Report on state-level physician discipline may be misleading by ignoring full range of actions

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A report that slammed state medical boards for lack of disciplinary actions against physicians does not examine the full context of processes to review the decisions and actions of doctors.

The Federation of State Medical Boards (FSMB) responded to a new report by Public Citizen, a Washington, D.C.-based consumer advocacy group.

This month, Public Citizen claimed data from 2019 to 2021 show rates are decreasing for state medical boards to take serious disciplinary actions involving physicians’ medical licenses and ability to practice. That could indicate the boards choose “to protect the livelihood of questionable physicians,” instead of enhancing patient safety.

But those type analyses can be misleading due to lack of context and the number of disciplinary measures that physicians may face, said Joe Knickrehm, FSMB vice president of communications. He shared this response with Medical Economics:

“Comparing state medical boards solely based on the number of ‘serious’ disciplinary actions taken does not accurately indicate a board’s effectiveness or ineffectiveness. The Public Citizen report does not take into account the wide range of disciplinary steps boards can take such as letters of reprimand or fines, which are often enough to stop problem behaviors – pre-empting further problems in the future.

“These kinds of interventions and positive outcomes are not always publicly recorded or counted in these kinds of analyses. Without additional context into the variance of the statutory, funding, judicial, administrative, and geographic environments from state to state, these kinds of reports may be misleading and do not fully demonstrate a medical board’s focus and efforts on patient safety and the delivery of quality health care.”

Public Citizen got it right in calling for more money and staff for state medical boards, according to FSMB.

“We do agree with Public Citizen’s call for better or increased funding to state medical boards to ensure they have adequate resources and staffing to fulfill their duties more efficiently and effectively,” Knickrehm added.

Public Citizen said boards should make proactive investigations instead of only responding to complaints, and should split from state medical societies, cutting the number of doctors on the boards and replacing them with disinterested members of the public.

State legislators also should increase their oversight of state medical boards, according to Public Citizen.

The boards themselves should use the National Practitioner Data Bank (NPDB), a nationwide record created by the Health Care Quality Improvement Act of 1986. That law requires hospitals to query physicians when they seek admitting privileges, but state medical boards are not required to do so, even when complaints are filed.

Lawmakers in New Jersey and Texas have enacted legislation requiring their licensing boards to query NPDB. Congress nationally should amend the 1986 act to require the state boards to use the database to check physicians for licensures and renewals, according to Public Citizen.

“The licensing boards are the last line of defense for the public from incompetent and miscreant physicians,” the Public Citizen report said.