State Medical Boards Lax When It Comes to Doctor Discipline

State medical boards aren’t doing enough to discipline potentially dangerous doctors, according to a report from Public Citizen.

On average, the rate of serious disciplinary actions such as license revocation was 0.81 per 1,000 doctors, a 12% decrease from the previous report (0.92 per 1,000 doctors), according to Robert Oshel, PhD, a consultant to Public Citizen’s Health Research Group.

Even the most aggressive state — Ohio — issued only 1.82 serious disciplinary actions per 1,000 doctors, and that number was also down from the last report, when Kentucky took the top slot at 2.29 serious actions per 1,000 doctors.

“One of the most significant findings is that none of the boards are taking as many actions per 1,000 physicians as the best boards did in our report before the pandemic,” Oshel told MedPage Today. “Whether the pandemic has something to do with it, we don’t know.”

“It would appear that there’s considerable room for improvement by all the boards,” he added.

Oshel also noted the “tremendous” variation in rates of serious disciplinary action across the boards, noting that Indiana performed the worst at 0.17 actions per 1,000 doctors.

“Indiana is right next door to Ohio, so this really emphasizes the fact that this isn’t some regional difference,” he said. “To me, that says there’s something different about these boards and how diligent they are in taking action to protect the health and safety of the residents. Are they looking out for physicians, or are they looking out for patients?”

Oshel and Robert Steinbrook, MD, director of the Health Research Group at Public Citizen, co-authored the report, which evaluated serious disciplinary actions from medical licensing boards across the U.S. from 2021-2023. (Prior reports did the same for the 2017-2019 and 2019-2021 time periods.)

What’s new about this year’s report is that it was expanded to include osteopathic boards, Oshel said. After excluding 10 boards that didn’t license at least 5,000 doctors (nine DO boards and one MD board), they ended up with 64 boards.

Ultimately, they found the highest rates of serious discipline in Ohio (1.82), the Michigan osteopathic board (1.62), Wisconsin (1.49), North Dakota (1.39), and Illinois (1.35), while the most lax boards were Indiana (0.17), Georgia (0.24), the Pennsylvania allopathic board (0.26), Delaware (0.31), and South Carolina (0.34).

In a similar vein, a recent study in JAMA Network Open found that physicians were very rarely disciplined for spreading misinformation. Among more than 3,000 medical board disciplinary proceedings involving doctors in the top five most populous states, there were only six sanctions for spreading misinformation, for a rate of 0.1%.

There are a number of reasons why rates of serious disciplinary actions are low across the board, Oshel said. It could be that boards are underfunded, or that the standards of evidence required to take action vary by state.

“If it’s clear and convincing evidence versus beyond a reasonable doubt, the latter won’t take as many actions,” he noted. “If it’s a preponderance of evidence, boards could take more action.”

Also, “if boards are dominated by physicians, maybe they are looking out to protect physicians,” he said, adding that some boards have public members as a safeguard.

The data about physician discipline come from the public file at the National Practitioner Data Bank (NPDB), a federal program that collects required disciplinary information about doctors and other healthcare providers. While the de-identified file is available to the public, the information reported to NPDB is not public, so consumers can’t use it to look up disciplinary actions against their doctors.

Instead, medical boards, hospitals, and other parties run queries to the databank to check on their physicians, Oshel said.

NPDB was established by the Healthcare Quality Improvement Act of 1986 and went into effect in September 1990.

“Congress had found there was a problem of physicians getting in trouble in one state, having a bad malpractice or disciplinary record, and then moving to another and not telling the licensing board or hospitals,” Oshel said. “So they would get licensed and privileged and get into trouble all over again.”

“The idea was that if this kind of information was available, then we would have fewer problems of incompetent physicians with a bad behavioral record just repeating their bad record elsewhere,” he added.

Oshel was hired as a research director at NPDB in 1993, and ultimately created the public use file before retiring in 2008.

The late Sidney Wolfe, MD, co-founder of the Health Research Group at Public Citizen, launched the discipline report using data from the Federation of State Medical Boards (FSMB), which eventually stopped making the data publicly available. Eventually, Oshel suggested reviving the report using disciplinary data from the NPDB instead, and using the FSMB data on the number of physicians licensed in each state, which are still publicly available.

Oshel said the report focuses on serious discipline only, rather than non-serious actions such as letters of reprimand, or even probation, which allow providers to continue practicing unhindered.

How good hospitals and state boards are at checking NPDB — and using that information — varies, Oshel said. State medical boards are required to report disciplinary action, but they do not have to check on licensees.

Hospitals, on the other hand, are required by law to query all new applicants for clinical privileges, and once every 2 years on all medical staff, Oshel said.

“But it’s the old story of, you can lead a horse to water but you can’t make it drink,” he said. “They may get the information, but if they’re in desperate need of a neurosurgeon, they may take somebody with a somewhat questionable record.”

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