Ranking of the Rate of State Medical Boards’ Serious Disciplinary Actions in 2003 (HRG Publication #1696)
Public Citizen’s Health Research Group
Ranking of the Rate of State Medical Boards’
April 14, 2004
Sidney M. Wolfe, M.D.
Based on data from the Federation of State Medical Boards (FSMB) on the number of disciplinary actions taken in 2003 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 2003 (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 2002(adding to this the number of osteopathic physicians if the board is a combined M.D./D.O. board). We then multiplied the result by 1,000 to get state disciplinary rates per 1,000 physicians.
Because some small states do not have many physicians, an increase or decrease of one or two serious actions in a year can have a much greater effect on the rate of discipline in such states than it would in larger states. Therefore, starting with this year, we are calculating the three-year average rate of discipline (for each year and the preceding two years) for all states and listing them by rank so that trends over the past decade can more accurately be examined (see Table 2). As of next year (for the disciplinary data for 2004), we will only be reporting 3-year averages which, for next year, will be the average of the disciplinary rates for 2002, 2003 and 2004.
There were 2,992 serious disciplinary actions taken by state medical boards in 2003, up 4.5% from the 2,864 serious actions taken in 2002. State rates ranged from 1.46 serious actions per 1,000 physicians (Rhode Island) to 11.58 actions per 1,000 physicians (Kentucky), a 7.9-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 7.88 serious disciplinary actions per 1,000 physicians or 0.788 percent---this would have amounted to a total of 6,638 (0.788 percent of 842,379 non-federal doctors) serious actions a year. This would be 3,646 more serious actions than the 2,992 that actually occurred in 2003, an increase of 121%.
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 action rates in 2003, were, starting with the lowest: Rhode Island (1.46 actions per 1,000 physicians), Wisconsin (1.66 per 1,000 physicians), Minnesota (1.67 per 1,000 physicians), Delaware (1.71 per 1,000 physicians), Michigan (1.77 per 1,000 physicians),
Mississippi (1.77 per 1,000 physicians), Pennsylvania (1.96 per 1,000 physicians), Hawaii (1.97 per 1,000 physicians), Arkansas (2.00 per 1,000 physicians), Maryland (2.00 per 1,000 physicians), North Carolina (2.04 per 1,000 physicians), Maine (2.13 per 1,000 physicians), Florida (2.30 per 1,000 physicians), Illinois (2.54 per 1,000 physicians), and Kansas (2.57 per 1,000 physicians).
Table 2 shows that five of these 15 states, (Wisconsin, Minnesota, Tennessee, Delaware, and Hawaii) have consistently been in the bottom 15 states for nine consecutive 3-year average periods. Pennsylvania and Illinois have been in the bottom 15 states for eight of the last 3-year average periods. Large decreases in rates and rankings occurred for states such as Mississippi, in the top 10 states for seven consecutive 3-year averages until 2001 (the average of 1999, 2000 and 2001) but falling substantially since then to 20th for the latest 3-year average. Similarly Arkansas, in the top 10 states in the late 1990’s, has fallen sharply to 29th since the 2000 3-year average in the last several years. Michigan, which was rated 14th or 15th in the late 1990’s has sunk to 40th. Looked at another way, 10 of the bottom 15 states, as measured by the rate of discipline in 2003 alone, were also in the bottom 15 for 2003 using the new 3-year moving average (the average rates for 2001, 2002 and 2003).
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 consistently high performance.
Best States (those with the highest rates of serious disciplines).
The top 10 states are (in order): Kentucky (11.58 actions per 1,000 physicians), Wyoming (11.42 per 1,000 physicians), North Dakota (10.25 per 1,000 physicians), Arizona (8.21 per 1,000 physicians), Oklahoma (7.88 per 1,000 physicians), Vermont (7.34 per 1,000 physicians), Montana (7.18 per 1,000 physicians), Alaska (6.96 per 1,000 physicians), West Virginia (6.80 per 1,000 physicians), and Ohio (6.18 per 1,000 physicians).
As can be seen in Table 2, three of these 10 states (Wyoming, Oklahoma and Alaska) have been in the top ten for all nine of the three-year average periods listed. Ohio has been in the top 10 of these three-year average periods for seven of the last nine, Kentucky, North Dakota and West Virginia for six of the last nine, and Arizona for five of the last nine.
With the exception of Vermont, which has improved considerably over the past several years, all of the other nine top-10 states, as measured by the rate of serious disciplinary actions in 2003 alone, were also in the top ten as measured by the 2003 3-year average (2001, 2002 and 2003).
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:
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. Illinois and Pennsylvania, other large states, have consistently been near the bottom and California and New Jersey have hovered around the middle. Massachusetts, consistently in the bottom 15 states for the three-year averages until the 2001 three-year average, has improved substantially since then.
Given the importance of medical boards in protecting patients from doctors who are not practicing medicine in the best manner and are thus endangering the lives and health of residents, 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. Then action must be taken, legislatively and through pressure on the medical boards, to increase the amount of discipline and, thus, the amount of patient protection.
Table 2: Ranks Based on Average Doctor Disciplinary Rates Over Three Years*
*Each year, a disciplinary rate was calculated. For each year, a moving average rate was calculated by adding the rate in that year to the rate in the two preceding years and dividing by three. This rate was then ranked. The ranking in the column marked “2003” thus represents the ranking of that states average rate over the period 2001-2003.
**The District of Columbia did not provide data for 2000