State Medical Boards (SMBs) help protect the public by using various methods of accountability to ensure that physicians practice medicine ethically and responsibly. However, some SMBs have failed to remove physicians from practice in a timely manner after having committed serious ethical violations. At the American Society of Bioethics and Humanities (ASBH) 2022 Annual Meeting, Tristan McIntosh, PhD, presented results from work she and her team did exploring this issue with funding from a Making a Difference grant, Helping State Medical Boards Effectively Protect Patients by Identifying and Promulgating Promising Practices and Essential Resources.
Serious ethical violations by physicians—such as sexual abuse of patients, unnecessary invasive procedures, or improper prescribing of controlled substances—directly harm patients and undermine trust in the healthcare system. Egregious behaviors like these can be felony crimes, and yet are systematically under-reported and often go unpunished. Only one tenth of one percent of physicians each year have their medical license suspended, surrendered, or revoked—a number that is lower than would be expected based on what is known about the prevalence of behaviors that merit such discipline. In fact, even when SMBs receive reports about egregious physician wrongdoing, they seldom take severe disciplinary action.
Prof. McIntosh moderated a panel at ASBH22, held October 26-29 in Portland, Oregon, that raised questions about this disparity. What can state medical boards do to effectively address serious ethical violations by physicians? What strategies are there for improving practices that protect patients from harmful physicians?
The presentation focused on ways to help SMBs fulfill their purpose and protect patients more consistently. Prof. McIntosh and her team worked with a large and diverse panel of experts from SMBs to generate and evaluate effective and innovative practices, resources, and legal provisions that SMBs could adopt. The study involved a series of surveys asking panelists to rate the importance of each recommendation, ultimately resulting in a rank-order list of 63 particularly effective ways to help SMBs adequately discipline physicians and protect patients. Prof. McIntosh and her team organized the recommendations into five groups:
- Board composition and characteristics
- Board website, outreach and education
- Internal board operations and investigations
- Improved coordination and information sharing between stakeholders
- Licensing and disciplinary considerations
Among the specific recommendations Prof. McIntosh’s team make is making complaints easier to file, which can reduce the degree to which administrative burden impedes timely investigation and appropriate discipline. Providing specific definitions for what behaviors are reportable can create a clearer path to reporting misconduct, a goal that can also be achieved by removing vague categories such as “other” or “N/A” from reporting documents. The recommendation to allow anonymous reporting could help insulate those who report wrongdoing from workplace backlash. The researchers also recommend suspending a physician’s license when it is suspended in another jurisdiction.
Some of the recommendations generated over the course of the study are already being implemented, as reported by a portion of the participating panelists. 31% of panelists said that their SMB has banned using reporting categories such as “other” or “N/A” when reporting to the National Practitioner Data Bank. Prof. McIntosh and her team have partnered with the Federation of State Medical Boards to disseminate the project’s recommendations to leaders of SMBs to facilitate adoption of the recommendations. Project findings have also been shared with leaders of various national medical and health organizations, and federal and state officials, to support a more unified effort in putting the recommendations into practice.
Read more from Prof. McIntosh’s MAD grant:
- Tristan McIntosh et al., Protecting Patients from Egregious Wrongdoing by Physicians: Consensus Recommendations from State Medical Board Members and Staff, Journal of Medical Regulation, Oct 2021
- Elizabeth Pendo et al., Protecting Patients from Physicians Who Inflict Harm: New Legal Resources for State Medical Boards, Saint Louis University Journal of Health Law & Policy, 2021