Health Letter, January 2020
By Azza AbuDagga, M.H.A., Ph.D.
Image: Elvira Koneva/Shutterstock.com
There are 70 state medical boards in the U.S. and its territories. These boards are government entities that are intended to act as gatekeepers of the medical profession. The mission of each state medical board is to protect the health, safety and welfare of the public from all incompetent, unprofessional and improperly trained physicians through the proper licensing, disciplining and regulating of physicians.
State medical boards rely on complaints from the public (including patients and their families) and medical professionals as well as information from other sources (including courts, health insurance companies, hospitals, professional societies and malpractice insurers) to identify, investigate and discipline dangerous physicians. Medical boards also disclose some information on their websites about their licensed physicians, including whether adverse licensing actions have been taken against the particular physicians that they have licensed. Therefore, public awareness of state medical boards is critical for the success of medical boards in achieving their mission.
A recent national online survey showed substantial gaps in public knowledge of the role of state medical boards and how to report to them, even though a sizable proportion of the survey respondents reported that they have been subjected to physician misconduct.
The survey was conducted in October 2018 by The Harris Poll, a public opinion tracking company, and was commissioned by the Federation of State Medical Boards (FSMB), an organization that represents state medical boards in the U.S. The FSMB released the results of this survey on May 30, 2019.
Overall awareness of state medical boards
Of the 2,018 adult Americans (aged 18 or older) who participated in the survey, only 49% knew that state medical boards are responsible for the licensing and regulating of physicians in the U.S. Additionally, 36% of the survey respondents incorrectly thought that other organizations (such as the American Medical Association [AMA] or state medical associations/societies) have these responsibilities, and 16% were “not at all sure” of who has them. Older respondents (aged 65 or older), as compared with younger ones, more commonly knew that state medical boards have these responsibilities.
Perhaps because of the lack of public knowledge about the role of state medical boards, only 31% of the respondents correctly understood that state medical boards should be the first authorities to contact if they had a complaint about the competence or conduct of a physician. Fifty-three percent of the respondents thought other entities (including the AMA, a lawyer, health insurance company or the physician’s office/hospital/group) should be contacted first, and the remaining 16% were “not at all sure” whom to contact first. More older respondents than younger ones knew that state medical boards should be contacted first regarding complaints against physicians.
Only 27% of the respondents knew how to find out if a physician has ever received a disciplinary action against their medical license, indicating that most Americans do not look up their physicians on state medical board websites.
Experiences of physician misconduct
The survey showed that 409 (20%) of the respondents reported being subjected to physician misconduct (defined as experiencing an interaction with a physician who they believed was acting unethically or unprofessionally or providing substandard care). More women than men (24% versus 12%, respectively) and more adults aged 18 to 34 than adults aged 65 or older (22% versus 12%, respectively) reported being subjected to physician misconduct. The survey also found that respondents living in the Midwest and South were nearly twice as likely to cite experiencing physician misconduct than those living in the Northwest.
Of the 409 respondents who reported being subjected to physician misconduct, only 33% indicated that they filed a complaint against or reported the physician to any organization (including a state medical board). Notably, a higher proportion of men (41%) than women (30%) indicated that they had reported their physician misconduct experiences, even though more women have experienced these types of interactions.
The survey findings regarding considerable underreporting of physician misconduct and lack of knowledge among most Americans about the role of state medical boards support the long-held beliefs among consumer advocates about the need for better public outreach by state medical boards. These results also show that it is imperative for the FSMB and each of its state medical board members to communicate to the public their specific action plans for remedying these problems in order to protect the public from physicians with a history of misconduct.
To its credit, the FSMB four years ago launched DocInfo — a database search tool that contains licensure and disciplinary action information that the organization compiles from state medical boards regarding U.S. physicians. However, the disciplinary information available in this database, as well as the data available from many state medical boards, tend to be limited to final board orders. These orders tend to be legal documents that do not include a plain English summary of board actions. They also tend to bury the reasons for physician discipline in complicated legal language.
Additionally, DocInfo excludes key information that the FSMB and state medical boards have, including clinical-privileges sanctions taken by hospitals and other health care organizations against physicians, criminal convictions against physicians and malpractice payments made on behalf of physicians. State medical board websites may include some of that information, such as clinical-privileges actions, but not all of it. It is critical for all available information about physicians to be publicly disclosed because it can be helpful to alert consumers about potentially dangerous physicians.
It is time for each state medical board to launch an awareness campaign to educate the public, especially younger adults, about its role in receiving and investigating complaints about dangerous and potentially dangerous physicians. It is also critical for each board to “create a safe environment for reporting, so patients feel comfortable coming forward to boards,” as acknowledged by FSMB President and Chief Executive Officer, Dr. Humayun Chaudhry.
Unless state medical boards take action to implement these steps, the status quo will continue and consumers will be kept in the dark about many dangerous physicians who have harmed patients.