States Vary Widely in Regulations, Procedures for Punishing Wrongdoing Among Doctors

The percentage of doctors who are disciplined or pay a malpractice claim is 4 times less in some states than in others, according to a new study by University of Michigan Medical School researchers. Inasmuch as there is not likely to be a 4-fold difference in the behavior of doctors from state to state, the reason for this difference lies in the wide variation between states’ regulations, procedures, and resources for punishing physician wrongdoing, according to the University of Michigan investigators. In each state, they say, the medical board acts as a self-governing body with wide discretion about what kind of punishments to give for different violations.

The data showed that Delaware, Kentucky, and Ohio had the highest adjusted rates for all disciplinary actions. But the researchers said that the states with the lowest rates (Massachusetts, New York, Connecticut, and Pennsylvania) were the ones that should probably have their current standards examined more closely. Lead author John A. Harris, MD, an obstetrician/gynecologist and Robert Wood Johnson Foundation Clinical Scholar at the University of Michigan Medical School, explained that while there is no “right” rate of physician discipline, no state should be in the extremes.

The study, published in BMJ Quality and Safety, is the first national academic evaluation of this issue and the first study to use statistical techniques to more reliably calculate the actual situation in each state.

The study relied on data from the National Practitioner Data Bank (NPDB), which covers all 50 states and the District of Columbia from 2010 through 2014. The NPDB has collected data from each state concerning actions taken by state medical boards against doctors who have been shown to have committed wrongdoings, such as substance abuse, sexual misconduct, improper prescribing, fraud, and negligence. The database includes information about punishments that range from minor fines or monitoring to major actions including revoking or suspension of medical licenses. Malpractice claims information includes payments made by doctors.

The study authors used this data and combined it with information on the number of physicians practicing in each state to calculate a “reliability-adjusted” yearly state rate of all medical board disciplinary actions per 1000 physicians. For the nation as a whole, there are 3.75 disciplinary actions each year for every 1000 practicing physicians, including 1.15 serious disciplinary actions. However, the range among states was very large, from 7.93 disciplinary actions of any kind per 1000 physicians in Delaware to 2.13 per 1000 in Massachusetts, and from 2.71 major actions per 1000 physicians in Delaware to 0.64 in New York.

The United States is one of the few nations that lacks a national system for regulating and punishing physician misbehavior, Dr Harris said.

“Ultimately, don’t we want all doctors operating in the same ethical way, and being disciplined appropriately if they fail to do so?” he said in a statement.