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How Does California Rank in Physician Discipline? Review of Public Citizen Araticle

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Summary of Public Citizen’s Report: Ranking of the Rate of State Medical Boards’ Serious Disciplinary Actions, 2019-2021

Public Citizen (watchdog group) presumed that all states have the same percentage of doctors deserving reporting.  They then ranked states with more complaints vs those with less.  Here is a summary of the article.  What do you think?

Our view is that the depth of inquiry and the expertise used to review cases is the key factor.  A numerical approach is specious.  But here is in outline form what Public Citizen (a respected outfit) says.

Overview

  • Source: Public Citizen, published August 16, 2023

  • Purpose: Evaluates state medical boards’ effectiveness in disciplining physicians for misconduct, incompetence, or illegal behavior from 2019-2021.

  • Data: National Practitioner Data Bank (NPDB), focusing on serious disciplinary actions (e.g., license revocations, suspensions, surrenders, restrictions) per 1,000 licensed physicians.

  • Key Assumption: Physician misconduct rates are uniform across states; differences in disciplinary rates reflect board performance, funding, and enforcement practices.

  • National Findings:

    • Michigan led with 1.74 actions per 1,000 physicians, followed by Ohio (1.61), North Dakota (1.60), and Colorado.

    • Lowest performers: District of Columbia (0.19), Nevada, New Hampshire, and Georgia.

    • National decline in disciplinary actions compared to 2017-2019.

    • If all states matched Michigan’s rate, ~1,133 more actions would occur annually, doubling the national total from 1,281 to 2,414.

    • 75% of 9,286 physicians with 5+ malpractice payments since 1990 faced no licensure action.

  • Recommendations: Increase NPDB use, public access to physician-specific data, more legislative oversight, and better funding for boards.

California-Specific Findings

  • Ranking: 27th out of 51 (including D.C.), with 0.83 serious disciplinary actions per 1,000 physicians per year.

  • Context: California has the most licensed physicians but ranks in the lower half, suggesting lax enforcement compared to states like Michigan or New York (7th, 1.25 actions per 1,000).

  • Limitations: Excludes actions by California’s separate osteopathic board, which licenses ~10% of the state’s physicians.

  • Implied Issues: Low ranking may stem from inadequate funding, physician-dominated boards, or reactive rather than proactive investigations, though specific causes are not detailed.

Review

  • Strengths: Clear, data-driven comparison using NPDB data; highlights systemic issues and proposes reforms.

  • Weaknesses: Limited state-specific analysis (e.g., no explanation of California’s regulatory or funding challenges); exclusion of osteopathic boards may skew results.

  • Implications for California: Middling rank suggests need for stronger oversight to enhance patient safety, particularly given the state’s large physician population.