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State rankings on doctor discipline end with FSMB’s halting of reports

For decades, a press release of the Washington DC-based Health Research Group (HRG) grabbed attention each year with its rankings of state medical boards based on the rates of revocations, suspensions, and other serious discipline in each state. But no more.

Beginning in 2013, the Federation of State Medical Boards, which collects discipline data from individual states, opted to drop the “Annual Summary of Board Actions” report that allowed HRG, part of Public Citizen, to develop its rankings.

Opinions differ, however, as to whether the disappearance of the rankings is good or bad. Were the comparisons and rankings valid?

The rankings were calculated by averaging the number of licenses that are revoked or suspended by a state board, then dividing by the number of doctors in the state. The metric, titled “serious actions per thousand physicians,” was well publicized in the press until the discontinuation of FSMB’s report. Public Citizen has argued that the federation intentionally terminated its own report to prevent HRG from publishing the ranking report, due to complaints from state medical boards.

Michael Carome, director of Public Citizen’s Health Research Group, contends FSMB’s decision to discontinue the report was a calculated maneuver to “prevent our group and other groups like us from doing these rankings, presumably because of unhappiness from members of state medical boards and members from the organization (FSMB) when they were ranked poorly.”

The FSMB denies that it was motivated by a desire to stop Public Citizen from issuing its annual report on medical board discipline. In FSMB’s view, Public Citizen’s methodology did not address the full range of what medical boards do, and HRG misused the information in the FSMB report by basing a judgment of board effectiveness on numbers that could relate to an excess of bad doctors in a state.

The FSMB House of Delegates formally voted in 2012 to discontinue distribution of the Annual Summary of Board Actions report after gauging opinion within the medical regulatory community, says Lisa Robin, FSMB chief advocacy officer.

“Over the years following the report’s launch in the 1980s, many state medical boards added a variety of new programs and approaches to licensure and discipline that made the report and its methodology increasingly outmoded in terms of its relevance to state board activities.”

Boards’ rehabilitation and educational programs, partnerships with physician health programs, increased use of preventive non-disciplinary actions, and other new approaches didn’t fit well into the “board action” format, Robin said. “Public Citizen focused only on what it called “serious” disciplinary actions.” But “a less serious disciplinary action is not a ‘non-action.’ It still requires medical board resources and can be just as effective a tool in protecting the public.”

“Lower levels of discipline, such as a public letter of reprimand or a fine, are often enough to stop problem behavior, pre-empting further problems in the future.”

“Because of its structure, FSMB’s report was not able to validate through statistical evidence the positive impact of these developments on public safety,” thus decreasing its value in terms of providing an accurate assessment of state regulatory activity, Robin said.

The FSMB contends that rankings don’t include detailed contextual analysis of the environmental factors affecting each individual state. “The tremendous variance of the statutory, funding, judicial, and administrative environments among states makes it impossible to provide a meaningful ‘state-by-state’ report of physician disciplinary data,” Robin said.

Some boards did like the HRG rankings, according to Carome, and those boards tended to be the ones that ranked well. He maintains that the rankings were not meant to capriciously highlight medical boards struggling with disciplining their doctors, but to help the boards rectify the discipline shortfalls that often stemmed from inadequate resources.

“One of the things we have always said in our reports about boards performing poorly is the issue of inadequate staffing often goes hand-in-hand with inadequate funding,” Carome said. “Without the necessary resources, state boards are impaired in their ability to monitor physician activity or misconduct and to investigate fully when they get allegations of misconduct.”

The rankings, Carome pointed out, have given boards leverage for more funding so they could improve performance, or have helped justify current levels
of funding for boards that were performing well. While he believes many medical boards are failing in properly disciplining physicians, better oversight and increased funding would unquestionably improve the performance of medical boards across the U.S., Carome said.

In 2014, the FSMB released its first “National Medical Regulatory Trends and Actions report,” which includes data about a broad range of state medical board activities, providing what it believes is “a more contextually accurate and representative reporting of the structure and activities of state boards.”

The report, which will be updated in Fall 2016, is available at