By State Medical Boards

By ROBERT JAMES CIMASI; MHA, ASA, FRICS, MCBA, AVA, CM&AA, CMP^™

By TODD A. ZIGRANG; MBA, MHA, ASA, FACHE

(C) Health Capital Consultants, LLC All rights reserved. St. Louis, MO USA

A SPECIAL ME-P REPORT

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Every state and the District of Columbia require the licensure of all allopathic (M.D.) and osteopathic (D.O.) physicians [1] Although the specific criteria for licensure vary by state, each state requires candidates to submit proof of completion of the requisite number of years of graduate medical education and passage of examinations verifying that “the physician is ready and able to practice competently and safely in an independent setting [2].

Moral Character

Additionally, a physician applying for licensure is typically required to have “good moral character,” absent his or her involvement in illegal activities [3] Most physicians satisfy the exam requirement by submitting proof of their successful completion of the United States Medical Licensing Examination (USMLE) or the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) to the licensure board [4] However, as some practicing physicians may have been licensed under a previously administered exam, certain state licensing boards may consider a combination of other examinations sufficient to meet licensure requirements, so long as those exams were completed prior to 2000 [5]

Of State Medical Boards

The licensure of physicians is governed by a state medical board, the “primary responsibility” of which board, according to the Federation of State Medical Boards, is to “protect consumers of health care by ensuring that all physicians…are properly licensed and comply with various laws and regulations pertaining to the practice of medicine” [6] To accomplish this goal, state legislatures have delegated certain powers to the state’s medical board, including the power to grant, suspend, and revoke licenses; conduct investigations into complaints against physicians; and, release guidelines related to best medical practices [7] State medical boards have traditionally consisted solely of physicians; however, there has recently been an increase in the number of non-physician board members on state medical boards [8].

History

Over the last 50 years, state medical boards have faced intense scrutiny regarding their commitment to disciplining physicians based on quality concerns [9] In 1960, the American Medical Association (AMA) heard “sobering” facts from the Federation of State Medical Boards that “much confusion over the definitions and objectives exists” related to state medical board enforcement of medical standards [10] From 1963 to 1967, 0.06% of all physicians were subject to discipline, while in 1981, 0.14% of all physicians were subject to discipline, due in large part to the problems identified by the AMA [11] Although the rate of physician discipline rose eightfold by the mid-1990s, to date, there are continuing concerns regarding state medical board enforcement of quality standards.

A March 2011 report by advocacy group Public Citizen found that over 55% of physicians who faced clinical privilege disciplines by hospitals from 1990 to 2009 did not have a corresponding action from a state medical board [12] Additionally, in 2011, state medical boards imposed 3.06 “serious disciplinary actions” (e.g., revocations, surrenders, suspensions, and probations of medical licenses) per 1,000 physicians, an increase from the 2010 rate of 2.97 per 1,000, but a decrease from the 2004 rate of 3.72 per 1,000 [13] Numerous reasons have been offered to explain the disparity in quality enforcement by state medical boards, the most prominent being that physicians are loath to report fellow physicians for major disciplinary actions such as licensure revocation[14]

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Assessment

Other reasons include a focus by state medical boards on “character-related misconduct” over clinical quality standards [15] as well as a lack of resources to investigate and enforce quality standards, which forces state medical boards to rely on physicians and hospitals to “police” themselves [16].

More:

• Is Medical Licensing Really Necessary?
• Will Future Doctors Need a Medical License?
• Psychopathy and the Medical Profession

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 REFERENCES

[1]       “State Medical Boards: Future Challenges for Regulation and Quality Enhancement of Medical Care,” By James N. Thompson, Journal of Legal Medicine, Vol. 33, No. 9 (January-March 2012).

[2]       “State Medical Boards: Future Challenges for Regulation and Quality Enhancement of Medical Care,” By James N. Thompson, Journal of Legal Medicine, Vol. 33, No. 9 (January-March 2012); “Healthcare Valuation: The Four Pillars of Healthcare Value,” By Robert James Cimasi, MHA, ASA, FRICS, MCBA, AVA, CM&AA, Hoboken, NJ: John Wiley & Sons, Inc., 2014, p. 449-450.

[3]       “Medical Practice: Education and Licensure,” in “Legal Medicine,” By S. Sandy Sanbar et al., 6th Ed., Mosby, 2004, p. 81.

[4]       “Medical Licensure,” American Medical Association, 2014, http://www.ama-assn.org/ama/pub/education-careers/becoming-physician/medical-licensure.page, (Accessed 12/19/14); “COMLEX-USA,” National Board of Osteopathic Medical Examiners, 2014, http://www.nbome.org/exams-faq.asp (Accessed 12/19/14).

[5]       “Medical Licensure,” American Medical Association, 2014, http://www.ama-assn.org/ama/pub/education-careers/becoming-physician/medical-licensure.page, (Accessed on 12/19/14); “Healthcare Valuation: The Four Pillars of Healthcare Value,” By Robert James Cimasi, MHA, ASA, FRICS, MCBA, AVA, CM&AA, Hoboken, NJ: John Wiley & Sons, Inc., 2014, p. 450.

[6]       “What is a State Medical Board?” Federation of State Medical Boards, 2014, http://www.fsmb.org/policy/what-is-a-smb-faq (Accessed 12/19/14).

[7]       “What is a State Medical Board?” Federation of State Medical Boards, 2014, http://www.fsmb.org/policy/what-is-a-smb-faq (Accessed 12/19/14).

[8]       “What is a State Medical Board?” Federation of State Medical Boards, 2014, http://www.fsmb.org/policy/what-is-a-smb-faq (Accessed 12/19/14); “Character, Competence, and the Principles of Medical Discipline,” By Nadia N. Sawicki, Journal of Health Care Law & Policy, Vol. 13, No. 1, 2010, p. 291.

[9]       “Character, Competence, and the Principles of Medical Discipline,” By Nadia N. Sawicki, Journal of Health Care Law & Policy, Vol. 13, No. 1, 2010, p. 287, n. 7; “To Err is Human: Building a Safer Health System – Summary,” Institute of Medicine, 2000, http://www.iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf (Accessed 12/19/14).

[10]     “Medical Licensure Statistics for 1960,” Journal of the American Medical Association, Vol. 176, No. 8 (May 27, 1961), p. 694.

[11]     “Medical Licensing Board Characteristics and Physician Discipline: An Empirical Analysis,” By Mark T. Law & Zeynep K. Hansen, Journal of Health Politics, Policy and Law, Vol. 35, No. 1 (February 2010), p. 66.

[12]     “State Medical Boards Fail to Discipline Doctors with Hospital Actions Against Them,” By Alan Levine et al., Public Citizen, March 2011, http://www.citizen.org/documents/1937.pdf (Accessed 12/19/14).

[13]     “Public Citizen’s Health Research Group Ranking of the Rate of State Medical Boards’ Serious Disciplinary Actions, 2009-2011,” By Sidney M. Wolfe, M.D., et al., Public Citizen, May 17, 2012, http://www.citizen.org/documents/2034.pdf (Accessed 12/19/14).

[14]     “Medical Boards are Too Lax, Critics Claim,” By Wayne J. Guglielmo, MA, MedScape, October 17, 2014, http://www.medscape.com/viewarticle/833141 (Accessed 12/3/14);

[15]     “Character, Competence, and the Principles of Medical Discipline,” By Nadia N. Sawicki, Journal of Health Care Law & Policy, Vol. 13, No. 1, 2010, p. 287.

[16]     “Medical Licensing Board Characteristics and Physician Discipline: An Empirical Analysis,” By Mark T. Law & Zeynep K. Hansen, Journal of Health Politics, Policy and Law, Vol. 35, No. 1 (February 2010), p. 90; “Medical Licensure Statistics for 1960,” Journal of the American Medical Association, Vol. 176, No. 8, May 27, 1961, p. 694.

NC Update: H543v2 – 04152015

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Filed under: Career Development, Ethics, Health Law & Policy, Risk Management | Tagged: Health Capital Consultants, LLC, robert james cimasi, State Licensing of Physicians, state medical boards, TODD A. ZIGRANG | 3 Comments »