to boost funding. As a result, it was ranked first in 2003 and now consistently finishes among the top states for policing physician misbehavior.
I wasnt here when all that happened, but Im sure it did have an impact, says Roger Downey, a spokesman for the Arizona Medical Board. Sidney Wolfe and his report tend to get a lot of media coverage, and with the media coverage comes a lot of questions on why your board did so poor in the rankings.
After finishing first in the rankings for three consecutive years in the '90s (1995-97), Mississippi has now finished last two years in a row this decade. In an interview last month, Mississippi State Board of Medical Lincensure Executive Director H. Vann Craig said disruptions caused by Hurricane Katrina have led to fewer complaints against physicians and, consequently, fewer investigations and fewer sanctions. In contrast, Louisiana--which has had its own share of Katrina-related disruptions--improved this year to 11th place after finishing 13th last year.
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