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Thursday, May 16, 2024

What Can State Medical Boards Do to Effectively Address Serious Ethical Violations?

McIntosh, T., Pendo, E., et al. (2023).
The Journal of law, medicine & ethics
 51(4), 941–953.


State Medical Boards (SMBs) can take severe disciplinary actions (e.g., license revocation or suspension) against physicians who commit egregious wrongdoing in order to protect the public. However, there is noteworthy variability in the extent to which SMBs impose severe disciplinary action. In this manuscript, we present and synthesize a subset of 11 recommendations based on findings from our team’s larger consensus-building project that identified a list of 56 policies and legal provisions SMBs can use to better protect patients from egregious wrongdoing by physicians.

From the Conclusion

There is a growing awareness of the role SMBs have to play in protecting the public from egregious wrongdoing by physicians. Too many cases of patient abuse involve a large number of victims across a long period of time. SMBs are often in a position to change these circumstances when they establish and consistently utilize and enforce policies, procedures, and resources that are needed to impose severe disciplinary actions in a timely and fair manner. Many improvements in board processes require action by state legislatures, changes to state statutes, and increases to SMB budgets. While most of the actions we advocate in this paper would be facilitated and enhanced by existing or new statutes or regulations, and more frequently increased budgets, most of them can be at least partially implemented independently with modest budgetary impact in the short-term. The recommendations expanded upon in this paper are the result of input from individuals of various roles and expertise, including members of the FSMB, SMB members, health lawyers, patient advocates, and other healthcare leaders. Future efforts may wish to engage an even wider range of stakeholders on these topics, possibly with a greater emphasis on engaging patient and consumer advocates.

Here is my summary:

State medical boards can take several steps to effectively address serious ethical violations by physicians:
  1. Increase the rate of serious disciplinary actions: Data shows there is wide variation in the rate of serious disciplinary actions taken by state medical boards, with some boards being overly lax. Boards should prioritize public protection over protecting the livelihoods of problematic physicians.
  2. Improve board composition and independence: Boards should have more public members and be independent from state medical societies to reduce conflicts of interest. This can lead to more rigorous investigations and appropriate disciplinary actions.
  3. Enhance data collection and sharing: The National Practitioner Data Bank should collect and share more detailed data on physician misconduct, while protecting sensitive information. This can help identify patterns and high-risk physicians.
  4. Mandate reporting of misconduct: State laws should require physicians to report suspected sexual misconduct or other serious ethical violations by colleagues. Failure to report should result in disciplinary action.
  5. Increase transparency and public accountability: Medical boards should publicly report on disciplinary actions taken and the reasons for them, to improve transparency and public trust.
In summary, state medical boards need to take a more proactive and rigorous approach to investigating and disciplining physicians who commit serious ethical violations, in order to better protect patient safety and the public interest.