State Medical Boards’ Inconsistent, Lax Enforcement Against Doctor Misconduct Endangers Patients
WASHINGTON D.C. – State medical boards across the U.S. continue to fall short in disciplining physicians responsible for negligent medical care, according to a Public Citizen report released today. The number of serious actions taken by medical-licensing boards has decreased by about 4% from 2023-2025 compared to 2019-2021. In addition, the likelihood that any medical license will have a serious disciplinary action taken against it has decreased by over 16%.
Public Citizen found wide variation in serious disciplinary actions taken per 1,000 physicians among licensing boards of the 50 states and the District of Columbia during the 2023-2025 study period. Alaska, which licensed about 6,500 physicians in 2024, had the highest annual rate of serious disciplinary actions, with an average of 1.76 serious disciplinary actions per 1,000 physician licensees per year. Indiana, which licensed about 36,200 physicians in 2024, had the lowest rate, with only 0.28 serious disciplinary actions per 1,000 physicians per year.
Other states with higher rates of doctor discipline in the latest rankings included Ohio, Alabama, Kentucky, and North Dakota. In addition to Indiana, medical boards with the lowest rates of doctor discipline include Georgia, Rhode Island, Idaho, Pennsylvania, New Mexico, and the District of Columbia.
The observed patterns in the rates of disciplinary action cannot be explained by differences in the competence or conduct of physicians across the states. Nor is there any evidence that the rates of serious disciplinary actions taken by highly-ranked states are sufficient to protect patients from dangerous doctors.
“The findings suggest that many licensing boards are inadequately enforcing their states’ medical practice acts,” said Robert Oshel, Ph.D., an advisor to Public Citizen’s Health Research Group and lead author of the report. “Physicians who endanger patients through negligence and malpractice should be held accountable, no matter which states they are licensed in.”
“Patients deserve a higher standard of performance by state medical licensing boards,” said Robert Steinbrook, M.D., Health Research Group director for Public Citizen and an author of the report. “The public must be protected from physicians who are unable or unwilling to care for patients properly.”
Public Citizen’s experts have long advocated for medical board reforms such as appointing nonconflicted board members, improved funding and staffing, ensuring independence from state medical societies, increasing the use of the National Practitioner Data Bank (NPDB) by medical boards and improving reporting of disciplinary actions.
The report also calls for federal legislation requiring state medical boards to use the data in the NPDB when licensing all physicians and renewing their licenses and opening the physician-specific data in the NPDB to the public. Oshel, a report author, is a former NPDB research director.
The “Ranking of the Rate of State Medical Boards’ Serious Disciplinary Actions, 2023-2025” report calculates the rate of serious disciplinary actions taken against physicians between 2023-2025, a calculation that accounts for both the number of actions and the number of doctors in a state. Serious disciplinary actions were defined as those that had a clear impact on a physician’s ability to practice. Boards from the 50 states and the District of Columbia took 1,378 serious disciplinary actions in 2023, 1,406 in 2024, and 1,447 in 2025. The overall annual rate of serious disciplinary actions per 1,000 licenses for 2023-2025 was 0.84.