Close Up on State Medical Boards
State medical boards work to protect the public in part by disciplining physicians who fail to maintain professional standards. How they go about this crucial task varies from state to state, but the basic process is pretty much the same everywhere. “Boards review and investigate complaints,” explains the Federation of State Medical Boards (FSMB), “and take appropriate action against a physician’s license if the person is found to have violated the law. State laws require that boards assure fairness and due process to any physician under investigation.”
It sounds reasonable enough but the reality can be daunting. Many boards must review thousands of complaints each year to determine which ones fall within their jurisdiction and are worth further investigation. For each complaint that is pursued (and most are), boards must collect evidence, conduct interviews, weigh a myriad of factors and decide on appropriate discipline. The primary goal is to protect patients, but with trained physicians and board resources increasingly in short supply, boards are also eager to reduce costs and rehabilitate doctors willing and able to change.
How well the nation’s medical boards succeed in this difficult balancing act is an open question. There is anecdotal evidence on both sides—heartbreaking stories about patients suffering and dying because boards failed to take appropriate actions, and horrific stories of good doctors whose careers and lives have been ruined without just cause. As powerful as these individual stories are, they do not give us a reliable, evidence-based understanding of how the nation’s 70 individual boards do their work or how well. These are not questions that are easily or quickly answered, but they are worth serious consideration, which is what we try to give them in this issue.
“There’s really no way to evaluate boards. In medicine, the emphasis is on evidence-based decisions and outcomes. But when it comes to our boards, we don’t have that. There aren’t those statistics; there aren’t those measures.” — Kevin Cauley JD