How well is the public protected from bad doctors? A new analysis unveils alarming results

A new analysis indicates that thousands of dangerous doctors are slipping through the cracks due to lax enforcement by state medical boards.

Wide variation in rates of serious disciplinary actions among the nation's 64 state medical boards suggests that "many (if not most) boards are doing a dangerously lax job in enforcing their states' medical practice acts," says a report of state medical board activity by the consumer rights advocacy group Public Citizen.

The researchers ranked 54 boards during 2021-2023, providing fodder for journalists to examine how vigorously these bodies execute their main job of protecting the public from clinicians who harm patients through abuse or substandard care.

Thirty-seven states and the District of Columbia have a single board that licenses all physicians, and 13 states have separate licensing boards for allopathic and osteopathic physicians. Ten boards were not ranked because they license fewer than 5,000 physicians.

The report found that physicians in Ohio, with the highest rate, were disciplined 11 times as often as physicians in neighboring Indiana, which had the lowest rate.

"There is no evidence that the observed differences in state disciplinary action rates can be explained by differences in the competence or conduct of the physicians practicing in the various states; therefore, the observed differences are likely related to the performance of the licensing boards," the report states.

Source: Public Citizen 2024 report. Graphic by Kevin Ridder

A national dip in disciplinary actions

Discouragingly, the national rate of serious disciplinary actions per 1,000 licensees dropped 12% to 0.81 during 2021-2023, from 0.92 in during a comparison period of 2019-2021.

Researchers used records of serious disciplinary actions from the National Practitioner Data Bank's Public Use Data File, which the authors defined as "those that had a clear impact on a physician's ability to practice." That included measures such as license revocations, suspensions, and voluntary surrenders or limitations while under investigation. Probation didn't count.

The researchers do not define an appropriate level of disciplinary action to protect the public, but they did assert that all boards have room for improvements.

No board reached a leading 2017-2019 rate of 2.29, set by Kentucky. If all boards had matched that standard, serious actions would have numbered 3,527 last year, versus the 1,196 actions that were actually taken.

The report calls out boards in two states for substantial backslides:

• Pennsylvania, which has the fifth largest number of licensed physicians in the country, had zero serious discipline actions in 2023. Both its allopathic and osteopathic boards fell in the national rankings in 2021-2023 from the prior period.
• California's allopathic board, which oversees 156,000 physicians-more than any other board - also dropped in the rankings. If that board had taken serious actions at the same rate as the Ohio board, it would have taken an average of 283 serious actions per year during the study period rather than its actual average of 113.

On the other hand, the researchers commend the West Virginia osteopathic board, which had the highest rates in the country of 2.46 during 2021-2023 and 3.00 during 2019-2021. That board was not ranked due to its small number of licensed physicians.

Wyoming, California's osteopathic board, and Nevada's allopathic board all moved up significantly in the rankings.

What to do with this data

• Report on the rigor with which physicians are disciplined in your state.
• Ask why enforcement gaps exist and what if anything the medical boards and the state legislature are doing to address them.
• Examine potential for reforms such as mandating the appointment of non-conflicted board members and requiring boards to query the National Practitioner Data Bank.