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North Dakota seems to discipline a lot of its doctors. Based on data obtained from the Federation of State Medical Boards (FSMB) on the number of disciplinary actions taken in 2000 against doctors, the Public Citizen’s Health Research Group has calculated the rate of serious disciplinary actions (revocations, surrenders, suspensions and probation/restrictions) per 1,000 doctors in each state and compiled a national report ranking state boards by number of serious disciplinary actions taken against them.
The calculation of rates of serious disciplinary actions (revocations, surrenders, suspensions, and probations/restrictions) per 1,000 doctors by state is created by taking the number of such actions and dividing it by the American Medical Association data on nonfederal physicians as of December 1999, then multiplying the result by 1,000 to get state disciplinary rates per 1,000 physicians.
Nationally, there were 2,746 serious disciplinary actions taken by state medical boards in 2000, up slightly from the 2,696 serious actions taken in 1999. However, there were more physicians practicing in 2000, and the rate per 1,000 physicians was essentially the same in the two years: 3.50 serious actions per 1,000 physicians in 1999 and 3.49 in 2000. State rates ranged from 12.43 serious actions per 1,000 doctors (North Dakota) to 0.85 per 1,000 physicians (Idaho), a 14.6-fold difference between the best and worst states.
Public Citizen points out that if all the boards did as good a job as the lowest of the top five boards, the lowest rate for No. 5, Oklahoma being 6.68 serious disciplinary actions per 1,000 physicians or 0.668%, this would amount to a total of 5,255 (0.668% of 786,685 nonfederal doctors) serious actions a year. This is 1.9 times as many (2,509 more serious actions) than the 2,746 that actually occurred in 2000.
These were the bottom 15 states, those with the lowest serious disciplinary rates in 2000, starting with the lowest: Idaho (0.85 per 1,000 physicians), South Dakota (1.24), Hawaii (1.33), Delaware (1.39), Minnesota (1.53), Massachusetts (1.58), Illinois (1.67), Washington (1.78), Montana (1.91), New Mexico (2.13), Maryland (2.21), Nebraska (2.39), Texas (2.42), Kansas (2.53), and West Virginia (2.54). Of the 15 states with the worst disciplinary records, eight of them, Massachusetts, Illinois, Maryland, Washington, Minnesota, Kansas, Hawaii, and Delaware also were in the bottom 15 states in 1999 and 1998. In 2000, the bottom 24 states all had rates of serious disciplinary action that were one-half or less than the rate of all of the top five states.
Public Citizen says these data raise serious questions about the extent to which patients in many states with poorer records of serious doctor discipline are being protected from physicians who might well be barred from practice in states with boards that are doing a better job of disciplining physicians. "It is likely that patients are being injured or killed more often in states with poor doctor disciplinary records than in states with consistent top performances," the group says.
The top 10 states, or those with the highest rate of serious disciplinary actions per 1,000 physicians are: North Dakota (12.43 per 1,000 physicians), Alaska (11.47), Kentucky (8.51), Wyoming (8.10), Oklahoma (6.68), Utah (6.27), Arizona (6.18), Ohio (5.89), Georgia (5.35), and New York (5.08). Four of these 10 states (Alaska, Oklahoma, Wyoming, and Ohio) also were in the top 10 in 1998 and 1999, and one state, Alaska, has been in the top 10 for 10 straight years. Oklahoma, fifth this year, has been in the top 10 states for nine of the last 10 years. Wyoming, fourth this year, has been in the top 10 for eight of the last 10 years and Ohio, eighth this year, have been in the top 10 for six of the last 10 years.
Only two of the nation’s 15 largest states, Ohio, and New York, are represented among those 10 states with the highest disciplinary rates. Other large states such as Michigan and California (14th and 19th respectively in 2000) have shown improvement from 40th and 37th in 1991. But other large states such as Texas, Illinois, and Massachusetts (38th, 44th, and 45th in 2000) have not disciplined much of the last 10 years.