Your board gave you your license; it can also take it away
State medical boards decide who is and is not allowed to practice medicine. 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 physician’s license to practice. Considering how significant these actions are to physicians throughout the United States, and to everyone involved in the health care system, it is startling that so many know so little about board oversight.
Most physicians make it to retirement without ever bothering to learn the ins and outs of board discipline. But thousands each year are not so fortunate. It is only when these practitioners run afoul of the board that they begin to learn, often painfully, what they should have known all along about how the board disciplines the physicians it licenses.
The same but different. While the various state boards are more alike than they are different, no two are exactly the same. All board members are appointed by the governor of the state, and according to the Federation of State Medical Boards (FSMB), all boards “investigate complaints from consumers, discipline physicians who violate the law, conduct physician evaluations and facilitate physician rehabilitation when appropriate.” But the composition of each board, its jurisdiction, procedures, resources and reporting structure, even its official name—all are decided state by the state. For example:
- The Washington State Board has 21 members, 13 of whom are physicians, while Mississippi’s board has 11 members, including eight MDs.
- In Alabama, the board investigates complaints against medical doctors and doctors of osteopathy only. The Texas board has jurisdiction over physicians, physician assistants, acupuncturists and surgical assistants. Mississippi also includes podiatrists and radiologist assistants.
- While you can find each board online simply by searching for “state medical board,” official designations vary. Depending on where you live, your search might take you to the Connecticut Medical Examining Board, the Mississippi State Board of Licensure, or the Florida Board of Medicine.
What remains consistent nationwide is the obligation of boards 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, boards are notified by law enforcement, the courts and other government agencies about any relevant criminal or civil actions.
How far any one complaint is pursued is determined by board staff according to established procedures. Again, the details vary from state to state, but the overall process is pretty much the same everywhere (for more about this, see the PBI Field Guide to the Legal Landscape elsewhere on this site).
If the board decides to investigate the complaint, its investigators pursue many of the same avenues that police do when investigating a criminal complaint, and with much the same authority. Board investigators conduct interviews, gather and analyze evidence and at least 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 board has broad latitude in determining what kind of disciplinary action is called for. The primary goal is always to protect the health and safety of the public within the confines of Administrative Law. In other words, boards have authority over physicians’ ability to practice medicine, but they can’t put anyone in jail or compensate victims for pain and suffering. The former is a matter for the criminal justice system, the latter for civil court (where malpractice suits are adjudicated).
In the most extreme cases, of course, boards may suspend a doctor’s license for a period of months or years, or revoke it entirely. But if the infraction involved is relatively minor—failure to pay a licensing fee, for instance—the board can take non-punitive administrative action that does not directly affect the physician’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 board may require the physician to complete specific continuing medical education (CME) courses, undergo treatment at a state Physician Health Program, 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 doctor can be placed on probation for a period of time to help ensure that the rehabilitation has had more than a momentary impact.
Boards can also decide that a physician should be allowed to return to practice, but only under certain conditions. A doctor may be forbidden to see patients of the opposite sex, for instance, or required to see patients only when accompanied by a trained chaperon. A restricted license might mean the physician can no longer prescribe controlled substances or perform certain procedures. Failure to abide by such requirements and restrictions can result in loss of license.
Boards cannot take any of these actions without due process, with one exception. If the board believes that a physician is so impaired physically or mentally that they pose an imminent threat to the public, it can suspend their license immediately, pending a hearing in the near future.