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Physicians Disciplined by a State Medical Board
James Morrison, MD;
Peter Wickersham, MS, MApStat
JAMA. 1998;279:1889-1893.
Context.— State medical boards discipline several thousand physicians each year. Although certain subgroups, such as those disciplined for malpractice, substance use, or sexual abuse, have been studied, little is known about disciplined physicians as a group.
Objective.— To assess the offenses, contributing factors, and type of discipline of a consecutive series of disciplined physicians.
Design.— Case-control study on publicly available data matching 375 disciplined physicians with 2 groups of control physicians, one matched solely by locale, and a second matched for sex, type of practice, and locale.
Subjects.— All disciplined physicians publicly reported by the Medical Board of California from October 1995 through April 1997.
Main Outcome Measures.— Characteristics of disciplined physicians, offenses leading to discipline, and type of discipline.
Results.— A total of 375 physicians licensed by the Medical Board of California (approximately 0.24% per year) were disciplined for 465 offenses. The most frequent causes for discipline were negligence or incompetence (34%), abuse of alcohol or other drugs (14%), inappropriate prescribing practices (11%), inappropriate contact with patients (10%), and fraud (9%). Discipline imposed was revocation of medical license (21%), actual suspension of license (13%), stayed suspension of license (45%), and reprimand (21%). Type of offense was significantly associated with severity of discipline (P=.03). In logistic regression models comparing disciplined physicians with controls matched by locale, board discipline was significantly associated with physicians' sex (odds ratio [OR] for women, 0.44; 95% confidence interval [CI], 0.28-0.70) and involvement in direct patient care (OR, 2.56; 95% CI, 1.75-3.75). In the regression model with additional matching criteria, disciplinary action was negatively associated with specialty board certification (OR, 0.42; 95% CI, 0.29-0.60) and positively associated with being in practice more than 20 years (OR, 2.02; 95% CI, 1.39-2.92).
Conclusions.— A small but substantial proportion of physicians is disciplined each year for a variety of offenses. Further study of disciplined physicians is necessary to identify physicians at high risk for offenses leading to disciplinary action and to develop effective interventions to prevent these offenses.
From the Department of Veterans Affairs Medical Center Coatesville, Coatesville, Pa (Dr Morrison); and the Department of Clinical Biostatistics, Wyeth-Ayerst Research, Radnor, Pa (Mr Wickersham).
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