Medical licensing board characteristics and physician discipline: an empirical analysis

This article investigates the relationship between the characteristics of medical licensing boards and the frequency with which boards discipline physicians. Specifically, we take advantage of variation in the structure of medical licensing boards between 1993 and 2003 to determine the effect of organizational and budgetary independence, public oversight, and resource constraints on rates of physician discipline. We find that larger licensing boards, boards with more staff, and boards that are organizationally independent from state government discipline doctors more frequently. Public oversight and political control over board budgets do not appear to influence the extent to which medical licensing boards discipline doctors. These findings are broadly consistent with theories of regulatory behavior that emphasize the importance of bureaucratic autonomy for effective regulatory enforcement.

Four decades of complaints to a State Medical Board about graduates from one medical school: implications for change in self-regulation processes

In the context of the impending national registration of health practitioners in Australia including doctors, this column describes the types and patterns of complaints to a State Medical Board across an extended period, about graduates from one medical school. De-identified data concerning complaints about medical practitioners who had graduated from the University of Queensland, made to the Medical Board of Queensland between 1968 and 2006, were analysed. The main outcome measures were category of complaint, total complaint rate per doctor-year, frequency of complaints per practitioner and outcomes of complaints. There were 12 categories of complaints, encompassing different aspects of clinical management, impairment and unethical conduct. Outcomes included "no further action", a hierarchy of recommendations and conditions on registration, suspension, deregistration, health assessment, or referral to alternative bodies. Complaints predominantly related to clinical standards, and this also applied to those who attracted multiple complaints. Most cases were managed without resort to sanctions of any kind. Sanctions may be underutilised, particularly in cases of apparent recalcitrance. Improved tracking and appropriate reeducation and disciplinary measures will assist in better protecting the public under the new national registration arrangements.

Continuing medical education in Vietnam: new legislation and new roles for medical schools

Driven by health care reform and the advent of the private sector in the late 1980s, and by commitments made to the Association of Southeast Asian Nations (ASEAN), Vietnam is faced with a need to increase the regulation and training of its health care professionals. Previously, a diploma from an accredited health professional school was sufficient to practice for a lifetime. Legislation has recently been passed that will institute a licensing system, will require continuing medical education (CME) to maintain the license, and will probably place a large burden on the health professional schools and training institutes to provide CME. Supported by international nongovernmental organizations and foreign universities, the medical universities in Vietnam are responding and are preparing for their new and expanded role.

[Problems licence activities on render high-technological medical care]

Enumeration of basis problems render high-technological medical care with pay attention on licence activities on render this help.

Physicians vs. Wannabes: TMA sues podiatrists, chiropractors, family therapists

The Texas Medical Association is embroiled in scope-of-practice lawsuits against the regulatory boards of three health care groups. TMA is suing podiatrists, chiropractors, and family therapists.

Do state medical board applications violate the americans with disabilities act?

PURPOSE

To determine whether medical licensing board application questions about the mental or physical health or substance use history of the applicant violate the Americans with Disabilities Act (ADA) of 1990.

METHOD

Content analysis of 51 allopathic licensing applications (50 states and District of Columbia) was performed at the University of Medicine and Dentistry of New Jersey-New Jersey Medical School in 2005. Questions referencing physical or mental health or substance use were identified by a team of physicians and reviewed and categorized based on the ADA and appropriate case law by legal counsel.

RESULTS

Of the 51 applications reviewed, 49 (96%) contained questions pertaining to the physical or mental health or substance use history of the applicant. Thirty-four of the 49 (69%) state medical licensing applications contained at least one "likely impermissible" or "impermissible" item based on the ADA and appropriate case law.

CONCLUSIONS

Most state medical licensing applications contain questions that ask about the physical or mental health and substance use of physician applicants. Many licensing applications appear to be in violation of the ADA, even 19 years after enactment of the regulation. These questions do not elicit responses by which professional competence can be judged. The presence of these questions on licensing applications may cause physicians to avoid or delay treatment of personal illness.

Commentary: impaired physicians and the new politics of accountability

Several recent articles, including the one by Schroeder and colleagues in this issue, document violations of the Americans with Disabilities Act (ADA) by state medical boards that ask applicants for initial licensure and relicensure whether they have any history of mental illness. The authors of these articles argue that the boards' violation of the ADA is a disincentive for applicants to seek treatment, especially for depression. This commentary discusses the behavior of the boards, and efforts to address it, in the larger context of what organizations that educate, examine, license, certify, credential, and represent physicians are doing to improve the accountability of members of the profession and, as a result, the quality of their services.

Boundary violation

Regulation of the interstate practice of medicine represents a challenge to state medical boards. Although laws prohibiting the unlicensed practice of medicine were originally enacted to protect the public from unqualified practitioners, they could be invoked in a whole host of common clinical situations such as calling in prescriptions to a patient in another state, giving expert testimony in another jurisdiction, or reviewing radiology films on the internet, with potentially serious criminal ramifications. In this article a recent case describing a physician's being prosecuted for the illegal practice of medicine across state lines is presented and followed by a discussion of the numerous ways in which contemporary practitioners are likely to engage in such acts. The function of state medical legislation is explored as it relates to prohibitions on interstate practice. It is suggested that states, and possibly the federal government, should devise legislative solutions to allow for the good faith intermittent practice of interstate medicine.

Radiation injury is potentially a severe consequence of fluoroscopically guided complex interventions

Fluoroscopically guided interventions and radiation injury: Is physician training in radiation management adequate? Radiation injury from fluoroscopically guided complex medical interventions is relatively rare but sometimes seriously debilitating. This manuscript provides a summary of their occurrence. The question is raised as to whether or not the seriousness of these radiation effects and their underlying causes are sufficient justification to warrant new proposals on how to credential physicians before they are declared qualified to perform complex interventional procedures.