About Physician Discipline
How State Medical Boards Regulate Physicians after Licensing
The ongoing duty of a state medical board goes far beyond the licensing and ongoing registration of physicians. Boards also have the responsibility of determining when a physician’s professional conduct or ability to practice medicine warrants modification, suspension, or revocation of a license to practice medicine. Boards safeguard the public by disciplining physicians who engage in unprofessional, improper, or incompetent medical practice.
Boards review and investigate complaints and/or reports received from patients, other state medical boards, health professionals, government agencies and health care organizations about physicians who may be incompetent or acting unprofessionally, and take appropriate action against a physician’s license if the person is found to have violated the law. State laws require that boards ensure fairness and due process to any physician under investigation.
Board members devote much time and attention to overseeing the practice of physicians. When a board receives a complaint about a physician, the board has the power to investigate, hold hearings and impose discipline, including suspension, probation or revocation of a physician’s license, public reprimands, and fines.
While medical boards find it necessary to suspend or revoke licenses when appropriate, some problems can be resolved with additional education or training in appropriate areas. Boards may place restrictions on a physician’s license or put a physician on probation to protect the public while the physician receives special training or rehabilitation aimed at an existing issue.
What Is Considered Unprofessional Conduct?
Each state’s Medical Practice Act defines unprofessional conduct within the state. Although laws vary from jurisdiction to jurisdiction, some examples of unprofessional conduct include the following:
- Alcohol and substance abuse
- Sexual misconduct
- Neglect of a patient
- Failing to meet the accepted standard of care in a state
- Prescribing drugs in excess or without legitimate reason
- Dishonesty during the license application process
- Conviction of a felony
- Fraud
- Inadequate record keeping
- Failing to meet continuing medical education requirements
In cases in which it is determined that a physician must face disciplinary action, state medical boards issue mandates or actions known as “board orders.” The board order stipulates which disciplinary actions are to be taken against the physician. These actions represent a wide variety of forms of discipline, ranging from being required to take a continuing medical education course to having one’s license revoked. Boards also issue board orders for less serious issues or administrative problems, such as when a physician is late in renewing his or her license.
Understanding Board-Action Categories
State and territorial medical boards utilize a variety of tools as they go about the process of regulating the activities of physicians and other health professionals. When issues arise — whether they are minor, such as failure to pay a fee, or more serious, such as inappropriate behavior with a patient — board actions may be taken by state boards, allowing them the flexibility to apply a level of disciplinary response that is appropriate for the issue being addressed. Categories of board actions include:
Administrative action: Non-punitive action that does not result in the modification or termination of a physician’s license. These actions are generally administrative and may be issued for reasons such as failure to pay a licensing fee.
Fine: In some cases, state boards may levy a monetary penalty against a physician.
CME required: Physician is required to complete continuing medical education (CME).
Conditions imposed: Physician must fulfill certain conditions to avoid further sanction by the state board.
License denied: Physician’s application for a medical license or renewal of a current license is denied.
License restricted: Physician’s ability to practice medicine is limited (e.g., loss of prescribing privileges).
License revoked: Physician’s license is terminated; individual can no longer practice medicine within the state or territory.
License surrendered: Physician voluntarily surrenders medical license, sometimes during the course of a disciplinary investigation.
License suspended: Physician may not practice medicine for a specified period of time, perhaps due to disciplinary investigation or until other state board requirements are fulfilled.
Probation: Physician’s license is monitored by a state board for a specified period of time.
Reprimand: Physician is issued a warning or letter of concern.
The Rights of Physicians under Investigation
Whatever the complaint, physicians are afforded the right of due process as a state medical board investigates an allegation of unprofessional conduct.
Due process asserts that an individual is innocent until proven guilty. This principle applies to formal hearings and judicial procedures that the medical board conducts. Boards must adhere to established rules and principles to ensure that a physician is not treated unfairly, arbitrarily or unreasonably. In instances when the alleged behavior threatens patients with immediate harm, such as sexual misconduct or impairment from alcohol or drug abuse, boards have authority to issue an emergency suspension until the investigation of the physician is completed.
Understanding the Difference between a Medical Board Disciplinary Action and Malpractice
The differences between a disciplinary action taken by a medical board and a malpractice judgment or settlement against a physician are significant.
Board actions and malpractice claims are two different things. Board actions are issued against physicians after a formal process of complaint, investigation, and hearing. While an action taken by a medical board against a physician indicates that a violation of the Medical Practice Act has occurred, malpractice claims are not always reliable measures of a physician’s competence or a violation of the law. Issues such as a physician’s time in practice, the nature of the physician’s specialty, the types of patients treated, and geographic location can have a significant influence on the number and amounts of malpractice judgments and settlements.
Malpractice settlements are sometimes handled by insurance companies who opt for settlement based on the terms of coverage, not the validity of the underlying claim. These terms may also authorize settlement of a claim without any consultation of the physician involved or an ultimate determination of fault.
It is common practice for medical boards to use malpractice data as a tool to detect unprofessional conduct that may violate the Medical Practice Act. Some boards have built-in levels of malpractice that trigger investigations, such as a certain number of malpractice settlements in a certain span of time.
How State Medical Boards Share Information about Disciplined Physicians
All state medical boards engage in an ongoing, cooperative effort to share licensure and disciplinary information with one another by regularly contributing data to the FSMB’s Physician Data Center (PDC) — a comprehensive data repository that contains information about all of the actively licensed physicians in the United States and its territories, as well as board disciplinary actions dating back to the early 1960s.
The PDC collects, maintains, and reports on an ongoing basis all disciplinary actions taken against physicians. It is updated continuously, and includes disciplinary actions taken by state medical boards as well as actions taken by other entities — ranging from U.S. government agencies, such as the Department of Health and Human Services, to international licensing authorities.
When the FSMB receives board orders or disciplinary reports, it matches them to existing records in the PDC. In total, the PDC contains more than 2 million physician records, including information about physicians who are currently licensed, no longer licensed or deceased.
How the FSMB Uses National Disciplinary Information to Assist State Medical Boards
The FSMB provides services that draw upon its repository of data on disciplinary actions to bolster state board efforts to protect the public. One of the key services is the FSMB Disciplinary Alert Service (DAS), which was created to alert state boards when one of their physicians receives disciplinary action in another state.
Many physicians, including those who have been disciplined, hold licenses in more than one state. To prevent them from changing jurisdictions undetected, medical boards voluntarily share licensee data with the FSMB’s Physician Data Center (PDC). This information enables the DAS to proactively notify boards within 24 hours when one of their licensees has been disciplined in another state or territory. The notified board can then initiate its own actions. State boards typically receive thousands of alerts from the FSMB’s Disciplinary Alert Service each year.
Medical boards have used the information provided by the DAS in many different ways, including:
- Revoking the licenses of dangerous physicians
- Identifying physicians who try to quietly move to a different state without reporting an action taken against them in another state
- Detecting physicians attempting to escape the probation requirements of another jurisdiction
- Ensuring physicians with substance abuse problems relocating to a new state continue monitoring and treatment under the auspices of a state medical board
The Importance of Reporting
While the overwhelming majority of patient-physician interactions that occur each day in the United States are conducted in an appropriate and professional manner, state medical boards recognize that issues such as physician alcohol and substance abuse, fraud, incompetence and sexual misconduct exist. These issues are taken very seriously by state medical boards, which in recent years have advocated for strengthened reporting requirements to ensure individuals or organizations who are aware of, or witness, inappropriate behavior come forward to report the problem. Physicians, hospitals, law enforcement agencies and consumers all can help reduce future issues by reporting inappropriate behavior.
To help address the issue of under-reporting, the Federation of State Medical Boards House of Delegates unanimously adopted new policy in 2016 that urges physicians, hospitals and health organizations, insurers and the public to be proactive in reporting instances of unprofessional behavior to medical boards whenever it is suspected. In some states’ Medical Practice Acts, the duty to report issues that may impact patient safety — including inappropriate or unprofessional conduct — is included as a formal requirement of physicians. Consumers must feel safe and secure in any medical interaction, and they should always speak up if they suspect inappropriate behavior. Information and tips to help consumers are provided in the next section.
The occurrence of sexual boundary violations between physicians and patients is a particularly serious issue, as is sexual harassment between physicians and their peers, subordinates, and other health care team members. Recent high-profile cases of physician misconduct have created greater public awareness and reinforced the need for better reporting and strong oversight by state medical boards to protect the public. The FSMB’s House of Delegates passed new policy recommendations regarding Physician Sexual Misconduct in 2020, intended to help address the issue on many levels – including the development of more effective reporting mechanisms.