How will state medical boards handle cases involving disclosure and apology for medical errors?

Surveys were sent to 68 American state medical boards, including territories of the United States, inquiring how they handle—or will handle—cases involving disclosure and apology after medical errors. Surveys were not sent to specialty boards. Thirty-eight state medical boards ( n = 38, 56%) responded to the survey, with 31 completing the survey (46% completion rate) and seven boards ( n = 7) providing explanations for nonparticipation and other thoughts; 30 boards did not respond in any manner. Boards that completed the survey indicated that disclosure and apology and other positive post-event behavior by physicians are likely to be viewed favorably and disclosing physicians will not be easy targets for disciplinary measures, though boards also stressed they view each case on the merits and patient safety is their top priority. Recommendations are made for policy makers and other stakeholders.

Protecting the Public’s Health-Except in Tennessee

No abstract available. Article truncated after 150 words. State regulatory boards that regulate professionals such as doctors, nurses, psychologists, etc. are often appointed by politicians and headed by lawyers. Under this category has been most Medical Boards and their parent organization the Federation of State Medical Boards. Although they claim to be protecting the public, they seem more concerned with identifying “disruptive” physicians and blacklisting them through the National Practitioner Data Bank (1). However, in July the Federation issued a warning to physicians against propagating COVID-19 vaccine misinformation and disinformation citing a "dramatic increase" by physicians (2). The statement gave some hope that the Federation was striving to maintain some degree of professional standards by saying that spreading disinformation to the public was dangerous because physicians enjoy a high degree of public credibility. The Tennessee Board of Medical Examiners followed the Federation’s lead by issuing a verbatim restatement warning that physicians who spread false information about COVID-19 vaccinations …

Gender Biases in Online Physician Ratings: Female Doctors Evaluated More Harshly by Patients (Preprint)

BACKGROUND Prior research has highlighted gender differences in online physician reviews, however, to date no research has linked online ratings with quality of care. OBJECTIVE To compare a consumer-generated measure of physician quality (online ratings) with a clinical quality outcome (sanctions for malpractice or improper behavior), to understand how patients’ perception and evaluation of doctors differ based on the physician’s gender and quality. METHODS We use data from a large online doctor reviews website and the Federation of State Medical Boards. We implement paragraph vector methods to identify words that are specific to and indicative of the separate groups of physicians. We then enrich these findings by utilizing the NRC word-emotion association lexicon to assign emotional scores to the various segments: gender, gender and sanction, and gender and rating. RESULTS We find significant differences in the sentiment and emotion of reviews for male and female physicians. We find that numerical ratings are lower and the sentiment in text reviews is more negative for women who will be sanctioned than for men who will be sanctioned; sanctioned male doctors are still associated with positive reviews. CONCLUSIONS Conclusions: Given the growing impact of online reviews on demand for physician services, understanding the different reviews faced by male and female physicians is important for consumers and for platform architects in order to revisit their platform design.

Consumer background and composition on state medical boards: Who are these citizen members and do they adequately protect the public?

The composition and background of members of state medical boards, including public or citizen members, can impact the functionality and public perception of medical boards in the United States. This study analyzed the number of public members on each state medical board and their professional backgrounds or expertise to regulate the medical profession. The findings show that for nearly half of state medical boards public members comprise at least a quarter of their voting members; however, more than half of public members for all state medical boards have no measurable medical experience or background, including in patient safety. The need for public members to have medical expertise or background – especially in patient safety -- is discussed along with potential policy recommendations.

Protecting Patients from Egregious Wrongdoing by Physicians: Consensus Recommendations from State Medical Board Members and Staff

ABSTRACT Purpose There is wide variability in the frequency and severity of disciplinary actions imposed by state medical boards (SMBs) against physicians who engage in egregious wrongdoing. We sought to identify cutting-edge and particularly effective practices, resources, and statutory provisions that SMBs can adopt to better protect patients from harmful physicians. Main findings Using a modified Delphi panel, expert consensus was reached for 51 recommendations that were rated as highly important for SMBs. Panelists included physicians, executive members, legal counsel, and public members from approximately 50% of the 71 SMBs that serve the United States and its territories. Conclusion The expert-informed list of recommendations can help support more effective and transparent actions and processes by SMBs when addressing suspected egregious wrongdoing. While some SMBs may be limited in what policies and provisions they can adopt without approval or assistance from state government, many of these recommendations can be autonomously adopted by SMBs without external support.

FSMB Census of Licensed Physicians in the United States, 2020

ABSTRACT There are 1,018,776 licensed physicians in the United States and the District of Columbia, representing a physician workforce that is 20% larger than it was a decade ago, according to data from 2020 compiled by the Federation of State Medical Boards (FSMB). The licensed physician population has grown in number relative to the total population, but concerns about a doctor shortage remain as both the general and physician populations age. Late career physicians generally work fewer hours and retire at higher rates, while younger physicians place more emphasis on work-life balance that may also limit work hours, even as many older physicians have delayed retirement in recent years. The mean age of licensed physicians is now 51.7 years, a year higher than it was in 2010. The physician workforce is increasingly mixed in gender and type of physician, with more women and more individuals with Doctor of Osteopathic Medicine (DO) degrees, specialty board certification and international medical degrees than a decade ago. The ability to inventory a nation’s health care workforce across all specialties and jurisdictions is essential to the delivery of quality health care where it is needed most. This paper marks the FSMB’s sixth biennial census of licensed physicians in the United States and the District of Columbia and provides valuable information about the nation’s available physician workforce, including information about medical degree type, location of undergraduate medical education, specialty certification, number of active licenses, age and sex. As the impact of the COVID-19 pandemic on the United States is not yet fully known, this report should help state medical boards as they consider changes to their statutes and regulations to facilitate telemedicine and licensure portability after the pandemic ends and before another national public health emergency.

Demanding Better: A Case for Increased Funding and Involvement of State Medical Boards in Response to America’s Drug Abuse Crisis

ABSTRACT The federal response to the U.S. drug overdose epidemic has largely focused on supply-reduction efforts. Yet, this response has led to serious consequences for patients, prescribers and the public. Specifically, demand-reduction activities have been inadequately prioritized and pursued, and supply-reduction efforts targeted at the prescribers of controlled medications have resulted in reluctance to prescribe medically necessary controlled medications, thereby compromising access to treatment. Meanwhile, overdose death rates have remained tragically high as unabated demand has yielded shifts in the supply of substances of abuse. This article reviews federal responses to the opioid crisis, examining the allocation of federal funding as well as the U.S. Department of Justice’s enforcement actions against health care providers. The article then provides recommendations for how state medical boards can be better utilized in responding to the overdose epidemic. These recommendations include requiring that state medical boards be the primary investigators of questions relating to medical need, allocating federal funding to state medical boards, instituting continuing medical education requirements for controlled medication prescribers and expanding screenings for problematic substance use.

Pass/Fail Scoring of USMLE Step 1 and the Need for Residency Selection Reform

The Federation of State Medical Boards and the National Board of Medical Examiners recently announced a change in the United States Medical Licensing Examination Step 1 scoring convention to take effect, at the earliest, on January 1, 2022. There are many reasons for this change, including decreasing medical student stress and incentivizing students to learn freely without solely focusing on Step 1 performance. The question remains how this will affect the future of the otolaryngology–head and neck surgery match. By eradicating Step 1 grades, other factors, such as research, may garner increased importance in the application process. Such a shift may discriminate against students from less well-known medical schools, international medical graduates, and students from low socioeconomic backgrounds, who have fewer academic resources and access to research. Residency programs should try to anticipate such unintended consequences of the change and work on solutions heading into 2022.

An Evaluation of the Vulnerable Physician Workforce in the United States During the Coronavirus Disease-19 Pandemic

BackgroundThe coronavirus disease-19 (COVID-19) pandemic threatens to overwhelm the healthcare resources of the country, but also poses a personal hazard to healthcare workers, including physicians. To address the potential impact of excluding physicians with a high risk of adverse outcomes based on age, we evaluated the current patterns of age of licensed physicians across the United States.MethodsWe compiled information from the 2018 database of actively licensed physicians in the Federation of State Medical Boards (FSMB) across the US. Both at a national- and the state-level, we assessed the number and proportion of physicians who would be at an elevated risk due to age over 60 years.ResultsOf the 985,026 licensed physicians in the US, 235857 or 23.9% were aged 25-40 years, 447052 or 45.4% are 40-60 years, 191794 or 19.5% were 60-70 years, and 106121 or 10.8% were 70 years or older. Age was not reported in 4202 or 0.4% of physicians. Overall, 297915 or 30.2% of physicians were 60 years of age or older, 246167 (25.0%) 65 years and older, and 106121 (10.8%) 70 years or older. States in the US reported that a median 5470 licensed physicians (interquartile range [IQR], 2394 to 10108) were 60 years of age or older. Notably, states of North Dakota (n=1180) and Vermont (n = 1215) had the lowest and California (n=50786) and New York (n=31582) the highest number of physicians over the age of 60 years (Figure 1). Across states, the median proportion of physicians aged 60 years and older was 28.9% (IQR, 27.2%, 31.4%), and ranged between 25.9% for Nebraska to 32.6% for New Mexico (Figure 2).DiscussionOlder physicians represent a large proportion of the US physician workforce, particularly in states with the worst COVID-19 outbreak. Therefore, their exclusion from patient care will be impractical. Optimizing care practices by limiting direct patient contact of physicians vulnerable to adverse outcomes from COVID-19, potentially by expanding their participation in telehealth may be a strategy to protect them.