Physicians hold themselves to some of the highest ethical and professional standards of any profession. They complete years of postgraduate and continuing education while also committing to treat the infirm, preserve patient privacy, and instruct the next generation in the profession. Although physicians have the privilege and responsibility of self-regulation, state medical boards provide oversight to ensure the rules are followed. Disciplinary actions against physicians are rare, but they can result in reputational damage, fines, or loss of license. Among the over 1 million licensed physicians in the United States, about 8,000 disciplinary actions are taken each year by state medical boards, according to a recent report by the Federation of State Medical Boards (FSMB). Physician discipline is reserved for the most serious violations, involving some 4,000 board actions a year—a number that has remained fairly constant over the past 10 years, the FSMB wrote. The FSMB does not publish the specific breakdown of reasons for state board actions on its website. However, a recent viewpoint published in JAMA and co-authored by Dr. Humayun J. Chaudhry, DO, FSMB’s president and chief executive officer, provided insight on the reasons physicians are subject to discipline. Sexual misconduct/sexual boundary issues Since the #MeToo movement was launched in 2017 by women in Hollywood who had been sexually harassed or abused, this issue is being brought to light in all segments of society. Medicine is no exception. The FSMB recently completed an in-depth review of the handling of reports of sexual misconduct, including harassment and abuse toward patients by physicians, JAMA article authors explained. The review was “motivated by concerning reports of unacceptable behavior by physicians.” In 2019, sexual misconduct/sexual boundary issues were among the top three reasons that state medical boards imposed disciplinary actions for unprofessionalism. These reasons were cited in 15% of such cases, according to the article. “The actual number may be higher because boards often use a variety of terms, including unprofessional conduct, physician-patient boundary issues, or moral unfitness to describe such actions,” authors wrote. Another 4% of cases involved “physician-patient boundary issues.” The FSMB has begun a project to encourage boards to align their categorization of all disciplinary actions to better illuminate the scope of this type of misconduct. “Members of the medical profession must acknowledge their ethical ‘duty to report,’” authors wrote. There may be serious repercussions for failing to do so. “In some states, a failure by a physician to report another licensee’s actual or suspected sexual misconduct may subject them to disciplinary action for unprofessional conduct, such as licensure suspension, letter of reprimand, or monetary fines,” authors wrote. In some states, fines run as high as $100,000, and have extended to failure to report a colleague’s fraudulent prescribing or drug diversion, they added. ‘Unprofessional conduct’ tops reasons for discipline The most common reason for physician disciplinary action for professionalism in 2019 was the catch-all term “unprofessional conduct,” which was cited in 50% of cases, authors wrote. Another 6% involved “professional misconduct.” Each state’s Medical Practice Act defines unprofessional conduct a little differently, so laws vary depending on the jurisdiction. Violations can include failure to meet continuing medical education requirements, alcohol/substance abuse, and neglect of a patient. According to FSMB, some additional examples of “unprofessional conduct” include the following: Sexual misconduct Failure to meet accepted standards of care Prescribing drugs in excess or without legitimate reason Dishonesty during the license application process Conviction of a felony or fraud Inadequate record-keeping Alcohol/substances A review of cases brought before the AMA's Council on Ethical and Judicial Affairs (CEJA) provides another national view on physician behaviors that may lead to disciplinary review, according to a report issued in the American Journal of Bioethics. Authors reviewed 5 years of physician discipline cases involving 298 cases and 293 doctors and identified common categories of disciplinary action. The two most common categories of physician behavior leading to disciplinary review were substance abuse disorders (28%) and controlled-substance violations (27%). Also common were negligence/incompetence (21%), criminal activity (20%), fraud/misrepresentation (19%), and boundary violations (12%). Common boundary violations included a romantic relationship with a patient, treating family members as patients, and having sexual contact with a patient. The authors noted that the broad categories of alleged behavior were similar to those found in other studies. “Physicians and physicians-in-training should be educated regarding this subcategorization in order to decrease the rate of discipline and improve patient care,” they said. Unreported patient complaints Few patients file complaints with state medical boards, even when they believe they have experienced substandard care, according to a survey commissioned by the FSMB in 2019. Among those with perceived unethical, unprofessional, or substandard care, only 33% reported the interaction or filed a complaint against the physician. And among those who filed a complaint, only 34% took their complaint to a state medical board. Source
