March 27, 2003

Ranking of State Medical Boards’ Serious Disciplinary Actions in 2002

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 disciplinary actions

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 disciplinary actions

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.  

Table 1. Ranking of Serious Doctor Disciplinary Actions By State Medical Licensing Boards – 2002

Rank 2002	State	Number of Serious  Actions, 2002	Total Number of Physicians,  2000	Serious Actions Per 1,000 Doctors
1	Wyoming	12	1,011	11.87
2	North Dakota	14	1,599	8.76
3	Alaska	11	1,283	8.57
4	Kentucky	72	9,500	7.58
5	Oklahoma	48	6,353	7.56
6	Arizona	88	11,791	7.46
7	Ohio	247	33,138	7.45
8	Colorado	89	12,029	7.40
9	Montana	15	2,205	6.80
10	Utah	31	5,056	6.13
11	New Mexico	23	4,327	5.32
12	Alabama	52	9,954	5.22
13	West Virginia	22	4,296	5.12
14	Idaho	12	2,412	4.98
15	Iowa	33	6,784	4.86
16	Oregon	44	9,473	4.64
17	Georgia	84	18,995	4.42
18	Louisiana	50	12,068	4.14
19	Mississippi	22	5,346	4.12
20	New York	322	80,134	4.02
21	Massachusetts	107	28,851	3.71
22	Maine	13	3,528	3.68
23	New Jersey	109	29,757	3.66
24	California	329	95,038	3.46
25	Texas	163	47,994	3.40
26	District of Columbia	14	4,134	3.39
27	Nebraska	14	4,290	3.26
28	Virginia	64	19,673	3.25
29	Illinois	120	37,138	3.23
30/31	Indiana	44	13,929	3.16
30/31	New Hampshire	11	3,480	3.16
32	Vermont	7	2,280	3.07
33	Arkansas	17	5,738	2.96
34	Missouri	40	15,572	2.57
35	Rhode Island	10	3,919	2.55
36	Kansas	17	6,847	2.48
37	Michigan	60	24,901	2.41
38	Connecticut	32	13,312	2.40
39	South Dakota	4	1,672	2.39
40	Nevada	9	3,893	2.31
41	Washington	36	16,154	2.23
42	Minnesota	30	14,218	2.11
43	Pennsylvania	82	39,052	2.10
44	Florida	93	44,747	2.08
45	North Carolina	43	20,851	2.06
46	Maryland	39	21,883	1.78
47	South Carolina	17	9,607	1.77
48	Tennessee	22	14,954	1.47
49	Wisconsin	20	14,241	1.40
50	Delaware	3	2,219	1.35
51	Hawaii	4	3,746	1.07
	United States	2,864	805,372	3.56

Table 2: Ranking for the Last Ten Years

Rank 2002	Rank 2001	Rank 2000	Rank 1999	Rank 1998	Rank 1997	Rank 1996	Rank 1995	Rank 1994	Rank 1993	State
1	38/39	4	3	7	3	31	3	1	21	Wyoming
2	6	1	2	11	9	2	34	10	3	North Dakota
3	3	2	1	1	2	6	8	2	8	Alaska
4	5	3	6	14	7/8	14	14	4	4	Kentucky
5	2	5	5	2	5	7	12	5	2	Oklahoma
6	1	7	21	38	19/20	5	10	17	16	Arizona
7	8	8	7	10	7/8	8	9	24	22/23	Ohio
8	17	31	10	18	6	4	5	12	6	Colorado
9	19	42	32	34	11	13	18	3	14	Montana
10	9	6	33	20	25/26	16	38	46	39	Utah
11	30/31/32	41	27	8	50	23	15	43/44	49	New Mexico
12	12	12	13	17	23/24	38	30	43/44	29	Alabama
13	11	36	17	5	12	11	7	6	1	West Virginia
14	7	50	4	25	30	21	36	30	37/38	Idaho
15	4	11	11	23	4	3	2	7	5	Iowa
16	15	17	30	31	28/29	29	16	20	22/23	Oregon
17	10	9	15	12	23/24	19	4	8	10	Georgia
18	24	20	23	15	34/35	44	13	18	11	Louisana
19	13	13	8	3	1	1	1	9	9	Mississippi
20	14	10	14	16	16	18	17	29	34	New York
21	27/28	45	39	47	45	43	40	37	45	Massachusetts
22	38/39	22	24	9	22	17	32	33	41	Maine
23	23	26	28	35	42	20	25	19	18	New Jersey
24	25	19	20	27	18	27	20	34/35	32	California
25	30/31/32	38	34	28/29	37	35	19	23	28	Texas
26	51		41	33	44	36	50	51	51	District of Columbia
27	34	39	50	28/29	43	24	41/42	15	50	Nebraska
28	22	18	22	40	34/35	50	41/42	32	30	Virginia
29	45	44	43	41	21	46	45	40	31	Illinois
30/31	41	24	16	21	19/20	33	28	16	7	Indiana
30/31	21	23	18	30	46	51	49	49	47	New Hampshire
32	35	16	9	6	25/26	10	6	39	17	Vermont
33	16	15	12	4	13	15	23	28	26	Arkansas
34	27/28	25	31	48	17	30	37	13	12	Missouri
35	42	33	35	24	10	25	26	26	42	Rhode Island
36	20	37	45	44	41	12	46	22	37/38	Kansas
37	29	14	19	13	15	28	21	34/35	35	Michigan
38	40	28	46	32	31	37	27	42	36	Connecticut
39	48	49	44	19	14	42	33	11	13	South Dakota
40	18	21	25	26	32	9	11	31	20	Nevada
41	37	43	37	36/37	28/29	40	24	27	24	Washington
42	44	46	48	42	51	47	39	45	33	Minnesota
43	36	29	36	45	27	32	43	47	48	Pennsylvania
44	26	34	38	49	36	22	22	25	25	Florida
45	30/31/32	32	26	43	33	48/49	35	36	40	North Carolina
46	43	40	40	36/37	38	41	29	21	19	Maryland
47	47	27	29	22	40	45	44	14	15	South Carolina
48	33	35	49	51	48	48/49	31	38	44	Tennessee
49	46	30	42	46	39	34	47	41	27	Wisconsin
50	49	47	51	50	47	26	48	48	43	Delaware
51	50	48	47	39	49	39	51	50	46	Hawaii