State medical boards ‘dangerously lax’ at targeting incompetent physicians, watchdog group says

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State medical boards have some declining and minimal rates of examining misconduct, opting instead “to protect the livelihood of questionable physicians.”

The figures for serious disciplinary actions against physicians among the 50 states and the nation’s capital were published in a new report by Public Citizen, the Washington, D.C.-based nonprofit consumer advocacy group. Public Citizen ranked the states based on serious disciplinary actions per 1,000 physicians in 2019, 2020, and 2021.

Serious disciplinary actions are “those that had a clear impact on a physician’s ability to practice,” such as license suspensions, revocations, denial of renewal, or investigations. Figures come from the National Practitioner Data Bank (NPDB), a resource that should be open to the public, according to Public Citizen.

Michigan topped the list with an annual average of 1.74 serious disciplinary actions per 1,000 physicians per year for 2019 to 2021. Washington, D.C., was at the bottom with an average 0.19 serious disciplinary actions per 1,000 doctors a year.

Who’s watching the docs?

The Public Citizen report said low rates of disciplinary actions show “many, if not most, state medical boards are doing a dangerously lax job in enforcing their states’ medical practice acts.”

“The public deserves to be protected from dangerous doctors,” analyst Robert Oshel, PhD, said in a news release. Oshel is adviser to Public Citizen’s Health Research Group and is former NPDB associate director for research.

“There is no evidence that physicians in any state are, overall, more or less likely to be incompetent or miscreant than the physicians in any other state,” Oshel said. “Thus, differences in discipline rates between states reflect variations in boards’ enforcement of medical practice laws, domination of licensing boards by physicians, and inadequate budgets rather than differences in physician incompetence or misbehavior.”

Where the physicians are

Among the states, New York had the second-largest number of physicians (102,361 in 2020) and the seventh highest rate for serious disciplinary actions at 1.25 per 1,000 physicians per year. If New York had the same rate as Michigan, Public Citizen calculated that would have resulted in 49 more serious disciplinary actions a year.

California led the nation for number of doctors (152,50 in 2020) and had 0.83 serious actions per 1,000 physicians. At the Michigan rate, California would have had 139 more serious disciplinary actions a year, according to Public Citizen.

The national average total of serious disciplinary actions per year was 1,281 for all states.

If all states had the same rate as Michigan, there would have been 1,133 more serious disciplinary actions per year across the country. That would have led to a jump from 1,281 actions to 2,414, according to Public Citizen.

On the decline

The 2019-2021 national average was 165 actions lower than the average of 1,446 for the period 2017, 2018, and 2019. Public Citizen “could not account for the effects, if any, of the COVID-19 pandemic on serious disciplinary actions in 2020 and 2021,” the report said.

Michigan’s serious action count was lower than the three highest rate logged in a similar report Public Citizen compiled for the 2017-2019 period. During that time, Kentucky led the nation with an average of 2.29 serious disciplinary actions per 1,000 physicians per year.

Michigan or any state could set a new higher standard for physician disciplinary cases.

“Clearly, there is no reason to believe that even the highest rate currently observed is the best that can be achieved, let alone adequate for protecting the public from dangerous physicians,” the report said.

Dr. Robert Steinbrook, director of Public Citizen’s Health Research Group, agreed.

“Michigan’s rate of serious disciplinary actions against physicians is a floor, not a ceiling,” Steinbrook said in a statement. “All state medical boards could do a far better job of protecting the public from dangerous doctors and improving the quality of medical care.”