WASHINGTON – State medical officials Thursday derided a report thatranked Maryland 43rd in the nation last year when it came to discipliningdoctors, saying data used for the report was “inaccurate andunsubstantiated.”
Both MedChi, the state medical society, and the state licensure boardsaid the rankings released Wednesday by Dr. Sidney Wolfe of PublicCitizen’s Health Research Group are skewed because the report uses the”wrong count” of Maryland doctors in the equations.
While the Board of Physician Quality Assurance licenses approximately 20,000 physicians, only about 11,000 of them actually practice here, saidMedChi Executive Director Michael Preston.
“Wolfe’s research is fundamentally flawed. He is using the wrong denominator in his equation. Put in the right number of doctors and we gofrom 43rd to 17th,” Preston said.
Wolfe acknowledged that he uses the number of non-federal physicians– a figure provided by the Federation of State Medical Boards — ratherthan the actual number of practicing physicians in the state. But henoted that he has been using the same data since 1992, and thatMaryland’s ranking has dropped from 19th place to 43rd in that time.
The study said that Maryland had 1.78 serious actions per 1,000physicians in the state in 2001. Serious actions included licenserevocationns, suspension and surrender, among others, making Maryland oneof the worst in the nation at disciplining doctors.
Wolfe said the low rate of disciplinary actions is at least partly dueto the fact that, in Maryland, accusations of substandard care must bereferred to MedChi for peer review by two volunteer specialist, which hesees as a conflict of interest. In other states, officials said, thelicensing board investigates all such cases.
But Preston defended MedChi’s role in investigations saying there is”no correlation between membership and the results of the review.” Of the871 peer reviews MedChi conducted from 1991 to 1998, Preston said, 45percent went against the doctor. He said that figure shows MedChi has”nothing to hide.”
A move to remove MedChi from the review process, and to lower thestandard of proof for disciplinary actions from “clear and convincing” to”preponderance of the evidence,” failed in the legislature earlier thisyear.
Irving Pinder, the executive director of the state licensure board,said the seemingly low level of disciplinary action in Maryland could bethe result of the state’s rigorous licensure process and lengthyorientation program, which may be “catching them from the front end.” ToPinder and Preston, the study tries to oversimplify a complex issue.
“Things aren’t as black and white as Wolfe would like them to be.There is a lot of gray, especially in substandard care cases,” Pindersaid.
The top-ranked states in Wolfe’s study were Arizona, Oklahoma, Alaska, Kentucky and North Dakota. The District of Columbia, Hawaii, Delaware,South Dakota and South Carolina had the lowest level of disciplinaryactions.
“If you really needed to go to a doctor would you rather go to Alabamaor Alaska than to Maryland?” asked Pinder. “Maybe our doctors are justbetter to begin with.”