Keeping state medical boards alive

The Times article “California disciplined fewer doctors in 2007” relies on data from the consumer advocacy group Public Citizen. Each year, such groups issue reports ranking medical boards by the number of “serious” disciplinary actions they’ve taken in the preceding year (such as license revocations, surrenders, suspensions and probations). Their goal is to affect change by drawing public scrutiny to medical boards they believe are performing poorly. While well-meaning, like many independent ranking reports, the methodology used by these groups can be less than scientific and even misleading. By limiting their reports to “serious” actions, these ranking reports miss the much larger picture of how medical boards protect the public.

Few relationships are more important than the one between a physician and a patient. We depend on our physicians to treat us, heal us and help keep us in good health. We put our lives in their hands. That’s why it’s so important that we are confident our physicians are well-qualified, well-trained and well-performing. If a physician is performing in an incompetent or unethical way, patients need to be protected from that physician.

This is where state medical boards come in. Each is charged with protecting patients by ensuring that laws governing medical practice are being followed. The overwhelming majority of physicians perform their duties with the utmost care and competence. Unfortunately, there are times when physicians perform poorly or in an unlawful manner. In those cases, it is the job of state medical boards to appropriately discipline offenders.

Medical boards sanction physicians in many ways. Lower levels of discipline, such as a public letter of reprimand or a fine, are often enough to stop problem behavior and preempt problems in the future. Or a board may order a physician to obtain needed training in a particular area of practice, limiting him from practicing a certain procedure until he has demonstrated competence in the area. A less serious disciplinary action is still action. It still requires medical board resources and can be just as effective a tool in protecting the public.

Medical boards also frequently preempt future disciplinary action through education and rehabilitation programs. These methods effectively protect the public while often salvaging an increasingly valuable commodity -- physicians -- for our communities.

These forms of discipline aren’t reflected in annual ranking reports. Ironically, a medical board that reduces the number of “bad” doctors in a state through highly effective remediation and education would rank low in a ranking report -- because it had so few bad doctors to “seriously” discipline.

Today, we are asking the organizations that rank medical boards to set aside their rankings and work with us on an issue crucial to public protection: adequate funding and staffing for medical boards.

Medical boards are typically funded by the licensure fees they collect when physicians renew their licenses. Unfortunately, in some states these revenues are diverted into a general fund, rather than going directly back to the medical board. Medical boards then must compete with other state programs to obtain adequate funding, too often receiving a diminished share of physician licensing fees. As a result, many medical boards do not have enough investigators, attorneys and support staff to properly carry out investigations -- significantly impeding their ability to prosecute cases in a timely manner.

Patient protection must be a top priority for state legislators. Adequate funding and staffing for medical boards is in the best interest of all healthcare consumers. We encourage these consumer advocacy groups to join us in our mission to strengthen our medical boards and provide greater protection for the patients of all our states.

James N. Thompson is president and chief executive of the Federation of State Medical Boards.

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