Ranking of State Medical Boards’ Serious Disciplinary Actions in 2000

Based on data we obtained today (April 6, 2001) from the Federation of State Medical Boards (FSMB) on the number of disciplinary actions taken in 2000 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 number of serious disciplinary actions taken against doctors in the year 2000 (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.Ds as of December 1999 (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 1000 physicians.

Nationally, there were 2,746 serious disciplinary actions taken by state medical boards in 2000, up slightly from the 2,696 serious actions taken in 1999. However, there were more physicians practicing in 2000 and the rate, per 1000 physicians, was essentially the same in the two years: 3.50 serious actions per 1000 physicians in 1999 and 3.49 in 2000.

State rates ranged from 12.43 serious actions per 1,000 doctors (North Dakota) to 0.85 per 1,000 physicians (Idaho), a 14.6-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 lowest rate for #5, Oklahoma being 6.68 serious disciplinary actions per 1,000 physicians or 0.668 percent, this would amount to a total of 5,255 (0.668 percent of 786,685 non-federal doctors) serious actions a year. This is 1.9 times as many (2,509 more serious actions) than the 2,746 that actually occurred in 2000.

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 2000, were, starting with the lowest: Idaho (0.85 per 1,000 physicians), South Dakota (1.24), Hawaii (1.33), Delaware (1.39), Minnesota (1.53), Massachusetts (1.58), Illinois (1.67), Washington (1.78), Montana (1.91), New Mexico (2.13), Maryland (2.21), Nebraska (2.39), Texas (2.42), Kansas (2.53), and West Virginia (2.54). Of the 15 states with the worst serious disciplinary records, eight of the states, Massachusetts, Illinois, Maryland, Washington, Minnesota, Kansas, Hawaii, and Delaware were also in the bottom 15 states in 1999 and 1998 (see Table 2). In 2000, the bottom 24 states all had rates of serious disciplinary action that were one-half or less than the rate of all of the top five states.

These data 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 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): North Dakota (12.43 per 1,000 physicians), Alaska (11.47), Kentucky (8.51), Wyoming (8.10), Oklahoma (6.68), Utah (6.27), Arizona (6.18), Ohio (5.89), Georgia (5.35), and New York (5.08). Four of these 10 states (Alaska, Oklahoma, Wyoming, and Ohio) were also in the top 10 in 1998 and 1999 and one state, Alaska, has been in the top 10 for ten straight years. Oklahoma, 5th this year, has been in the top 10 states for nine of the last ten years. Wyoming, 4th this year, has been in the top 10 for eight of the last ten years and Ohio, 8th this year, have been in the top ten for six of the last ten years. (See Table 2)

It is clear that state-by-state performance is spotty. Only two of the nation’s 15 largest states, Ohio, and New York, are represented among those 10 states with the highest disciplinary rates. Other large states such as, Michigan and California (14th and 19th respectively in 2000) have shown improvement from 40th and 37th in 1991. But other large states such as Texas, Illinois, and Massachusetts (38th, 44th, and 45th in 2000) have not done very much doctor discipline for many of the last 10 years.

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:

  • Adequate funding (all money from license fees going to fund board activities instead of going into the state treasury for general purposes)
  • Adequate staffing
  • Proactive investigations rather than only following complaints
  • The use of all available/reliable data from other sources such as Medicare and Medicaid sanctions, hospital sanctions
  • Excellent leadership
  • Independence from state medical societies and other parts of the state government
  • A reasonable statutory framework for disciplining doctors (preponderance of the evidence rather than beyond reasonable doubt or clear and convincing evidence).

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.

Table 1. Ranking of Serious Doctor Disciplinary Actions By State Medical Licensing Boards–2000

Rank
2000
State Number of Serious Actions 2000

Total Number of
Physicians 1999

Serious Actions Per
1,000 Doctors

1

North Dakota

20

1,609

12.43

2

Alaska

14

1,221

11.47

3

Kentucky

80

9,401

8.51

4

Wyoming

8

988

8.10

5

Oklahoma

42

6,285

6.68

6

Utah

30

4,787

6.27

7

Arizona

71

11,487

6.18

8

Ohio

193

32,751

5.89

9

Georgia

99

18,497

5.35

10

New York

404

79,601

5.08

11

Iowa

33

6,693

4.93

12

Alabama

46

9,765

4.71

13

Mississippi

23

5,191

4.43

14

Michigan

102

24,551

4.15

15

Arkansas

21

5,638

3.72

16

Vermont

8

2,148

3.72

17

Oregon

34

9,234

3.68

18

Virginia

69

18,922

3.65

19

California

337

92,985

3.62

20

Louisiana

43

11,897

3.61

21

Nevada

13

3,611

3.60

22

Maine

12

3,356

3.58

23

New Hampshire

12

3,388

3.54

24

Indiana

47

13,647

3.44

25

Missouri

53

15,470

3.43

26

New Jersey

100

29,208

3.42

27

South Carolina

27

9,315

2.90

28

Connecticut

37

13,237

2.80

29

Pennsylvania

106

38,524

2.75

30

Wisconsin

37

13,933

2.66

31

Colorado

31

11,814

2.62

32

North Carolina

53

20,344

2.61

33

Rhode Island

10

3,854

2.59

34

Florida

113

43,835

2.58

35

Tennessee

38

14,774

2.57

36

West Virginia

11

4,323

2.54

37

Kansas

17

6,724

2.53

38

Texas

114

47,108

2.42

39

Nebraska

10

4,181

2.39

40

Maryland

48

21,715

2.21

41

New Mexico

9

4,231

2.13

42

Montana

4

2,094

1.91

43

Washington

28

15,688

1.78

44

Illinois

61

36,618

1.67

45

Massachusetts

45

28,456

1.58

46

Minnesota

21

13,713

1.53

47

Delaware

3

2,160

1.39

48

Hawaii

5

3,747

1.33

49

South Dakota

2

1,612

1.24

50

Idaho

2

2,354

0.85

United States

2,746

786,685

3.49

Table 2. Ranking for Last 10 Years

Rank 2000

Rank 1999

Rank 1998 

Rank 1997 

Rank 1996 

Rank 1995 

Rank 1994 

Rank 1993 

Rank 1992 

Rank 1991 

State

1

2

11

9

2

34

10

3

5

13

North Dakota
2 1 1 2 6 8 2 8 7 6 Alaska
3 6 14 7/8 14 14 4 4 16 5 Kentucky
4 3 7 3 31 3 1 21 4 9 Wyoming
5 5 2 5 7 12 5 2 1 2 Oklahoma
6 33 20 25/26 16 38 46 39 43 18 Utah
7 21 38 19/20 5 10 17 16 22 22 Arizona
8 7 10 7/8 8 9 24 22/23 19 23 Ohio
9 15 12 23/24 19 4 8 10 9 4 Georgia
10 14 16 16 18 17 29 34 39 49 New York
11 11 23 4 3 2 7 5 2 3 Iowa
12 13 17 23/24 38 30 43/44 29 30 31 Alabama
13 8 3 1 1 1 9 9 6 6 Mississippi
14 19 13 15 28 21 34/35 35 40 40 Michigan
15 12 4 13 15 23 28 26 18 29 Arkansas
16 9 6 25/26 10 6 39 17 15 10 Vermont
17 30 31 28/29 29 16 20 22/23 24 14 Oregon
18 22 40 34/35 50 41/42 32 30 37 32 Virginia
19 20 27 18 27 20 34/35 32 42 37 California
20 23 15 34/35 44 13 18 11 12 7 Louisiana
21 25 26 32 9 11 31 20 25 26 Nevada
22 24 9 22 17 32 33 41 44 46 Maine
23 18 30 46 51 49 49 47 47 44 New Hampshire
24 16 21 19/20 33 28 16 7 14 15 Indiana
25 31 48 17 30 37 13 12 13 12 Missouri
26 28 35 42 20 25 19 18 28 20 New Jersey
27 29 22 40 45 44 14 15 11 11 South Carolina
28 46 32 31 37 27 42 36 35 30 Connecticut
29 36 45 27 32 43 47 48 48 47 Pennsylvania
30 42 46 39 34 47 41 27 26 34/35 Wisconsin
31 10 18 6 4 5 12 6 8 17 Colorado
32 26 43 33 48/49 35 36 40 34 42/43 North Carolina
33 35 24 10 25 26 26 42 41 50/51 Rhode Island
34 38 49 36 22 22 25 25 21 27 Florida
35 49 51 48 48/49 31 38 44 49 38 Tennessee
36 17 5 12 11 7 6 1 3 8 West Virginia
37 45 44 41 12 46 22 37/38 20 25 Kansas
38 34 28/29 37 35 19 23 28 29 21 Texas
39 50 28/29 43 24 41/42 15 50 38 39 Nebraska
40 40 36/37 38 41 29 21 19 27 42/43 Maryland
41 27 8 50 23 15 43/44 49 33 33 New Mexico
42 32 34 11 13 18 3 14 10 19 Montana
43 37 36/37 28/29 40 24 27 24 17 24 Washington
44 43 41 21 46 45 40 31 36 36 Illinois
45 39 47 45 43 40 37 45 46 48 Massachusetts
46 48 42 51 47 39 45 33 31 28 Minnesota
47 51 50 47 26 48 48 43 51 16 Delaware
48 47 39 49 39 51 50 46 50 41 Hawaii
49 44 19 14 42 33 11 13 32 50/51 South Dakota
50 4 25 30 21 36 30 37/38 23 34/35 Idaho
41 33 44 36 50 51 51 45 45 District of Columbia