WASHINGTON - April 27 - Public Citizen today released its ranking of state medical boards, with Mississippi being ranked worst and Kentucky being the best.
The annual rankings are based on data from the Federation of State Medical Boards (FSMB), specifically on the number of disciplinary actions taken against doctors in 2003-2005. Public Citizen calculated the rate of serious disciplinary actions (revocations, surrenders, suspensions and probation/restrictions) per 1,000 doctors in each state for each year and compiled a national report ranking state boards by the average rate of serious disciplinary actions per 1,000 doctors for the years 2003-2005.
There were 3,255 serious disciplinary actions taken by state medical boards in 2005, down 1.2 percent from the 3,296 serious actions taken in 2004. The three-year state disciplinary rates ranged from 1.62 serious actions per 1,000 physicians (Mississippi) to 9.08 actions per 1,000 physicians (Kentucky), a 5.6-fold difference between the best and worst states.
The bottom 10 states – those with the lowest serious disciplinary action rates for 2003-2005 – were, starting with the lowest: Mississippi (1.62 actions per 1,000 physicians), Delaware (1.63 per 1,000 physicians), Minnesota (1.65 per 1,000 physicians), Wisconsin (1.72 per 1,000 physicians), Nevada (2.03 per 1,000 physicians), Maine (2.04 per 1,000 physicians), South Carolina (2.06 per 1,000 physicians), Maryland (2.14 per 1,000 physicians), South Dakota (2.18 per 1,000 physicians) and Hawaii (2.19 per 1,000 physicians).
Four of the 15 lowest-ranking states (Wisconsin, Minnesota, Delaware and Hawaii) have been in the bottom 15 states for the past 10 three-year periods. In addition, five of these 15 states have been in the bottom 15 for at least five of the past three-year periods: Rhode Island (5), South Carolina (6), Washington (7), Maryland and Connecticut (9). Large decreases of at least a 20-state drop in ranking have occurred from the 1999-2001 ranking to the current rank in four states: Arkansas went from No. 15 to No. 38; Michigan, from No. 20 to No. 40; Mississippi, from No. 9 to No. 51; and Nevada, from No. 22 to No. 47.
“These data again raise serious questions about the extent to which patients in many of these states with poorer records of serious doctor discipline are being protected from physicians who might well be barred from practice in states with boards that are doing a better job of disciplining physicians,” said Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group. “It is quite possible that in states with poor doctor disciplinary records, patients are being injured or killed more often by doctors who should have been disciplined than patients in states with consistently high disciplinary performance.”
The top 10 states are (in order): Kentucky (9.08 serious actions per 1,000 physicians), Alaska (8.49 per 1,000 physicians), Wyoming (8.19 actions per 1,000 physicians), Ohio (6.33 per 1,000 physicians), Arizona (6.20 per 1,000 physicians), Oklahoma (6.19 per 1,000 physicians), North Dakota (6.07 per 1,000 physicians), Colorado (5.75 per 1,000 physicians), West Virginia (5.45 per 1,000 physicians) and Missouri (5.34 per 1,000 physicians). Nine of these 10 states were in the top 10 states in last year’s three-year ranking. Last year, Missouri was ranked No. 11.
Boards are likely to be able to do a better job in disciplining physicians if most, if not all, of the following conditions are true:
- They have adequate funding (all money from license fees going to fund board activities instead of going into the state treasury for general purposes);
- They have adequate staffing;
- They undertake proactive investigations rather than only responding to complaints;
- They use all available/reliable data from other sources such as Medicare and Medicaid sanctions, hospital sanctions and malpractice payouts;
- They have excellent leadership;
- They are independent from state medical societies and other parts of the state government; and
- A reasonable legal framework exists for disciplining doctors (the “preponderance of the evidence” rather than “beyond reasonable doubt” or “clear and convincing evidence” as the legal standard for discipline).
“Most states are not living up to their obligations to protect patients from doctors who are not practicing medicine in the best manner and are thus endangering the lives and health of residents,” Wolfe said. “Serious attention must be given to finding out which of the above variables are deficient in each state. Then action must be taken, legislatively and through pressure on the medical boards, to increase the amount of discipline and, thus, the amount of patient protection.”
In order to avoid fluctuations in disciplinary rates in some smaller states that do not have many physicians, Public Citizen calculated the three-year average rate of discipline (for last year and the preceding two years) for all states and listed them by rank for the three-year average rate, not the rate for 2005 alone.
The calculation of rates of serious disciplinary actions is created by taking the number of such actions (the first two categories of the FSMB data) and dividing it by the American Medical Association data on non-federal M.D.s as of December 2003 (adding to this the number of osteopathic physicians if the board is a combined medical/osteopathic board). The result was multiplied by 1,000 to get state disciplinary rates per 1,000 physicians. This rate calculation is done for each of the past three years (2003-2005), and the average rate is used as the basis for this year’s state board rankings.
The full report can be viewed here.