Ranking of State Medical Boards' Serious Disciplinary Actions in 2001

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April 9, 2002  

Sidney M. Wolfe, M.D.

Based on data we obtained today from the Federation of State Medical Boards (FSMB) on the number of disciplinary actions taken in 2001 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 1000 doctors in the year 2001 (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 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 2,708 serious disciplinary actions taken by state medical boards in 2001, down slightly from the 2,746 serious actions taken in 2000. Since there were also more physicians practicing in 2000, the rate per 1,000 physicians decreased from 3.49 in 2000 to 3.36 in 2001. 

State rates ranged from 10.52 serious actions per 1,000 doctors (Arizona) to 0.73 actions per 1,000 physicians (District of Columbia), a 14.4-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, Kentucky being 6.32 serious disciplinary actions per 1,000 physicians or 0.632 percent, this would amount to a total of 5,089 (0.632 percent of 805,372 non-federal doctors) serious actions a year. This is 2,381 more serious actions than the 2,708 that actually occurred in 2001. 

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 2001, were, starting with the lowest: the District of Columbia (0.73 per 1,000 physicians), Hawaii (.80), Delaware (.90), South Dakota (1.20) South Carolina (1.35), Wisconsin (1.69),  Illinois (1.70), Minnesota (1.76), Maryland (1.78), Rhode Island (1.79), Indiana (1.94), Connecticut (1.95), Maine and Wyoming (both 1.98), and Washington (2.17). Of the 15 states with the worst serious disciplinary records, seven - Maryland, Hawaii, Delaware, South Dakota, Illinois, Minnesota, and Washington were also in the bottom 15 states in 2000 and 1999 (see table 2). In 2001, the bottom 27 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 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 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): Arizona (10.52 per 1,000 physicians), Oklahoma (8.66), Alaska (8.57), Iowa (6.49), Kentucky (6.32), North Dakota (6.25), Idaho (6.22), Ohio (6.07), Utah (5.54), and Georgia (5.00). Five of these 10 states (Oklahoma, Alaska, Kentucky, North Dakota and Ohio) were also in the top 10 in 2000 and 1999 and one state, Alaska, has been in the top 10 for more than ten straight years. Oklahoma, 2nd this year, has been in the top 10 states for nine of the last ten years. North Dakota, 6th this year has been in the top 10 states for eight of the last ten years. Iowa and Ohio, 4th   and 8th respectively this year have been in the top 10 for seven of the last ten years and Kentucky and Georgia, 5th and 10th this year have been in the top 10 for six of the last ten 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 (14th, 25th and  29th respectively in 2001) have gone down from their previous rankings of  10th, 19th and 14th in 2000. But other large states such as Massachusetts ,Texas, and Illinois, have fairly consistently been in the bottom half of the states for at least the past four or five years, although Massachusetts improved from 45tth in 2000 to 27th/28th in 2001.

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

- 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).

- 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 -- 2001
TABLE 2: Ranking for the Last Ten Years