Doctor discipline inches up but still off 14% from peak

State medical boards across the country took 60 more disciplinary actions against physicians in 2008 than they did in 2007. That increase -- less than 1% -- was not enough to silence critics who argue the boards are not doing enough to protect patients from bad doctors.

State medical board officials said staffing levels and funding affect a medical board's ability to address complaints against physicians quickly and fairly.

One example: Kansas, where an 11% budget increase last year helped the state board begin to address a case backlog and more than double the number of disciplinary actions taken.

Nationwide, the 5,379 disciplinary actions boards took against physicians in 2008 halted a three-year slide, but still represented a 14% drop from a 2004 peak of 6,265 actions.

The Federation of State Medical Boards, which released its annual report of board disciplinary actions in April, cautioned that the figures should not be used to compare states but only to assess discipline within each state over time. Officials also downplayed the importance of the increase in disciplinary actions.

"I don't think it really means much," said Barbara S. Schneidman, MD, MPH, the federation's interim president.

An analysis of disciplinary data by Public Citizen, a consumer advocacy group, came to a different conclusion. Its report said serious disciplinary actions -- license restrictions or revocations -- showed no change in 2008, staying at a rate of 2.92 per 1,000 physicians. That is down 21% from the 2004 peak of 3.72 serious actions per 1,000 doctors.

The Public Citizen report noted a wide variation in states' disciplinary rates and said "there is considerable evidence that most boards are under-disciplining physicians."

Funding impact

In the case of Kansas, a March 2008 Topeka Capital-Journal investigation highlighted problems at the Kansas State Board of Healing Arts that led to statutory changes allowing the board to act on a case-by-case basis. Previously, investigators had to wait for a pattern to emerge.

The Kansas Legislature also authorized an additional $410,000 in funding, bringing the total budget to $3.6 million.

The board used the money to hire six lawyers and investigators to help address a backlog, doubling the actions taken, licenses revoked and licenses restricted in 2008.

Jerry Slaughter, executive director of the Kansas Medical Society, said the board has made great progress in addressing its backlog and being more transparent about investigations.

The board probably won't catch up with complaints until 2010, said the board's executive director, Jack Confer.

Millions in fees had been diverted to the state's general fund over the last few years, Confer said, and again this year the board is being threatened with budget cuts of as much as 10%.

AMA policy calls for all fees and charges collected by medical boards to fund board activities and says legislatures should appropriate more funding when necessary.

The FSMB has similar policy.

"It's a matter of public safety," said Kansas Sen. Jim Barnett, MD, who helped get his state board more funding last year. "State governments can't sweep funds away from boards and expect the same level of performance."