Ranking of State Medical Board Serious Disciplinary Actions in 2002 (HRG Publication #1658)
Based on data we obtained from the Federation of State Medical Boards (FSMB) on the number of disciplinary actions taken in 2002 against doctors, Public Citizen’s Health Research Group has calculated the rate of serious disciplinary actions (revocations, surrenders, suspensions and probation/restrictions) per 1,000 doctors in each state and compiled a national report ranking state boards by the rate of serious disciplinary actions per 1,000 doctors in the year 2002 (See Table 1).
Our calculation of rates of serious disciplinary actions (revocations, surrenders, suspensions and probations/restrictions) per 1,000 doctors by state is created by taking the number of such actions (columns A and B from the FSMB data) and dividing it by the American Medical Association data on nonfederal M.D.s as of December 2000 (adding to this the number of osteopathic physicians if the board is a combined M.D./D.O. board) then multiplying the result by 1,000 to get state disciplinary rates per 1,000 physicians.
Nationally, there were 2,864 serious disciplinary actions taken by state medical boards in 2002, up 5.8% from the 2,708 serious actions taken in 2001. The latest published data on the number of doctors is from 2000; thus some of this increase may be attributable to the fact that there were certainly more doctors in 2002 than in 2000. State rates ranged from 1.07 serious actions per 1,000 doctors (Hawaii) to 11.87 actions per 1,000 physicians (Wyoming) an 11.1-fold difference between the best and worst states. If all the boards did as good a job as the lowest of the top five boards, the rate for #5, Oklahoma, being 7.56 serious disciplinary actions per 1,000 physicians or 0.756 percent, this would have amounted to a total of 6,089 (0.756 percent of 805,372 non-federal doctors) serious actions a year. This would be 3,225 more serious actions than the 2,864 that actually occurred in 2002.
Worst States (those with the lowest rate of serious disciplines).
As can be seen in table 1, the bottom 15 states, those with the lowest serious disciplinary rates in 2002, were, starting with the lowest: Hawaii (1.07 per 1,000 physicians), Delaware (1.35), Wisconsin (1.40), Tennessee (1.47), South Carolina (1.77), Maryland (1.78), North Carolina (2.06), Florida (2.08), Pennsylvania (2.10), Minnesota (2.11), Washington (2.23), Nevada (2.31), South Dakota (2.39), Connecticut (2.40) and Michigan (2.41).
Of these 15 states with the worst serious disciplinary records, six – Maryland, Hawaii, Delaware, South Dakota, Minnesota, and Washington – were also in the bottom 15 states in 2001 and 2000 (see table 2). In 2002, the bottom 16 states all had rates of serious disciplinary action that were one-third or less than the rate of all of the top six states.
These data again raise serious questions about the extent to which patients in many states with poorer records of serious doctor discipline are being protected from physicians who might well be barred from practice in states with boards that are doing a better job of disciplining physicians. It is extremely likely that patients are being injured or killed more often in states with poor doctor disciplinary records than in states with consistent top performances.
Best States (those with the highest rates of serious disciplines).
Table 1 lists each state's ranking and rate in descending order. The top 10 states, or those with the highest rate of serious disciplinary actions per 1,000 physicians are (in order): Wyoming (11.87 per 1,000 physicians), North Dakota (8.76), Alaska (8.57), Kentucky (7.58), Oklahoma (7.56), Arizona (7.46), Ohio (7.45), Colorado (7.40), Montana (6.80) and Utah (6.13). Five of these 10 states (North Dakota, Alaska, Kentucky, Oklahoma and Ohio) were also in the top 10 in 2001, 2000 and 1999 and one state, Alaska, has been in the top 10 for more than 10 straight years. Kentucky, 4th this year and Oklahoma, 5th this year, have been in the top 10 states for seven and nine of the last ten years, respectively. Arizona, 6th this year, has been in the top 10 states for 4 of the last 10 years. Ohio, 7th this year, has been in the top 10 for the last eight years in a row. And Colorado, 8th this year, returns to the top 10 for the 6th time in the last 10 years. (See Table 2).
It is clear that state-by-state performance is spotty. Only one of the nation's 15 largest states, Ohio, is represented among those 10 states with the highest disciplinary rates. Other large states such as New York, California and Michigan ranked 20th, 24th and 37th respectively in 2002. Michigan dropped from 29th in 2001 to 37th in 2002, New York from 14th in 2001 to 20th in 2002. Another large state, Massachusetts, improved from 45th in 2000 to 21st in 2002.
What Makes a Difference?
Boards are likely to be able to do a better job in disciplining physicians if most, if not all, of the following conditions are true:
Given the importance of medical boards in protecting patients in a state from doctors who are not practicing medicine in the best manner and are thus endangering the lives and health of residents of those states, most states are not living up to this obligation. Serious attention must be given to finding out which of the above variables are deficient in each state and taking action, legislatively and through pressure on the medical boards, to increase the amount of discipline and, thus, the amount of patient protection.