WASHINGTON – Maryland’s medical board was again ranked among the worst states in the nation when it came to disciplining physicians last year, continuing a 10-year trend, according to a ranking released this week.
But the state’s medical board and medical society defended the system, with one official saying the Public Citizen report that ranked Maryland 42nd is “demonstrably wrong.”
“It is Public Citizen’s usual silliness, which is demonstrably wrong,” said T. Michael Preston, executive director of MedChi, the state’s medical society. “They calculate the number of disciplinary actions with the wrong denominator.”
To rank the states, Public Citizen divides the number of physicians licensed in each state by the number of serious disciplinary actions each board has taken. But with three of the top medical schools and many government research centers in Maryland, the number of doctors who are licensed here is twice as large as the number who actually practice here, Preston said.
But Dr. Sidney Wolfe, director of the Public Citizen study, said Maryland is just making excuses.
“That’s a silly argument that other states use too,” Wolfe said. It is more accurate to calculate the level of discipline by using the total number of licensed physicians, he said, since every doctor licensed by the state should be susceptible to discipline.
Wolfe doubted that Maryland’s ranking would change significantly if only practicing physicians were counted, but Preston said such a formula would boost Maryland into the top tier of states.
The executive director of Maryland’s Board of Physician Quality Assurance, which is charged with disciplining doctors in the state, conceded the number of disciplinary actions it takes is low.
“I agree we have some work to do there,” said C. Irving Pinder Jr. “But at the same time you have to look at a couple of things.”
Pinder said the board is “getting a lot of problems on the front end” through “diligent” licensing of new physicians, which includes verification of credentials and mandatory orientation. It spends most of its time and resources on standard-of-care cases, which are based on assertions that a doctor is providing poor care.
Unlike substance abuse or inadequate record-keeping claims, standard-of- care cases require that two peer reviewers in the specialty of the accused doctor agree there has been a breach in standards, Pinder said. If they do not agree, there is no case, he said.
“We are actually getting penalized with this ranking because we go after the serious violators but the cases are very hard to prove with serious and convincing evidence,” he said.
Dale Austin, deputy executive vice president of the Federation of State Medical Boards, agreed that such cases are important and do take more time and resources.
“Quality of care kinds of issues generally don’t relate to a single case,” he said. “They are based on patterns of behavior and performance.”
But Wolfe said the problem is not the cases the Maryland board chooses to investigate, it is the board’s relationship to the state medical society. Not only does MedChi supply peer reviewers for standard-of-care cases, it also elects physicians to the board each year.
“The medical society is a trade association for doctors. It represents the interests of the doctors,” Wolfe said. “The board is supposed to be protecting the public by reviewing doctors. Close ties take away from the policing aspect of the board.”
But Pinder said the relationship between the board and the society is set by law and “would take a statute change to change our relationship.”
Proposals to put some distance between the board and MedChi passed the House of Delegates this year but could not get out of the Senate before the legislative session ended Monday. One proposal would have let the governor appoint board members instead of having MedChi elect them.
Austin said the Federation of State Medical Boards encourages working relationships with state medical societies.
“I know in Maryland the medical society is very much a part of the peer review process,” he said. “I can’t comment on whether that works or not.”
Austin said Public Citizen’s focus on the number of actions taken against physicians is less important than the kinds of cases investigated and their outcomes.
“Any action of a reprimand and a fine has pretty serious consequences to a physician,” he said.