Public active on medical boards, but not always tougher on doctors

Having nonphysicians on state medical boards, however, is seen as a credibility-builder for panels seeking more public trust.

By Andis Robeznieks, AMNews staff. Nov. 11, 2002. Additional information

There is a pattern when it comes to reforming state medical boards: Local media stir up the public with stories highlighting physician blunders and mismanaged investigations by the medical board.

The public then stirs up politicians, and lawmakers respond by adding more nonphysician "public" members to the board.

The implication: Physicians cannot be trusted to police other physicians, and nonphysicians are needed to keep the "old-boy network" from sweeping problems under the rug.

There is, however, some evidence showing that this perception is not reality. The Alabama, Mississippi and Louisiana medical boards all have physician-only membership. They also boast some of the most aggressive disciplinary rates.

The consumer watchdog group Public Citizen annually tabulates what it defines as "serious" disciplinary actions (license revocations and suspensions), and it listed Alabama 12th, Mississippi 13th, and Louisiana 24th in its state rankings for 2001.

47 states have public members on medical boards.

In contrast, Rhode Island has six public members on its 13-person board and was 42nd. And Delaware, where public members make up almost one-third of the medical board, ranked 49th.

Rather than taking it easy on their fellow physicians, some think professional pride makes doctors on medical boards take a tough stance against wayward colleagues.

"I've noticed that the physicians are sometimes harder on physicians than the 'consumer advocates' on the board," said Ronald Morton, MD, a member of the Medical Board of California. "I think they care. It's their profession that's being sullied by bad actors."

It's all in the perception

The perception remains, however, that nonphysicians give medical boards more credibility.

State legislatures are responding to that perception. California legislators recently voted to add two more public members to their medical board, which will now be made up of 12 physicians and nine public members.

"Our view is that we're not sure what it's going to get them," said Bob McElderry, associate director of the California Medical Assn.'s division for government relations. "Physicians are traditionally harder on their own than the public members are."

The trend is to increase the number of public members.

In 1967, California became the first state to add public members to its board. Since then, 46 states have jumped on the bandwagon.

The trend is to increase the number of public members. Colorado and Virginia now have four public members, up from two. North Dakota went from one public member to two. And medical boards in Maryland and Texas could see some changes after media scrutiny in those two states.

In Texas, reports in the Dallas Morning News led to calls to add public members, but because the Legislature meets only in odd-numbered years, the calls have gone unheeded so far.

The Texas board has 18 members, with three public members added in 1981 and three in 1993.

According to Kim Ross, the Texas Medical Assn.'s vice president for legislative affairs, the TMA advocates keeping a physician majority on the board but has supported the addition of public members each time the issue has come up through the regular legislative sunset cycle.

"The issue is not the board's membership," he said. "It's their resources." The problem, he said, is that only one-fifth of the medical license fees collected go toward financing the board's operations. The rest gets gobbled up by the state's general fund.

This year, the board used a $200,000 grant to increase its legal staff from four to nine attorneys in an attempt to reduce its case backlog.

Board spokeswoman Jill Wiggins credits the grant and the leadership of Executive Director Donald Patrick, MD, an Austin attorney and neurosurgeon hired in September 2001, with polishing the board's image.

"To a great extent, we've eliminated that backlog," Wiggins said. "And our new executive director used the criticism of the Dallas Morning News articles as a mandate to bring about a lot of change."

Media rarely touts good news

David Swankin, president of Citizen Advocacy Center, a support group for public members on health boards, said media coverage had led to reforms in Wisconsin and New Jersey, and more states may get added to the list.

"When's the last time you read or saw a nice story on a medical board?" Swankin asked. "It's usually: 'Here's a scandal.' The press generally only talks about what they're not doing and what they're doing bad."

Swankin believes the call for more public members is all part of a general movement toward more openness. "I think there's a movement for transparency in health care, generally," he said, adding that, specifically, this movement includes public members on boards, physician profiles on the Web and outcome reporting.

The director of the Mississippi State Board of Medical Licensure is considering opening up its organization, even though it has faced little scrutiny to date. "Most of the public doesn't know we exist," said W. Joseph Burnett, MD. Dr. Burnett said public members could bring credibility and a different perspective to the Mississippi board.

Steve Alexander, appointed as a public member of the Medical Board of California last year, agrees. "I think the increase in number of public members brings in a little more balance -- and I don't mean that in a pejorative way," said Alexander, the president of a communications group and former chair of the State Board of Behavioral Sciences.

"I found you can't make any general statements about public and professional members about who is more strident," he added. "We're all there for one reason: public protection."

Swankin said there is no such thing as a "typical" state medical board member.

"I know there are a number of lawyers, but by no means could you say they're all lawyers or all men or all women," he said, adding that professions represented on boards include Catholic priest, Protestant minister, college professor, insurance salesman and private investigator.

"I don't think there's a state that, statutorily, has affirmative requirements," he said. "None of them say: 'This is what you have to be.' They say: 'This is what you can't be.' "

Common disqualifying factors include being the spouse of a physician or having an economic interest in a health care institution.

Although Dr. Burnett backs adding nonphysicians to the Mississippi board, he said the board itself hadn't voted on the issue, and the final decision is up to the state Legislature. Still, he thinks it's worth pursuing.

"Sometimes, on prescribing issues, a panel made up of just doctors could say, 'This could happen to anyone,' but a public member could say, 'That could happen to any of us, and even one time is too much,' " he said. "It's an opportunity to keep doctors focused on the fact that there are people suffering from doctors who are impaired."

ADDITIONAL INFORMATION:

Public member bandwagon

Nationwide, the public is playing a bigger role in state medical boards. In addition, some boards also include an additional category of nonphysician members and "other health professionals," and on some boards, the state health commissioner is an automatic member.

	All members	Physician members	Public members
Alabama	15	15	none
Alaska	8	5	2 (25%)
Arizona Medical Osteopathic	12 7	8 5	4 (33%) 2 (29%)
Arkansas	13	11	2 (15%)
California Medical Osteopathic	19 7	12 5	7 (37%) 2 (29%)
Colorado	13	9	4 (31%)
Connecticut	15	9	5 (33%)
Delaware	16	11	5 (31%)
District of Columbia	11	8	3 (27%)
Florida Medical Osteopathic	15 7	12 5	3 (20%) 2 (29%)
Georgia	13	12	1 (8%)
Hawaii	11	9	2 (18%)
Idaho	10	7	2 (20%)
Illinois	16	12	2 (13%)
Indiana	7	6	1 (14%)
Iowa	10	7	3 (30%)
Kansas	15	8	3 (20%)
Kentucky	14	12	2 (14%)
Louisiana	7	7	none
Maine Medical Osteopathic	9	6 6	3 (33%) 3 (33%)
Massachusetts	7	5	2 (29%)
Maryland	15	12	3 (20%)
Michigan Medical Osteopathic	19 9	10 5	8 (42%) 3 (33%)
Minnesota	16	11	5 (31%)
Mississippi	9	9	none
Missouri	9	7	1 (11%)
Montana	11	6	2 (18%)
Nebraska	8	6	2 (25%)
Nevada Medical Osteopathic	9 5	6 4	3 (33%) 1 (20%)
New Hampshire	9	5	2 (22%)
New Jersey	21	13	3 (14%)
New Mexico Medical Osteopathic	8 5	6 3	2 (25%) 2 (40%)
New York	159	102	57 (36%)
North Carolina	12	8	3 (25%)
North Dakota	11	9	2 (18%)
Ohio	12	8	3 (25%)
Oklahoma Medical Osteopathic	9 8	7 6	2 (22%) 2 (25%)
Oregon	11	9	2 (18%)
Pennsylvania Medical Osteopathic	11 11	7 6	2 (18%) 2 (18%)
Rhode Island	13	7	6 (46%)
South Carolina	10	9	1 (10%)
South Dakota	6	5	1 (17%)
Tennessee Medical Osteopathic	12 6	9 5	3 (25%) 1 (17%)
Texas	18	12	6 (33%)
Utah Medical Osteopathic	11 5	9 4	2 (18%) 1 (20%)
Vermont Medical Osteopathic	14 5	9 3	3 (21%) 2 (40%)
Virginia	18	12	4 (22%)
Washington Medical Osteopathic	19 7	13 6	4 (21%) 1 (14%)
West Virginia Medical Osteopathic	15 5	9 3	3 (20%) 2 (40%)
Wisconsin	14	10	3 (21%)
Wyoming	8	5	2 (25%)

Source: Federation of State Medical Boards

New York has separate board for doctor discipline

With 25 members (including 20 physicians), New York has the largest state medical board. The New York State Board of Medicine, however, has nothing to do with disciplining doctors. It issues licenses and operates under the department of education.

Physician discipline is handled by the Office of Professional Medical Conduct, which operates within the Dept. of Health and includes 102 doctors on its 159-member board.

The board handed out 349 medical license suspensions and revocations in 2001 or, as calculated by consumer watchdog group Public Citizen, 4.36 "serious actions" per 1,000 doctors. This put New York 14th on the group's ranking of state medical boards, which is a remarkable turn of events from its 1991 ranking of 49th.

Health department spokeswoman Kristine Smith said part of this turnaround was an increase in licensing fees that helped pay for more investigative staff. In 1996, fees were doubled from $300 every two years to $600.

Although the board adjudicates a high number of cases, Smith said it rarely meets under one roof. Cases are first heard by an investigating committee, consisting of two physicians and a public member. Comparable to a grand jury, this panel decides whether there is enough evidence to go forward with the case. If it's ruled there is enough, the case goes to a hearing committee (also made up of two doctors and a public member), which determines if the charges have been proven and then rules accordingly.

Appeals are heard by a review board whose three physicians and two public members serve three-year terms.

To maintain a board with so many members, Smith said, "There are constant recruitment efforts."

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