States called lax in reviewing inactive doctors

Many state medical boards don't ask physicians about their clinical activity status, allowing license renewal even though a doctor may not have treated a patient in years, according to a report in the February Pediatrics.

A second report in the same issue showed that roughly one in eight pediatricians has put his or her practice on hold for a year or longer. The study said about 30% of the pediatricians surveyed think physicians who return to practice after an absence of a year or more should be re-evaluated.

"The most important number that we found was that 34% [of state boards] query physicians' clinical activity status at both licensure and renewal," said Gary L. Freed, MD, MPH, lead author of both studies and chief of the division of general pediatrics and director of the Child Health Evaluation and Research Unit at the University of Michigan Health System. "That means that 66% don't."

Representatives from 64 state boards in allopathic and osteopathic medicine completed the survey concerning medical boards. More than 4,600 pediatricians 65 or younger were surveyed for the report on pediatrician clinical activity.

Measuring up

Dr. Freed said specialty boards are ahead of state medical boards in assuring physician competency. They require physicians to undergo more stringent and ongoing evaluation procedures to maintain board certification.

"If [physicians] are not participating in maintenance of certification or other activities to continuously demonstrate their knowledge and other acts of practice, then what really are we licensing them for?" he said. "I think the states could take a bit of a lesson from the [specialty] boards and hopefully begin to work with them more effectively to provide more information to the public that can be meaningful."

In 2003, the Federation of State Medical Boards formed a special committee to study maintenance of licensure. The following year, the FSMB's house of delegates adopted policy that boards are responsible for ensuring the ongoing competence of doctors seeking relicensure. At the federation's 2008 meeting, delegates recommended additional research into the impact a draft policy would have on state medical boards, licensed physicians and other stakeholders.

Most recently, an FSMB board meeting in mid-February addressed the model policy. Spokesman Drew Carlson said an update would be given to FSMB delegates in May.

The policy would recommend that state licensing boards require physicians applying for relicensure to complete a self-evaluation and practice assessment, show ongoing competence in areas such as patient care and medical knowledge, and be tested in their practice areas.

If delegates adopt the policy, it would be left to each board to adopt the recommendation, which also would require approval by state legislators.

"They have a very strong state's rights issue to deal with, but the sense I get is that there's enough public awareness and outcry for this kind of approach," said Michael Hagen, MD, vice president of Assessment Methods Development for the American Board of Family Medicine. "I think the state boards will ultimately all go down this line, but it will probably take quite a long period to accomplish it."