Regulatory Power

Regulatory Power

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Discipline

Your Regulator Granted You Your License. They Can Also Take It Away.

U.S. and Canadian regulators decide who is and is not allowed to practice medicine in their jurisdiction. They alone are authorized to grant licenses to those they consider qualified, place restrictions on licenses when they deem it necessary, and in the most serious cases, suspend or even revoke a clinician’s license to practice. Considering how significant these actions are to every licensed healthcare professional, it is startling that so many know so little about how their profession is regulated.

The Same, But Different

While the various state, provincial, and territorial regulators more alike than they are different, no two are exactly the same. All regulators investigate complaints from members of the public, discipline clinicians who violate the law or behave unprofessionally, evaluate clinicians, and mandate remedial actions, as appropriate. But the composition of each regulatory agency, its jurisdiction, procedures, resources, and reporting structure, even its official name—all are decided at the local level. For example:

The Washington State Medical Commission is composed of 21 members (13 physicians, two physician assistants, and six public members), while the College of Physicians and Surgeons of British Columbia has 15 members (eight physicians and seven members of the public).

In Alabama, the Alabama Board of Medical Examiners investigates complaints against medical doctors and doctors of osteopathy, physician assistants, certified registered nurse practitioners, and certified nurse midwives. The College of Dental Surgeons of British Columbia has jurisdiction over certified dental assistants, dental therapists, and dentists practicing in British Columbia, Canada.

You will find links to all U.S. state medical boards on the website for the Federation of State Medical Boards (FSMB). Links for Canadian provincial and territorial regulatory authorities can be found on the website for the Medical Council of Canada (MCC).

All regulators investigate complaints from members of the public, discipline clinicians who violate the law or behave unprofessionally, evaluate clinicians, and mandate remedial actions as appropriate.

What remains consistent is each regulator’s obligation to review all complaints about those under their jurisdiction. Virtually anyone can file a complaint—patients, peers, staff, hospitals, clinics, pharmacists, insurance companies. In addition, regulators are notified by law enforcement, the courts, and other government agencies of any relevant criminal or civil actions.

If regulators decide to investigate a complaint, they pursue many of the same avenues that law enforcement do when investigating a crime, and with much the same authority. Regulatory investigators conduct interviews, gather and analyze evidence, and, in some jurisdictions, issue subpoenas. They also work together with federal, state, and local law enforcement when appropriate.

Once the investigation is completed and a decision is reached, the regulator has broad latitude in determining what kind of disciplinary action is called for. In the most extreme cases, they may suspend a clinician’s license for a period of months or years to revoke it entirely. If the infraction involved is relatively minor – failure to pay a licensing fee, for instance – the regulator can take non-disciplinary action that doesn’t directly affect the clinician’s license at all. Reprimands, usually involving a warning or letter of concern, are common, fines less so.

When the offense falls somewhere between these two extremes, as most do, the regulator may require the clinician to complete specific Continuing Medical Education (CME) courses, undergo treatment at an approved Physician Health Program (PHP), or take some other remedial step before being allowed to return to practice. Rehabilitation is not an option a board offers lightly. Outside evaluators are often consulted first to determine if the physician is likely to be helped by such measures, and once the program is completed, the clinician may be placed on probation for a period of time to help ensure that the remedial effort has had lasting impact.

Regulators can also decide that a clinician should be allowed to return to practice, but only under certain conditions. They may be forbidden to see patients of the opposite sex, for instance, or required to see patients only when accompanied by a trained chaperone. A restricted license might mean the clinician can no longer prescribe controlled substances or perform certain procedures. Failure to abide by such requirements and restrictions can result in loss of license.

Regulators cannot take any of these actions without due process, with one exception. If they believe that a clinician is so impaired physically or mentally that they pose an imminent threat to the public, they can suspend their license immediately, pending a hearing.

Many clinicians retire without learning the ins and outs of regulator discipline. However, each year, several others are not so fortunate. Even those facing relatively minor complaints can quickly find themselves in deep water, struggling to understand what happened. Each of their stories and experiences are unique, but a common thread they express is how they wish they’d learned how to protect their license at the beginning of their career.