Long story short: chances are you don't know what you'd like to.
Consumer Reports did a deep dive on the actions of the California medical board, obtaining their entire database of doctors on probation. They had to file a public records request to obtain it, since the medical board originally refused their request, claiming release of the information "...would put too much of a burden on doctors and damage the doctor-patient relationship."
Funny, you'd think truth would be good for a relationship, apparently not for the doctor-patient one.
The good news is that out of about 100,000 doctors in California, only 440 were on probation. The bad news is two-fold: we don't know how many other doctors should on probation, and the case studies of the doctors practicing while on probation are pretty scary. Here are a few of Consumer Reports' examples:
- An orthopedist whose "gross negligence" lead to incorrect treatment which ultimately required a patient's leg to be amputated. The doctor received three years probation.
- A pediatrician who had at least 30 reported sexual misconduct situations with patients/parents within a 12 month period. He got eight years probation.
- A gastroenterlogist who even the Board agreed was giving unnecessary endoscopies and substandard care. He's on his third round of probation.
The trouble is that ordinary citizens can't usually find this kind of information. Consumer Reports rated all the state medical board websites, from bad to worse (ironically, California's was rated one of the "best"). At best the state boards don't make the information easy to find, and at worst don't make it available at all.
Much of the information, as well as information on malpractice suits, is available on the National Practitioner Data Base (NPDB), but -- by law -- that information is only available at a practitioner level to health care organizations, like hospitals or health plans. The public can access a Public Use Data File, which "...does not include any information that identifies individual practitioners or reporting entities. The file is designed to provide data for statistical reporting and analysis only."
Apparently we might care about physician bad behavior in aggregate but not about our own doctor.
The AMA has always been against public access to NPDB, reiterating to Consumer Reports that it is "inherently flawed." In true U.S. health care system fashion, rather than trying to fix those flaws they seem to prefer just not letting us even see the data, even though health care organizations use it.
Consumer Reports' survey found that 82% of us want doctors to have to tell patients if they are on probation, and 66% don't think doctors should even see patients while they are on probation, so evidently we do care. A lot.
Of course, this is the tip of the iceberg. In California, Consumer Reports found that in the last year there were 8,267 official complaints to the medical board. Of those, only 1,381 cases were opened. That resulted in 45 license revocations, 85 "voluntary" surrenders of licenses, 136 probations, and 86 reprimands. And I'll bet those reprimands were sternly worded too.
The question is, of course, what happens to all the complaints that didn't get a case opened, or to the cases that didn't result in a disciplinary action? Maybe they were groundless, but a former head of the NPDB told Consumer Reports that boards are often reluctant to take action because: "They're run mostly by doctors, and they are often reluctant to take actions against physicians unless they get a lot of pressure, or if something comes out in the press."
Moreover, the state boards vary about as much as 4-to-1 in how often they discipline physicians, according to a new study by the University of Michigan Medical School. On average, the study found, there were 3.75 actions each year for every 1000 practicing physicians, ranging from 7.93 in Delaware to 2.13 in Massachusetts. "Serious" actions -- and I'd like to know what actions aren't "serious" -- average 1.15 per 1000 physicians, ranging from 2.71 in Delaware to 0.64 in New York.
I'm not sure if this suggests there are more bad doctors in Delaware, or if their medical board is just more on the ball.
The UM authors note that state boards have "wide discretion" in when and how to discipline, and ask: "Ultimately don't we want all doctors operating in the same ethical way, and being disciplined appropriately if they fail to do so?" I know I do.
Meanwhile, Public Citizen took their own crack at the NPDB, focusing on physicians with reported sexual misconduct. They found that about 18% of physicians with a clinical privilege or malpractice report relating to sexual misconduct were not also disciplined by their state medical board, even though the information was available in NPDB. One of the lead authors charged that: "It's clear that medical boards are allowing some doctors with evidence of sexual misconduct to continue endangering patients and staff."
Pretty harsh words, even for Public Citizen.
Look, I'm not casting aspersions on physicians generally. Unlike more widespread questionable behavior like taking money from drug companies, the vast majority of physicians aren't doing things that should require action from their licensing board. There is a small minority of people who happen to be physicians doing bad things -- just as there is in every profession -- and our challenge is to identify them and stop them from harming patients.
On the other hand, I do blame the medical boards and their trade associations, like the AMA. I've written before about their cartel-like behavior, which suggests they are much more about protecting physicians' economic interests than patients. Otherwise, why put up barriers to patients being able to find out whether their physician is on probation, and for what? The odds are low that she/he will be, but isn't it better to know than not to know?
If having conversations about a disciplinary status would put a "burden" on physicians, well, maybe they'd try harder not to deserve it.