New Report Criticizes State Medical Boards for Not Disciplining More Docs

Minnesota is the worst state in the nation for disciplining doctors, according to Public Citizen's seventh annual ranking of state medical boards.

The report, released this week, also found that serious disciplinary actions against doctors across the nation rose slightly in 2009, but are still about 18% lower than they were at their peak five years ago.

Sidney Wolfe, MD, director of Public Citizen's Health Research Group, said that had the national rate of doctor discipline remained at that peak, there would have been 653 additional serious disciplinary actions against physicians in 2009.

"There is considerable evidence that most boards are under-disciplining physicians," Wolfe said. "Most states are not living up to their obligations to protect patients from doctors who are practicing medicine in a substandard manner."

The weighted average rate of disciplinary action in the top five states—Alaska, North Dakota, Kentucky, Ohio, and Arizona—was 5.45 serious disciplinary actions per 1,000 physicians. The weighted average rate in the bottom five states—Minnesota, South Carolina, Wisconsin, New Hampshire, and Connecticut—was 1.5 actions.

In other words, problem physicians are more than 3.6 times as likely to be seriously disciplined by medical boards in the top five states as in the bottom five.

The rankings are calculated using three years of data from the Federation of State Medical Boards on serious disciplinary actions taken against doctors in 2007-2009.

Lisa Robin, senior vice president of advocacy and member services at Federation of State Medical Boards (FSMB), says she has "mixed thoughts" about the rankings. "Public Citizen provides a valuable public service by pointing out that medical boards need to have sufficient funding and staffing. We are on the same page on that because to be able to do their jobs they need to be adequately funded," Robin says.

"We don't believe the boards should be ranked because there is so much difference and variability between the states, not only to resources and staffing, but statutory authority and differences in the laws that can account for some variance," she adds. FSMB last week released its own report showing a 6% increase in the number of disciplinary actions taken by state medical boards. In that report, FSMB specifically urged the media not to rank states.

Robin says Public Citizen only uses serious disciplinary actions. "They count other actions as non-actions. What that misses is a lot of the good work that medical boards do," Robin says.

"They have a range of sanctions and actions they can take and that would be from some sort of retraining in a problematic area, or where the physician is not as competent as he should be. There are also interventions with a letter of public reprimand or a fine and that may be sufficient to get the physician back practicing at an acceptable level." Robin says many state medical boards also have confidential programs for physicians with substance abuse problems that wouldn't be reflected in the Public Citizen report.

However, Wolfe said dismissing state-by-state comparisons because some boards have better funding, tougher laws, and larger staffs doesn't make sense. He added that Arizona's state medical board, which for several years had been among the worst in the nation, improved dramatically when the state legislature increased the board's staff and budget, and hired new leadership.

"That is exactly why you need to compare them. That is something that needs to happen to get those states that aren't doing such a good job to do a better job," he says.

Wolfe says that FSMB is a trade association that wants to protect all its members.

"It's difficult because some boards are doing better than others," he says. "If you don't want to make some boards look better than others, the easy way, the cop out, is to say ‘you shouldn't rank them because it makes some boards look better than others.' That is ridiculous."

The Public Citizen report said boards are likely to do better jobs disciplining physicians if they have good leadership, are independent, proactive, adequately staffed, and adequately funded, with all money from license fees going to fund board activities instead of going into the state treasury for general purposes.

In addition, Public Citizen said effective medical boards need a "reasonable legal framework" for disciplining doctors, such as "preponderance of the evidence" rather than "beyond reasonable doubt" or "clear and convincing evidence."