Which is worse - A Summary Suspension or Resigning Under Investigation?
A summary suspension can be imposed with lightening speed and is reportable after 14 days to the National Practitioner Data Bank (NPDB) and most state medical boards. If a summary suspension seems imminent is it better to resign while under investigation (which is also reportable) or is it better to fight it our?
In the context of U.S. hospital medical staff peer review and clinical privileges, neither resigning while under investigation nor facing a summary suspension is ideal — both will trigger mandatory reporting to the National Practitioner Data Bank (NPDB), which creates a permanent, queryable record visible to future hospitals, insurers, payers, and licensing boards. This often harms future credentialing and employability. However, the two scenarios differ significantly in their implications, process, and long-term consequences for a physician's career.
Key Reporting Rules Under NPDB/HCQIA
Hospitals and eligible entities must report:
Any professional review action that adversely affects clinical privileges for >30 days (e.g., suspension, restriction, revocation, or denial).
Acceptance of a surrender/resignation/restriction of privileges while the physician is under investigation (or in lieu of conducting one) related to professional competence or conduct.
An "investigation" starts when the hospital begins a non-routine inquiry (even if the physician is unaware) and continues until formally closed or final action is taken. The physician's knowledge is irrelevant for reporting.
Summary Suspension
Hospitals impose this immediately if leadership believes a physician's continued practice poses
imminent danger to patients (e.g., gross negligence, impairment, disruptive behavior threatening safety). Under California’s Business & Professions Code § 809.5(a) it is clear that a physician has little due process protection in a summary suspension assessment. In fact, this section overrides standard due process protections (§§ 809–809.4) and grants peer review bodies broad authority to:
"Immediately suspend or restrict clinical privileges... where failure to take that action may result in an imminent danger to the health of any individual," followed by notice and hearing rights.
In many cases a bad faith attack on a doctor will inevitably lead to an initial summary suspension because the bar is so low to impose the suspension. We often advise our doctors that a resignation is a final type action where as a summary suspension can then be challenged in a peer review hearing with some modicum of due process and the exchange of evidence.
However this process is slow and expensive. It does have the benefit of providing at least the chance of a physician clearing his/her record and in some (very limited cases) may provide a basis for a civil lawsuit. (But peer review is highly protected and even good cases are often barred by peer review privilege.)
Career Impact
The NPDB report explicitly states "summary suspension" (or whatever the final action is) based on competence/conduct concerns.
It raises red flags but shows the hospital followed patient-safety protocol and gave due process.
If lifted quickly or overturned at hearing, the hospital may file a Revision-to-Action Report noting exoneration/mitigation (but the original report stays).
Resigning While Under Investigation
Physicians often consider this to "escape" the process and avoid a harsher outcome.
Process and Reporting
If any non-routine investigation is open (even quietly), resignation = automatic NPDB report as "resignation while under investigation" (or surrender of privileges to avoid investigation).
This is true even if the physician is unaware of the investigation or claims personal reasons (e.g., relocating, burnout).
Leaves of absence, failure to renew privileges, or voluntary restrictions during investigation often count the same way.
No hearing is required because the physician voluntarily exited.
The benefit is that the reportings may be less specific and allow the physician to move forward with his/her career without the burden of more specific allegations. This is not automatic however as even a report by the MEC of a resignation under investigation can also include details as to the nature of the investigation. At times the contents of the report can be negotiated.
In short, the initiation of any peer review process at the MEC level is a direct threat to a doctor’s career. Immediate legal help is necessary and self help almost always digs a deeper hole. Remember that the MEC has a lawyer on call and in 99.9% of the cases the lawyer is involved at the very start of any investigation. Taking on the MEC without legal advise is not advised.
There are many excellent physician defense firms that specialize in representing doctors. Our medical lawyers at the Law Office of Daniel Horowitz strongly fight for the rights of doctors and we can move quickly and effectively to maximize your position in a conflict with medical staff and the MEC. Our firm has extensive trial experience and a reputation for out of the box solutions and physician centered focus and advocacy.
