Performance Improvement 2007. What Role Does the Physician Discipline Function of State Medical Boards Play in Assessing Medical Quality?



The study sought to describe how State Medical Boards generally addressed physician discipline and sought to identify innovative practices that Boards believe improve their functioning and enhance patient safety. The study included a literature review and development of a concept paper that described the physician discipline process, discussions with national experts, a technical advisory group, and cross-state analysis of Board structure and disciplinary performance data. Further information on Board structure and operations came from case study interactions in six states. Finding ways to assess medical boards' performance is important. States have given Boards a key role in safeguarding medical quality and patient safety. Medical litigation cases have also drawn attention to the importance of Medical Boards. Other private and public efforts also attempt to protect quality, but all depend on Medical Boards to address practitioners who don't meet minimum standards.

The study found that discipline of physicians beyond initial licensure was the Boards' main activity. Discipline was largely complaint-driven, meaning that Boards proactively began few cases. Almost 5% of complaints resulted in some level of sanction, which might be negotiated before a hearing or imposed after one. Board managers were asked what outcomes they intended to achieve and how they measured them. Only two performance measures were noted in all sites. The first was the number of disciplinary sanctions imposed. The second was timeliness of complaint resolution--and avoidance of a lengthy backlog of open cases. All stages of discipline cases were costly, particularly for cases concerning quality of medical care. Managers sought to improve Board effectiveness by: targeting resources more effectively, identifying the important cases from first contact, improving access to medical expertise, and taking advantage of information technology. Insufficient funds were cited by all Board managers. Many Board members and managers also wanted to do more for safety rather than merely react to complaints. For policy research, the next steps may be to more rigorously study existing state interventions or conduct demonstrations to see how well some of them may work in other states.

Report Title: State Discipline of Physicians: Assessing State Medical Boards through Case Studies
Agency Sponsor: ASPE, Office of the Assistant Secretary for Planning and Evaluation
Federal Contact: Bergofsky, Linda, 202-690-6443
Performer: Urban Institute; Washington, DC
PIC ID: 8344

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"PerformanceImprovement2007.pdf" (pdf, 717.63Kb)

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