Public Citizen Lists States With Most And Least Aggressive Physician Discipline

Many state medical boards “are doing a dangerously lax job” protecting the public from incompetent physicians, according to a report from Public Citizen, the consumer advocacy group.

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The report -- co-authored by Sidney Wolfe, MD, and Robert E. Oshel, PhD, of Public Citizen's Health Research Group -- ranked states by their rate of serious disciplinary actions, as reported by the federal National Practitioner Data Bank (NPDB), per 1,000 licensed physicians in each state from 2017 to 2019.

Oshel was formerly the NPDB's associate director for research.

Kentucky, Arizona, and Pennsylvania medical boards were the most aggressive by this measure, with 2.29, 1.81, and 1.78 serious actions per 1,000 physicians; Georgia, New Hampshire, and the District of Columbia were the least, with 0.32, 0.32, and 0.29 actions per 1,000, respectively.

The report also called out California, which has the 150,000 licensees -- more than any other state -- for being lenient. California ranked 33rd in its number of serious disciplinary actions or 0.85 per 1,000 physicians. And it took a shot at New York, despite having the nation's sixth highest rate (1.61 per 1,000), because it "was still considerably (30%) lower than Kentucky's rate of 2.29."

Public Citizen has previously used disciplinary actions by medical boards as a marker of how well each state protects patients from doctors who are incompetent, have serious behavioral problems or addictions, or otherwise jeopardize patients.

It uses that benchmark because there are no other objective standards to score medical boards and because "there is no reason to believe that physicians in any one state are more or less likely to be incompetent or miscreant than the physicians in any other state," the report said.

Public Citizen considered a decision against a physician's license a serious one if it involved license revocation, suspension, summary restriction, summary suspension, voluntary surrender while under investigation, voluntary limitations while under investigation, limitations or restrictions, denials of renewal and voluntary agreements to refrain or suspend pending completion of an investigation.

Wolfe, the Health Research Group's founder and senior advisor, told MedPage Today that in many states where medical boards fail to discipline or revoke the licenses of physicians with documented serious issues, the problem is lack of funding because physicians' license fees go into state general fund coffers.

That's the case in Georgia, he said, where a state auditor's report in November noted many key medical board positions could not be filled, Wolfe said. According to that report, the Georgia medical board remitted $7 million to the state from licensing fees while receiving only $2.5 million in state appropriations.

Wolfe noted that the percentages of disciplinary action collected for this current report are much lower than those in previous Public Citizen reports because it excluded probation this time. As in prior reports, it also excluded public letters of reprimand, a common form of disciplinary action in states including California.

The report also only included disciplinary actions against osteopathic physicians when the state board licensed both osteopathic and allopathic physicians, thus excluding disciplinary actions against osteopaths in 14 states with separate osteopathic licensing agencies. They are: Arizona, California, Florida, Maine, Michigan, Nevada, New Mexico, Oklahoma, Pennsylvania, Tennessee, Washington State, West Virginia, Vermont, and Utah.

The reason, Wolfe said, was because in some states the number of osteopathic physicians was too small for comparison. Public Citizen plans a separate report just on osteopathic doctors, he said. Numbers of osteopathic physicians are rapidly growing nationally and nearly 10% of practicing physicians in some states such as California are licensed by a separate osteopathic board.

Wolfe and Oshel also noted that a physician's medical malpractice payouts are another measure boards could use to assess competence, but they rarely do. Three-fourths of the 8,633 physicians with five or more malpractice payments "dangerously and unacceptably...have never had a medical board licensure action of any kind, serious or nonserious," the report said.

The report recommended several policy changes, including:

• Assure that revenue from physician license fees funds board activities "instead of sometimes going into the state treasury for general purposes"
• Assure boards have adequate staffing
• Medical board appointees should include members who have a commitment to safeguarding the public, "not protect the livelihood of questionable physicians"
• Open the NPDB database to the public so that any person can do a background check on a doctor
• Increase state legislative oversight of state medical boards
• Replace some medical board members who are physicians with members of the public "with no ties to the medical profession, hospitals, or other providers"; consultants can be hired when focused medical expertise is needed
• Require that medical boards check with the NPDB when they receive complaints about a physician

"If the boards consistently queried the NPDB on all their licensees, they would learn of all adverse actions taken by licensing boards in other states where their licensees may also be licensed, all malpractice payments, and all adverse actions taken by hospitals or other health care entities concerning their licensed physicians," the report said.

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