Tracking Doctor Discipline Just Got Harder

Public Citizen, a nonprofit citizen/consumer safety advocate, publishes a report each year about doctors that have been disciplined by state medical boards. But the state medical boards just made its job a lot harder.

As reported by ModernHealthcare.com, the Federation of State Medical Boards (FSMB) “has quietly killed its Annual Summary of Board Actions report.” It was the resource Public Citizen used to spread the word, ranking state medical boards by how many disciplinary actions per capita they imposed on physicians.

The federation had been compiling reports since 1985 and, according to ModernHealthcare, promised to issue a new and improved version in the autumn. But it won’t necessarily include per-state statistics.

Public Citizen, which has been interpreting the data since 1999, claims that the federation shuttered the report to stop it from giving information that might be useful and interesting to patients, but that providers hated. The organization says it will continue to rank state boards by finding data elsewhere.

As we’ve noted, the adequacy of state medical boards, which grant professional licenses as well as conduct disciplinary actions, is inconsistent. There’s little uniformity in how they operate, how much authority they have and how effective they are in ensuring that health-care practitioners are responsible and accountable for safety lapses.

Until this year, each spring the FSMB noted the number of physician licenses revoked, suspended, modified and ordered to be surrendered or retired by each medical board.

The FSMB prefaced its report by saying, “Because states operate with different financial resources, levels of autonomy, legal constraints and staffing levels, the FSMB discourages using data from this report to compare or rank states.”

Public Citizen ignored that suggestion. As explained by ModernHealthcare, it calculated a three-year average of the number of licenses revoked, suspended or modified by the state board, dividing that figure by the number of doctors in a state to create a “serious actions per thousand physicians” standard. It usually got a lot of media play.

The federation, medical board officials and physician groups claimed Public Citizen’s report was misleading because the number of board disciplinary actions is driven by the number of bad doctors in a state, not by the effectiveness of the board that oversees them; that different boards have different missions-some are punitive, others rehabilitative. They say you shouldn’t compare apples to oranges, that you can manipulate data to prove anything you want to prove.

Dr. Sidney Wolfe, founder and a senior adviser of Public Citizen’s health research group, told ModernHealthcare that it’s likely that states have the same ratio of misbehaving doctors-about 1 in 100, he estimates-so differences in board activity are likely to reflect variables such as board leadership and resources. He believes FSMB yanked the report to avoid trouble within the ranks. Trouble that it created.

Public Citizen contends that by airing the data in an accessible way, positive change has occurred-state legislatures have boosted funding to medical boards, and that better monitoring improves patient safety.

Helen Haskell, a member of the National Patient Safety Foundation’s board of governors and founder of Mothers Against Medical Error, told ModernHealthcare that even if medical boards are constrained by their state legislatures, “Public Citizen plays a vital role, and they’re the only people taking on this issue. If doctors are licensed by the state, they need to be regulated by the state, and someone needs to keep an eye on (the state boards) to make sure that happens.”

The FSMB notes that because all state boards have websites, the federation can’t just track disciplinary actions; it must describe board structure, board staffing, budget, frequency of board meetings, etc. Officials say they’re working with the Department of Health and Human Services to establish a “minimum data set” for state boards to post information on individual licensees so consumers can see “who’s practicing where.”

Kevin Bohnenblust, executive director of the Wyoming Board of Medicine, agreed that the annual report should change with the times; that it should reflect the realities of, for example, physician shortages in states such as Wyoming. “If we can make a physician better-with additional training or drug and alcohol treatment-then taking a license away doesn’t ultimately serve the community if you can get a doctor to practice safely again,” he told ModernHealthcare.

It’s a fair point. But we remain skeptical that closing raw data to interpretation by agencies with patient interests in mind is a positive move. When it comes to the availability of information, less is seldom more.

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