John Paul Fawcett
Peter Lurie, M.D., M.P.H.
Sidney M. Wolfe, M.D.
State medical boards should be using the Internet to provide detailed, user-friendly information on disciplined physicians to consumers. Public Citizen’s Health Research Group conducted a study to describe the content and user-friendliness of Web sites for all 50 states and the District of Columbia. Only seven states received an “A” for content and 20 an “A” for user-friendliness, including six of the seven that received an “A” for content. However, 17 states received a “C” or lower for content and 23 did so for user-friendliness. There was a modest improvement between our previous survey in 2000 and the current survey.
Consumers use the Internet to fill their prescriptions, seek medical advice, and learn about medical research. Hospitals, health maintenance organizations, doctors, and pharmaceutical companies advertise on the Web. And the Internet presence of state medical boards – those entities charged with licensing and regulating medical doctors – is also on the rise.
The boards serve patients by ensuring that, in order to be licensed, physicians meet minimum standards of training and competence. They are also required to discipline physicians who commit offenses such as incompetence, negligence, sexual misconduct, and violations of criminal laws. In addition to an insufficient number of disciplinary actions against doctors, many boards have not assumed an active role in disseminating adequate information about these disciplinary actions to patients, preferring all-too-often to shield physicians from adverse publicity. For years, patients have had to call or write the boards to learn whether their physician has been disciplined and, if so, why, how, and when.
Given the Internet’s power to rapidly and inexpensively disseminate vast amounts of information to many people, it is logical that the boards provide disciplinary information on the web. If the data are sufficiently detailed, complete, and easily accessible, providing this information on the Internet would not only benefit patients, but also the boards, which would receive fewer time-consuming phone and mail queries from patients and might then be able to devote more time and resources to their vital enforcement duties.
In 2000, Public Citizen’s Health Research Group (HRG) conducted a survey of state medical board Web sites to determine the status of disciplinary action information on the Internet. Recently HRG re-surveyed the state medical boards. This report presents the findings of that survey.
We created a grading scale to assess the content of disciplinary information each Web site provides on medical doctors. Although some Web sites include information on osteopaths, chiropractors, podiatrists and other medical professionals, we only evaluated content regarding medical doctors. An adequate amount of information on a given disciplinary action was defined as: 1) the physician’s name; 2) the disciplinary action taken by the board; 3) the offense committed by the physician; 4) a concise summary narrative of the physician’s misconduct; and 5) the full text of the actual board order. States that provided all five types of data earned a content grade of “A”; states that provided four of the five types of data earned a “B”; states that provided three of the five types of information received a “C”; states that reported two of the five types of information received a “D”; and states that named disciplined physicians but provided no details about the disciplinary action received an “F.” States that reported no doctor-specific disciplinary information on their Web site earned an “X.” The content score was assigned for information presented anywhere on the Web site, even if it was not present for all years for which data were posted or if it was difficult to locate.
We considered searchable databases, alphabetical listings of all physicians with a notation of who has been disciplined, and alphabetical listings of all disciplined physicians to be equally user-friendly. The scores were assigned as follows:
A: Content of searchable or listed disciplinary information is greater than or equal to information elsewhere on the Web site and the Web site provides one of the following: 1) a name-searchable database, 2) a single listing of all physicians, 3) a single listing of all disciplined physicians.
B: Content of searchable or listed disciplinary information is less than information elsewhere on the Web site, but is more than just the name of the disciplined physician and the Web site provides one of the three user-friendly formats listed in A.
C: Content of searchable or listed disciplinary information consists of the name of the physician only and the Web site provides one of the three user-friendly formats listed in A.
F: Disciplinary information is provided in reports, newsletters, or press releases, but not in a searchable database or list.
X: The Web site provides no disciplinary information.
Some board Web sites provide disciplinary information in more than one format. For example, a site might have both a searchable database of physician data and newsletters that report board actions. With such sites, it was often the case that the different formats provided different types of information. User-friendliness scores of “A”, “B”, and “C” were assigned according to information in the name-searchable database, not that provided in newsletters, reports, or press releases.
On April 3, 2002, we examined the Web sites of all 50 states and the District of Columbia to assess their content and user-friendliness scores. In addition, we determined whether other information was present, including the date of a disciplinary action and the address, telephone number, license number, license issue date, license expiration date, and specialty of the physician.
We also determined whether at least 10 years of data were present on the Web site. We attempted to abstract this information from the Web sites themselves. If unsuccessful, we contacted the state medical boards by email, then by fax or phone. For the remaining five boards, we searched their Web site databases for the names of doctors we knew from our prior work to have been disciplined in 1992.
We created a database in Microsoft Access 97 to record the data. Statistical analyses were conducted using Stata Version 6.0. The relationships between the boards’ 2001 rates of serious disciplinary actions, determined in an April 2002 HRG study, and their Web site content and user-friendliness grades were examined using the Kruskal-Wallis test. Each board was assigned to one of four geographic regions, based on classifications used by the U.S. Bureau of the Census, and the relationships between region and content and user-friendliness scores were examined using chi-square analyses. For the analyses comparing the content and user-friendliness grades and the analyses of these grades over time, we assigned zero points to an “X”, one point to an “F” and then one additional point as the letter grade increased. We then used Kendall’s Tau and the chi-square test to test whether there were correlations between 2002 content and user-friendliness grades and between both grades in 2000 and 2002. For all analyses, a p-value of 0.05 (2-sided) was considered statistically significant.
All 51 boards regulating medical doctors now have Web sites. Of these, 49 have Web sites providing doctor-specific disciplinary information (that is, the disciplined physicians are named). Although most of these boards have their own sites, a few states provide the data on the site of another regulatory body, such as the Department of Health. The remaining two states (South Dakota and Montana) have Web sites, but provide no disciplinary information. These two sites provide very basic information like board addresses, phone and fax numbers, and the roles and duties of the boards.
Only seven of the 51 boards (14%) earned an “A” for content. Twenty-seven (53%) received a “B”; four (8%) received a “C”; nine (18%) earned a “D”; two (4%) earned an “F”; and the two states (4%) that provided no doctor-specific disciplinary information on their Web sites received an “X” for content (see Table 1 and Appendix).
Table 1: Web Site Content Grades by State, 2002
|Content Grade||Number of States||Percentage of States||States|
|A||7||14%||Arizona, Maryland, North Carolina, New York, Ohio, South Carolina and Virginia|
|B||27||53%||Alaska, California, Colorado, District of Columbia, Florida, Iowa, Idaho, Illinois, Indiana, Kentucky, Massachusetts, Maine, Minnesota, Missouri, New Hampshire, New Jersey, New Mexico, Nevada, Pennsylvania, Tennessee, Texas, Utah, Vermont, Washington, Wisconsin, West Virginia and Wyoming|
|C||4||8%||Connecticut, Delaware, Michigan, and Oklahoma|
|D||9||18%||Alabama, Arkansas, Georgia, Hawaii, Kansas, Mississippi, Nebraska, Oregon and Rhode Island|
|F||2||4%||Louisiana and North Dakota.|
|X||2||4%||Montana and South Dakota|
The formats in which data are presented vary substantially among the states. Of the 51 boards, 20 (39%) received a user-friendliness score of “A,” eight (16%) received a “B,” 17 (33%) received a “C,” four (8%) received an “F” and two (4%) received an “X” (see Table 2 and Appendix). Of the 45 Web sites receiving an “A,” “B” or “C,” 42 Web sites feature a database from which physician disciplinary information can be retrieved by entering a doctor’s name in a search engine; six sites post data in a single listing of disciplined physicians; and four sites offer both formats. One Web site offers both a searchable database and a list of all physicians with an indication of who had been disciplined.
Table 2: Web Site User-friendliness Grades by State, 2002
|User-Friendliness Grade||Number of States||Percentage of States||States|
|A||20||39%||Arkansas, Arizona, Delaware, Hawaii, Idaho, Illinois, Kentucky, Maryland, Maine, Michigan, North Carolina, Nebraska, New Hampshire, New York, Ohio, Rhode Island, Tennessee, Virginia, Wisconsin and Wyoming|
|B||8||16%||California, Colorado, Connecticut, Florida, Iowa, Kansas, Massachusetts and Oklahoma|
|C||17||33%||Alaska, Alabama, Georgia, Indiana, Louisiana, Minnesota, Missouri, Mississippi, North Dakota, New Jersey, New Mexico, Oregon, Pennsylvania, South Carolina, Texas, Utah and Vermont|
|F||4||8%||District of Columbia, Nevada, Washington and West Virginia|
|X||2||4%||Montana and South Dakota|
More boards received an “A” for user-friendliness than for content (20 vs. 7). Six states (Arizona, Maryland, North Carolina, New York, Ohio and Virginia) received an “A” in both categories. Of the 34 states receiving content grades of “B” or higher, 19 (56%) received a “B” or higher on the user-friendliness scale. Although there is a positive correlation between content and user-friendliness grades, this did not reach statistical significance (p= 0.09; Kendall’s Tau).
Some board Web sites present additional information on physicians and the disciplinary actions against them (see Appendix for a detailed breakdown by state). Sixteen boards report the physician’s date of birth, 35 provide an address (business, home or unspecified), and 10 include a telephone number. Forty-seven boards provide the physician’s license number. Thirty-seven report the license issue date and 38 report the license expiration date. Twenty-eight boards report a doctor’s specialty. Forty-four boards provide the date that the disciplinary action was taken. Thirty-nine boards provide at least 10 years of disciplinary information.
Neither the content score nor the user-friendliness score was associated with the state’s disciplinary rate (p=0.58 and p=0.79; Kruskal-Wallis). When the grades were cross-tabulated against the states’ geographic regions, no statistically significant results were found for either the content grade (p=0.84; chi-square) or the user-friendliness grade (p=0.93; chi-square).
The 2000 and 2002 content grades were strongly associated (p<0.0001; Kendall’s Tau), as were the 2000 and 2002 user-friendliness grades (p=0.004; chi-square). All states now have Web sites compared to 44 in 2000 and 49 provide doctor-specific disciplinary information compared to 41 in 2000. For the content grade, 28 of the 51 states (53%) had the same grade in 2000 and 2002, 15 (29%) improved their grades by one unit and nine (18%) improved their grades by two or more units. For the user-friendliness grade, 17 states (33%) not considered user-friendly in 2000 were considered user-friendly in 2002. No state’s grade declined on either measure between 2000 and 2002.
All 51 state medical boards now have Web sites and 49 of them provide some doctor-specific disciplinary information on the Internet. However, 45 state medical boards continue to provide disciplinary information whose content or user-friendliness is inadequate compared to the six states that received an “A” in both categories. In two cases, such information was entirely absent.
Unless a board Web site provides adequate information about actions, patients will be unable to use the site to make an informed choice in selecting a physician. For these patients, contacting the board by phone or mail will still be necessary. This represents a lost opportunity for the board to enhance consumer access to doctor disciplinary data and reduce its own workload.
Disappointingly, only seven states (Arizona, Maryland, North Carolina, New York, Ohio, South Carolina and Virginia) earned an “A” for the content of information featured on their Web sites. Six of these states (all but South Carolina) also earned an “A” for user-friendliness. There was modest improvement in both content and user-friendliness scores between 2000 and 2002.
Some boards report other important information that is of interest to patients. For example, the California, Florida, Idaho, Massachusetts, and Tennessee boards provide data on malpractice claims. The California, Florida, Idaho, and Massachusetts sites also report disciplinary actions taken by hospitals against physicians. We believe that all states should include such data, but did not include it as part of our grading scheme.
Finally, there is no relationship between the content of medical boards’ Web sites and their rates of serious disciplinary actions. A relatively high rate of discipline hardly excuses a state from getting disciplinary information out in a complete and user-friendly manner. Conversely, having a complete, user-friendly Web site is no substitute for a higher rate of discipline. Both are needed.
HRG recommends that all state medical boards adopt high uniform standards for the content and user-friendliness of disciplinary information on the Internet
1. Each board should have a Web site that links to a database of physician information. For each physician disciplined by the board, the information should include the action taken by the board, the offense committed by the physician, and a summary narrative of the physician’s misconduct. The database should also feature links for each physician to the full text of board orders for that physician and other public documents related to the physician.
2. Patients should be able to retrieve all data concerning a specific physician by entering a physician’s name and/or license number in a search engine or by perusing an alphabetical list.
3. This information should be provided for all disciplinary actions taken in the last 10 years.
4. Disciplinary action information should be updated as frequently as the boards meet to consider actions (usually once a month).
5. Public access to disciplinary data should be preserved even when a physician’s license is suspended, revoked or expired.
6. If a court overrules or vacates a board action and exonerates the physician and the court decision is final, information on that action should be removed from the database. While an appeal is pending, or while a remanded action is being considered, information on the action and the court’s decision should continue to be reported in the database.
7. Any changes in a physician’s record resulting from a court decision should be made within two weeks of the court ruling.
 Wolfe, Sidney M.; McCarthy, Phyllis; Bame, Alana; Adler, Benita Marcus. 20,125 Questionable Doctors Disciplined by State and Federal Governments. Public Citizen’s Health Research Group, Washington, DC, 2000.
 Wolfe, Sidney M. Public Citizen’s Health Research Group Ranking of State Medical Boards’ Serious Disciplinary Actions in 2001. Public Citizen, Washington, DC, April 2002. https://www.citizen.org/hrg1616
 State Population Estimates and Demographic Components of Population Change: July 1, 1998 to July 1, 1999. (ST-99-1) Population Estimates Program, Population Division, U.S. Bureau of the Census, Washington, DC; December 29, 1999.
 For the user-friendliness analysis, the 2002 grades were converted into user- friendliness (grades “A,” “B” and “C”) and not user-friendliness (grades “F” and “X”) because these data were collected in only two categories in 2000. Thus, the analysis for the user-friendliness grades was conducted using chi-square, not Kendall’s Tau.