How hard does your state crack down on physicians behaving badly? A new study finds that there's wide variation, with some states punishing wayward doctors more frequently while others seem to turn a blind eye, according to a new study published in BMJ Quality and Safety.
The states of Delaware, Ohio, and Kentucky have the highest rates for disciplinary actions against physicians, while New York, Massachusetts, and Connecticut have the lowest. The variation could indicate the need for a national body to replace state medical licensing boards, according to the authors (BMJ Qual Saf, March 23, 2016, pp. 1-8).
Researchers from the University of Michigan Health System analyzed data from 2010 to 2014 in the U.S. Department of Health & Human Services' National Practitioner Data Bank, which covers all 50 states and the District of Columbia. They combined the data with statistics on the number of doctors practicing in each state to come up with a yearly rate of disciplinary action per 1,000 doctors.
On a national level, they found an average rate of 3.75 disciplinary actions per year for every 1,000 physicians practicing -- a rate that included 1.15 serious disciplinary actions per 1,000 physicians.
But when they broke the data down by state, they found a big variation. Delaware topped the list of states that cracked down the hardest, with 7.93 disciplinary actions of any type per 1,000 physicians. That compares to the most lenient state, Massachusetts, with a rate of 2.13 disciplinary actions of all types per 1,000 doctors.
Similar trends were found with major disciplinary actions, with Delaware again leading the enforcement pack with 2.71 major actions per 1,000 physicians, while New York was the most lenient in major actions, with just 0.64 actions per 1,000 doctors.
Statistics for states at the high and low end of the disciplinary scale are as follows:
| Average disciplinary rates by state per 1,000 doctors | ||
| State and rank on scale of disciplinary actions | All disciplinary actions per 1,000 physicians | Major disciplinary actions per 1,000 physicians |
| 1. Delaware | 7.93 | 2.71 |
| 2. Ohio | 7.57 | 1.27 |
| 3. Kentucky | 7.49 | 1.88 |
| 4. Nevada | 6.54 | 1.40 |
| 5. Maryland | 5.87 | 1.66 |
| All states | 3.75 | 1.15 |
| 46. New Jersey | 2.67 | 1.03 |
| 47. Pennsylvania | 2.34 | 1.53 |
| 48. Connecticut | 2.33 | 0.65 |
| 49. New York | 2.32 | 0.64 |
| 50. Massachusetts | 2.13 | 0.96 |
Without a national body governing physician behavior, there is bound to be variation in disciplinary rates, as state medical boards act essentially as self-governing bodies, the study authors noted. This can lead to "wide discretion" in the types of punishment doled out for different violations.
"In one state, the punishment for a particular violation could be a fine, while in another state you could lose your license for doing the same thing," co-author Dr. Elena Byhoff said. "It has implications for the ability of physicians to move from state to state," if their punishment in one state is not enough to keep a hospital or practice in another state from hiring them.
The researchers hope their study helps push the U.S. toward a system in which a national body governs physician behavior, as is the case in much of the rest of the world. They noted that Australia recently switched toward a national body after decades with a state-based system.
