Understanding State Medical Board Structures

Posted on March 18, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

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 “The Tale of Two Boards”

[By Eric A. Dover MD]

[By Michael Lawrence Langan MD]

SOAR

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The great majority of States have in reality two Medical Boards. All States have a “Board Proper” and all but a handful have an “Administrative Board”.

First Board

The “Board Proper” is, depending on the State, made up of seven to sixteen individuals. There will be a President (Chairperson) and President Elect. The Board Members are “volunteers”, typically placed by the State Governor. The individuals who constitute the Board may vary greatly and are somewhat determined by the medical disciplines overseen by the Medical Board. Oklahoma presently separates Medical Doctors (M.D.) and (D.O.) into two Boards http://www.okmedicalboard.org/

Other Medical Boards may oversee Physician Assistants (P.A.), Midwives, Respiratory Therapists, Podiatrists, Athletic Trainers, etc., who may or may not have direct Board representation. All States have M.D.s on the Board, and some Boards are all M.D.s. Others members of the Board may include D.O.s, P.A.s, Podiatrists, Midwives, Respiratory Therapists, a representative from the Secretary of State’s office, the Commissioner of State Boards or an Educational Director. Many, but not all Medical Boards, will have anywhere from one to three Public Members.

Some States require Public Member(s) come from a specific profession such as a lawyer or hospital administrator. Other States have no such qualifications; therefore the Public Member can be from any profession.

Second Board

The “Administrative Board” is the other Medical Board. They run the operation throughout the year. Their personnel, structure and operation vary widely from State to State.

Most States will have an Executive Director who supervises the Board.   Some states, such as New Mexico http://www.nmmb.state.nm.us/ or Indiana http://www.in.gov/pla/3638.htm, use a State Board Director for all boards, and don’t have a specific Executive Director.

Pennsylvania uses a State Administrator in lieu of an Executive Director. Individuals filling these positions are either legally or administratively trained.

http://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Medicine/Pages/default.aspx#.VOO-ZfZ0zIU

Many States have a Medical Director. They are physicians whose tasks, for example, may include working with Investigators, lending medical expertise or working on Board Committees. Many other State Medical Boards, such as Delaware don’t have one. http://dpr.delaware.gov/boards/medicalpractice/members.shtml

Medical Boards are divided regarding in-house Legal Staff. Oregon has in-house legal staff, but also relies upon a single Assistant Attorney General from the State Department of Justice   http://www.oregon.gov/OMB/Pages/index.aspx.

In Pennsylvania, all State Boards use the Office of General Council for legally related issues. http://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Medicine/Pages/default.aspx#.VOO-ZfZ0zIU.

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professor

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Assessment

Each State handles their Medical Board investigations differently. Some have in-house investigators. They may be ex-police officers, which are common, but they don’t have to be.

California’s Investigators are called “Peace Officers” and they aren’t typically ex-police http://www.mbc.ca.gov/

In North Dakota, the Board Members act as the investigative staff and will hire outside investigators if necessary https://www.ndbomex.org/

In Delaware, investigations are handled for all Boards by the Division of Professional Regulation http://dpr.delaware.gov/boards/medicalpractice/members.shtml.

About the Authors

Dr. Eric Dover is a board certified family practice and primary care physician in Portland, Oregon. He is a graduate of the University of California at Los Angeles [UCLA] School of Medicine.

Dr. Michael L. Langan graduated from Oregon Health Sciences University School of Medicine, Portland Oregon as a Medical Doctor 21 years ago. He had his residency training of Geriatric Medicine-Internal Medicine at Beth Israel Deaconess Medicine Center and Internal Medicine at St Vincent Hospital Medicine Center.

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SUBSTANCE ABUSE AND IMPAIRED PHYSICIANS

Posted on March 2, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

On Physician Health Programs [Help or Hindrance?]

[By Eric A. Dover MD]

Approximately 10-12% of physicians will develop a drug or alcohol problem at some point during their career. If physicians are impaired, they should be able to seek help from a firm but supportive and fair resource—one that demands sobriety and can determine when physicians are safe to practice.

About PHPs

Physicians with substance use disorders often seek the assistance of a state physician health program (PHP). Some physicians engage willingly with PHPs, but most are compelled to do so either by their hospital or their board of medicine.  PHPs meet with, assess, and monitor physicians who have been referred to them for substance use or other mental and behavioral health problems.

In most states, physicians who comply with any and all demands of the PHP often may continue to work, provided their sobriety is ensured through drug testing and other means. Many state boards of medicine rely completely on the PHPs for guidance about how to deal with impaired physicians.  PHPs are therefore extremely powerful.

The Problem

The problem with PHPs, though, is that despite their enormous power, they are generally barely known to most physicians and often operate with little oversight and no real means of appealing their recommendations.

To compound matters, evaluation/treatment centers and PHPs are often financially dependent on one another: Centers depend on referrals from PHPs for their viability and, reciprocally, PHP regional and national meetings are often heavily sponsored by these centers.

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Stress

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Largely Unknown Practices

Because PHP practices are largely unknown to physicians until they themselves are referred to one, physicians who do register complaints about standard PHP practice are often dismissed as bellyaching. But, some voices of concern have been heard.

For example, several years ago, a paper was published in the Journal of Addiction Medicine outlining concerns about standard PHP practice, which included the points raised above; along with others.

More recently, a group of North Carolina physicians complained about their state PHP to the state auditor. The auditor conducted an investigation and found poor oversight of the PHP by both the state medical society and the board of medicine, a lack of due process for physicians who disputed the PHP’s evaluations and/or recommendations, and multiple instances of potential conflicts of interest.

And so, some authorities suggest a national federation of PHPs to implement national standards for its members and commence routine audits of its members.

Assessment

Doctors who are unsafe to practice medicine ought to be prevented from doing so, but every doctor who enters any kind of treatment or monitoring program should be treated respectfully, and fairly, monitored appropriately, and have legitimate avenues of appealing decisions about their care.

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ABOUT

Dr. Eric Dover is a board certified family practice and primary care physician in Portland, Oregon. He is a graduate of the University of California at Los Angeles [UCLA] School of Medicine.

Conclusion

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