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Rosengart TK, Chen JH, Gantt NL, Angelos P, Warshaw AL, Rosen JE, Perrier ND, Kaups KL, Doherty GM, Zoumpou T, Ashley SW, Doscher W, Welsh D, Savarise M, Sutherland MJ, Sidawy AN, Kopelan AM. Sustaining Lifelong Competency of Surgeons: Multimodality Empowerment Personal and Institutional Strategy. J Am Coll Surg 2024; 239:187-189. [PMID: 38591782 DOI: 10.1097/xcs.0000000000001066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Affiliation(s)
- Todd K Rosengart
- From the Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX (Rosengart, Chen)
| | - Jennifer H Chen
- From the Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX (Rosengart, Chen)
| | - Nancy L Gantt
- Department of Surgery, Northeast Ohio Medical University, Youngstown, OH (Gantt)
| | - Peter Angelos
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL (Angelos)
| | - Andrew L Warshaw
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Warshaw)
| | - Jennifer E Rosen
- Division of Endocrine Surgery, MedStar-Washington Hospital Center, Washington, DC (Rosen)
| | - Nancy D Perrier
- Department of Surgical Oncology, Section of Surgical Endocrinology, The University of Texas MD Anderson Cancer Center, Houston, TX (Perrier)
| | - Krista L Kaups
- Department of Surgery, University of California San Francisco Fresno, Fresno, CA (Kaups)
| | - Gerard M Doherty
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Doherty, Ashley)
| | - Theofano Zoumpou
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ (Zoumpou)
| | - Stanley W Ashley
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Doherty, Ashley)
| | - William Doscher
- Department of Surgery, Zucker School of Medicine at Hofstra, Northwell, NY (Doscher)
| | - David Welsh
- Margaret Mary Health, Batesville, IN (Welsh)
| | - Mark Savarise
- Section of Community General Surgery, University of Utah South Jordan Health Center, South Jordan, UT (Savarise)
| | | | - Anton N Sidawy
- Department of Surgery, George Washington University, Washington, DC (Sidawy)
| | - Adam M Kopelan
- Department of Surgery, Newark Beth Israel Medical Center, RWJ Barnabas Health, Newark, NJ (Kopelan)
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Sheth BP, Schnabel SD, Comber BA, Martin B, McGowan M, Bartley GB. Relationship Between the American Board of Ophthalmology Maintenance of Certification Program and Actions Against the Medical License. Am J Ophthalmol 2023; 247:1-8. [PMID: 36370838 DOI: 10.1016/j.ajo.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/21/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the likelihood of disciplinary actions against medical licenses of ophthalmologists who maintained board certification through successful completion of the American Board of Ophthalmology Maintenance of Certification program compared with ophthalmologists who did not maintain certification. METHODS This was a retrospective cohort study of ophthalmologists certified by the American Board of Ophthalmology from 1992 to 2012 with time-limited certificates. Rates and severity of disciplinary actions against medical licenses were analyzed among ophthalmologists who did and did not maintain certification. RESULTS Of 9111 ophthalmologists who earned initial board certification between 1992 and 2012, 8073 (88.6%) maintained their certification and 1038 (11.4%) did not maintain their certification. A total of 234 license actions were identified in the study group. Among ophthalmologists who did not maintain board certification, the risk of a license action was more than 2 times that of those who maintained board certification (hazard ratio = 2.34, 95% CI=1.73-3.18). License actions were significantly higher in men than in women (hazard ratio = 2.02, 95% CI=1.43-2.86). Ophthalmologists who had a lapse in their certification had a higher severity of disciplinary actions (χ2 = 9.21, p <.01) than ophthalmologists who maintained their certification. CONCLUSIONS This study supports prior literature in other specialties demonstrating a higher risk of disciplinary licensure actions in physicians who did not maintain board certification as compared with those who did. Physicians who did not maintain certification were also more likely to have actions against their license reflecting a higher severity violation. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Bhavna P Sheth
- From the Department of Ophthalmology & Visual Sciences (B.P.S), Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
| | - Sarah D Schnabel
- American Board of Ophthalmology (S.D.S., B.A.C., B.M., M.M., G.B.B .); Department of Ophthalmology (G.B.B.), Mayo Clinic, Rochester, Minnesota, USA
| | - Beth Ann Comber
- American Board of Ophthalmology (S.D.S., B.A.C., B.M., M.M., G.B.B .); Department of Ophthalmology (G.B.B.), Mayo Clinic, Rochester, Minnesota, USA
| | - Brian Martin
- American Board of Ophthalmology (S.D.S., B.A.C., B.M., M.M., G.B.B .); Department of Ophthalmology (G.B.B.), Mayo Clinic, Rochester, Minnesota, USA
| | - Meghan McGowan
- American Board of Ophthalmology (S.D.S., B.A.C., B.M., M.M., G.B.B .); Department of Ophthalmology (G.B.B.), Mayo Clinic, Rochester, Minnesota, USA
| | - George B Bartley
- American Board of Ophthalmology (S.D.S., B.A.C., B.M., M.M., G.B.B .); Department of Ophthalmology (G.B.B.), Mayo Clinic, Rochester, Minnesota, USA
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Cuddy MM, Liu C, Ouyang W, Barone MA, Young A, Johnson DA. An Examination of the Associations Among USMLE Step 3 Scores and the Likelihood of Disciplinary Action in Practice. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1504-1510. [PMID: 35675131 DOI: 10.1097/acm.0000000000004775] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE As the last examination in the United States Medical Licensing Examination (USMLE) sequence, Step 3 provides a safeguard before physicians enter into unsupervised practice. There is, however, little validity research focusing on Step 3 scores beyond examining its associations with other educational and professional assessments thought to cover similar content. This study examines the associations between Step 3 scores and subsequent receipt of disciplinary action taken by state medical boards for problematic behavior in practice. It analyzes Step 3 total, Step 3 computer-based case simulation (CCS), and Step 3 multiple-choice question (MCQ) scores. METHOD The final sample included 275,392 board-certified physicians who graduated from MD-granting medical schools and who passed Step 3 between 2000 and 2017. Cross-classified multilevel logistic regression models were used to examine the effects of Step 3 scores on the likelihood of receiving a disciplinary action, controlling for other USMLE scores and accounting for jurisdiction and specialty. RESULTS Results showed that physicians with higher Step 3 total, CCS, and MCQ scores tended to have lower chances of receiving a disciplinary action, after accounting for other USMLE scores. Specifically, a 1-standard-deviation increase in Step 3 total, CCS, and MCQ score was associated with a 23%, 11%, and 17% decrease in the odds of receiving a disciplinary action, respectively. The effect of Step 2 CK score on the likelihood of receiving a disciplinary action was statistically significant, while the effect of Step 1 score became statistically nonsignificant when other Step scores were included in the analysis. CONCLUSIONS Physicians who perform better on Step 3 are less likely to receive a disciplinary action from a state medical board for problematic behavior in practice. These findings provide some validity evidence for the use of Step 3 scores when making medical licensure decisions in the United States.
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Affiliation(s)
- Monica M Cuddy
- M.M. Cuddy is measurement scientist, NBME, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0002-5756-9113
| | - Chunyan Liu
- C. Liu is senior psychometrician, NBME, Philadelphia, Pennsylvania
| | - Wenli Ouyang
- W. Ouyang is data analyst III, NBME, Philadelphia, Pennsylvania
| | - Michael A Barone
- M.A. Barone is vice president, Competency-Based Assessment, NBME, Philadelphia, Pennsylvania
| | - Aaron Young
- A. Young is vice president, Research and Data Integration, Federation of State Medical Boards, Euless, Texas
| | - David A Johnson
- D.A. Johnson is chief assessment officer, Federation of State Medical Boards, Euless, Texas
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Cuccolo NG, Crystal DT, Girard AO, Johnson AR, Ibrahim AMS, Sinkin JC, Lin SJ, Agag RL. Chaperone Use During Plastic Surgery Physical Examinations: Nationwide Provider Practices and Impact of Level of Training. Ann Plast Surg 2022; 88:366-371. [PMID: 35312646 DOI: 10.1097/sap.0000000000003182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Medical chaperones often play an important role during physical examinations, providing patient comfort and serving as medicolegal witness. The purpose of this study was to evaluate and compare practices regarding chaperone use by plastic surgery attendings and trainees. METHODS A voluntary survey was distributed to members of the American Council of Academic Plastic Surgeons. The survey included a standardized set of questions regarding physician demographics, nature of practice training, and current practices pertaining to chaperone use. Data were analyzed in a descriptive fashion. Ordinal logistic regression models were used to identify predictors of chaperone use. RESULTS We received 167 responses, of which 107 (64.1%) were attendings and 60 (35.9%) were trainees. In total, 78.3% of the respondents were male and 21.7% were female. Routine use of chaperones was reported at 58.6%. Compared with plastic surgery trainees, attending surgeons were 12.8 times more likely to use a chaperone during sensitive examinations (P < 0.001). In addition, male respondents were 6.43 times more likely than their female counterparts to involve a chaperone during sensitive examinations (P < 0.001). Forty-eight percent of the trainees acknowledged receiving education regarding chaperone use, and this cohort was 7 times more likely to use a chaperone when compared with trainees who had not received chaperone instruction (P < 0.001). CONCLUSIONS This study highlights the wide variability of chaperone use among plastic surgery attendings and trainees. Integration and standardization of chaperone education within plastic surgery training may be an effective technique to promote this practice and lead to improved patient-provider clinical experiences.
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Affiliation(s)
| | | | - Alisa O Girard
- From the Division of Plastic and Reconstructive Surgery, Robert Wood Johnson University Hospital, Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Ahmed M S Ibrahim
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jeremy C Sinkin
- From the Division of Plastic and Reconstructive Surgery, Robert Wood Johnson University Hospital, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Richard L Agag
- From the Division of Plastic and Reconstructive Surgery, Robert Wood Johnson University Hospital, Robert Wood Johnson Medical School, New Brunswick, NJ
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Goudra B. American Board of Anesthesiology and Accountability (or lack of): What the rest of the world can learn? Saudi J Anaesth 2022; 16:1-3. [PMID: 35261580 PMCID: PMC8846227 DOI: 10.4103/sja.sja_499_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/04/2021] [Accepted: 07/04/2021] [Indexed: 11/09/2022] Open
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Goudra B, Guthal A. US Residents' Perspectives on the Introduction, Conduct, and Value of American Board of Anesthesiology's Objective Structured Clinical Examination-Results of the 1 st Nationwide Questionnaire Survey. Anesth Essays Res 2021; 15:87-100. [PMID: 34667354 PMCID: PMC8462430 DOI: 10.4103/aer.aer_76_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/04/2021] [Accepted: 07/04/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction: Passing the Objective Structured Clinical Examination (OSCE) is currently a requirement for the vast majority (not all) of candidates to gain American Board of Anesthesiology (ABA) initial certification. Many publications from the ABA have attempted to justify its introduction, conduct and value. However, the ABA has never attempted to understand the views of the residents. Methods: A total of 4237 residents at various training levels from 132 programs were surveyed by asking to fill a Google questionnaire prospectively between March 8th, 2021 and April 10th, 2021. Every potential participant was sent an original email followed by 2 reminders. Results: The overall response rate was 17.26% (710 responses to 4112 invitations). On a 5-point Likert scale with 1 as “very inaccurate” and 5 as “very accurate,” the mean accuracy of objective structured clinical examination (OSCE) in assessing communication skills and professionalism was 2.3 and 2.1 respectively. In terms of the usefulness of OSCE training for improving physicians' clinical practice, avoiding lawsuits, teaching effective communication with patients and teaching effective communication with other providers, the means on a 5-point Likert scale with 1 as “Not at all useful” and 5 as “Very useful” were 1.86, 1.69, 1.79, and 1.82 respectively. Residents unanimously thought that factors such as culture, race/ethnicity, religion and language adversely influence the assessment of communication skills. On a 5-point Likert scale with 1 as “not at all affected” and 5 as “very affected,” the corresponding scores were 3.45, 3.19, 3.89, and 3.18 respectively. Interestingly, nationality and political affiliation were also thought to influence this assessment, however, to a lesser extent. In addition, residents believed it is inappropriate to test non-cardiac anesthesiologists for TEE skills (2.39), but felt it was appropriate to test non-regional anesthesiologists in Ultrasound skills (3.29). Lastly, nearly 80% of the residents think that money was the primary motivating factor behind ABA's introduction of the OSCE. Over 96% residents think that OSCE should be stalled, either permanently scrapped (60.8%) or paused (35.8%). Conclusions: Anesthesiology residents in the United States overwhelmingly indicated that the OSCE does not serve any useful purpose and should be immediately halted.
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Affiliation(s)
- Basavana Goudra
- Department of Anesthesiology and Critical Care Medicine Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Arjun Guthal
- Department of Molecular Biology, Princeton University, Princeton, NJ, USA
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Kendrick DE, Chen X, Jones AT, Clark M, Fan Z, Bandeh-Ahmadi H, Wnuk G, Kopp JP, Moreno BI, Scott JW, Sandhu G, Buyske J, Dimick JB, George BC. Is Initial Board Certification Associated With Better Early Career Surgical Outcomes? Ann Surg 2021; 274:220-226. [PMID: 33351453 DOI: 10.1097/sla.0000000000004709] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine if initial American Board of Surgery certification in general surgery is associated with better risk-adjusted patient outcomes for Medicare patients undergoing partial colectomy by an early career surgeon. BACKGROUND Board certification is a voluntary commitment to professionalism, continued learning, and delivery of high-quality patient care. Not all surgeons are certified, and some have questioned the value of certification due to limited evidence that board-certified surgeons have better patient outcomes. In response, we examined the outcomes of certified versus noncertified early career general surgeons. METHODS We identified Medicare patients who underwent a partial colectomy between 2008 and 2016 and were operated on by a non-subspecialty trained surgeon within their first 5 years of practice. Surgeon certification status was determined using the American Board of Surgery data. Generalized linear mixed models were used to control for patient-, procedure-, and hospital-level effects. Primary outcomes were the occurrence of severe complications and occurrence of death within 30 days. RESULTS We identified 69,325 patients who underwent a partial colectomy by an early career general surgeon. The adjusted rate of severe complications after partial colectomy by certified (n = 4239) versus noncertified (n = 191) early-career general surgeons was 9.1% versus 10.7% (odds ratio 0.83, P = 0.03). Adjusted mortality rate for certified versus noncertified early-career general surgeons was 4.9% versus 6.1% (odds ratio 0.79, P = 0.01). CONCLUSION Patients undergoing partial colectomy by an early career general surgeon have decreased odds of severe complications and death when their surgeon is board certified.
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Affiliation(s)
- Daniel E Kendrick
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Xilin Chen
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Michael Clark
- Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor, Michigan
| | - Zhaohui Fan
- Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Hoda Bandeh-Ahmadi
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Greg Wnuk
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jason P Kopp
- American Board of Surgery, Philadelphia, Pennsylvania
| | | | - John W Scott
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gurjit Sandhu
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jo Buyske
- American Board of Surgery, Philadelphia, Pennsylvania
| | - Justin B Dimick
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
- Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Brian C George
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
- Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
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Cooper WO, Simmons JH, Moore PE, Rush MG, Domenico HJ, Foster JE, Rice TD, Bolina S, Lowe K, Webber SA. Early Predictors of Performance Deficiencies in Academic Faculty: Pre-Employment Red Flags. Acad Pediatr 2021; 21:716-722. [PMID: 32650048 DOI: 10.1016/j.acap.2020.06.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine whether faculty who had red flags (unprofessional behavior, delayed response to queries, or delayed submission of required documentation) during pre-employment were more likely to have performance deficiencies than faculty who did not have red flags. METHODS The study included 187 faculty consecutively hired in a Department of Pediatrics in a large academic health system from 2013 to 2018. Faculty with and without pre-employment red flags were compared to identify the proportion who had subsequent performance deficiencies related to documentation, unprofessional behavior, performance, or premature departure from the faculty. RESULTS Most of the hired faculty were female (127, 0.68), physicians (136, 0.73), and clinicians or clinician-educators (124, 0.67). Sixteen faculty (0.09) had pre-employment red flags. In the 3 years after hiring, 31 (0.17) of the faculty cohort had at least 1 performance deficiency. Faculty with pre-employment red flags were more than 4 times as likely to experience a performance deficiency during follow-up (0.56 vs 0.13, P < .001). The hazard ratio for performance deficiency comparing faculty with pre-employment red flags to those without was 5.98 (95% confidence interval 2.73-13.1, P < .0001). CONCLUSIONS Faculty who had pre-employment red flags were significantly more likely to experience subsequent performance deficiencies. Given the substantial investment that individuals and academic medical centers make in recruiting and hiring new faculty, efforts to identify and assist faculty members at risk provide academic departments opportunities to provide the best environment for success for all faculty.
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Affiliation(s)
- William O Cooper
- Office of Faculty Development, Vanderbilt University School of Medicine (WO Cooper, JH Simmons, and JE Foster), Nashville, Tenn; Department of Pediatrics, Vanderbilt University School of Medicine (WO Cooper, JH Simmons, PE Moore, MG Rush, TD Rice, S Bolina, K Lowe, and SA Webber), Nashville, Tenn.
| | - Jill H Simmons
- Office of Faculty Development, Vanderbilt University School of Medicine (WO Cooper, JH Simmons, and JE Foster), Nashville, Tenn; Department of Pediatrics, Vanderbilt University School of Medicine (WO Cooper, JH Simmons, PE Moore, MG Rush, TD Rice, S Bolina, K Lowe, and SA Webber), Nashville, Tenn
| | - Paul E Moore
- Department of Pediatrics, Vanderbilt University School of Medicine (WO Cooper, JH Simmons, PE Moore, MG Rush, TD Rice, S Bolina, K Lowe, and SA Webber), Nashville, Tenn
| | - Margaret G Rush
- Department of Pediatrics, Vanderbilt University School of Medicine (WO Cooper, JH Simmons, PE Moore, MG Rush, TD Rice, S Bolina, K Lowe, and SA Webber), Nashville, Tenn
| | - Henry J Domenico
- Department of Biostatistics, Vanderbilt University School of Medicine (HJ Domenico), Nashville, Tenn
| | - Jo E Foster
- Office of Faculty Development, Vanderbilt University School of Medicine (WO Cooper, JH Simmons, and JE Foster), Nashville, Tenn
| | - Tonda D Rice
- Department of Pediatrics, Vanderbilt University School of Medicine (WO Cooper, JH Simmons, PE Moore, MG Rush, TD Rice, S Bolina, K Lowe, and SA Webber), Nashville, Tenn
| | - Sandie Bolina
- Department of Pediatrics, Vanderbilt University School of Medicine (WO Cooper, JH Simmons, PE Moore, MG Rush, TD Rice, S Bolina, K Lowe, and SA Webber), Nashville, Tenn
| | - Kathleen Lowe
- Department of Pediatrics, Vanderbilt University School of Medicine (WO Cooper, JH Simmons, PE Moore, MG Rush, TD Rice, S Bolina, K Lowe, and SA Webber), Nashville, Tenn
| | - Steven A Webber
- Department of Pediatrics, Vanderbilt University School of Medicine (WO Cooper, JH Simmons, PE Moore, MG Rush, TD Rice, S Bolina, K Lowe, and SA Webber), Nashville, Tenn
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Abstract
ABSTRACT
Boundary violations by non-psychiatric physicians have received relatively little attention in available literature. In this report, the authors reviewed 100 cases of professional boundary violations identified in physicians undergoing outpatient psychiatric evaluation. They included boundary violations with a patient, boundary violations with non-patients, such as family members, employees, and co-workers, and prescribing/treating irregularities. Fifty-three of the physicians had engaged in sexual boundary violations with patients. Twenty-two had engaged in sexual boundary violations with non-patients. Eighteen of the physicians had non-sexual violations involving financial matters, social relationships, confidentiality and other transgressions. Twenty-six of the 100 were involved in some type of prescribing/treating irregularity. Fifty-two percent of the physicians sampled met criteria for an Axis II personality disorder, 17 had a substance abuse diagnosis, and 13 had a paraphilia or sexual disorder. The implications of these findings are discussed in a context relevant to ethics and regulatory bodies.
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ElHawary H, Bucevska M, Pawliuk C, Wang AM, Seal A, Gilardino MS, Arneja JS. The Presence of Ghost Publications Among Canadian Plastic Surgery Residency Applicants: How Honest Are Canadians? Plast Surg (Oakv) 2021; 30:159-163. [PMID: 35572077 PMCID: PMC9096861 DOI: 10.1177/22925503211003843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Physicians with history of unprofessional behaviour during their medical
training are shown to be 3 times more likely to have board disciplinary
action later in their career. One realm in which unprofessional behaviour
takes place is the phenomenon of unverifiable publications or “ghost
publications.” To that end, this study aims to assess the rate of ghost
publications among a recent cohort of Canadian Plastic Surgery residency
applicants to determine if this phenomenon is geographic in nature. Methods: The current study was a retrospective, cross-sectional observational study; a
review of all residency applications submitted to a single Canadian Plastic
Surgery residency program from 2015 to 2018 was performed and all their
listed publications were verified for accuracy. The review was conducted by
a third party librarian and a research coordinator blinded to the authors
identifying information. “Ghost publication” was defined as any publication
listed as “published,” “accepted,” or “in-press” that did not exist in the
literature. Results: A total of 196 applications of 186 applicants were submitted over the span of
4 years. A total of 362 publications listed as peer-reviewed articles,
belonging to 114 applications were extracted and reviewed. Among the 362
publications listed as peer-reviewed articles, 2 could not be found in the
literature (0.55%). Additionally, 42 citations were found with 48 minor
differences than what was cited. Conclusions: The rate of ghost publications among recent applicants to a Plastic Surgery
residency program is low (less than 1%). Future studies should investigate
methods to further improve and instill the value of professionalism in our
future plastic surgery trainees.
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Affiliation(s)
- Hassan ElHawary
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marija Bucevska
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colleen Pawliuk
- BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Annie M. Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Alexander Seal
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mirko S. Gilardino
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jugpal S. Arneja
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Roberts WL, Gross GA, Gimpel JR, Smith LL, Arnhart K, Pei X, Young A. An Investigation of the Relationship Between COMLEX-USA Licensure Examination Performance and State Licensing Board Disciplinary Actions. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:925-930. [PMID: 31626002 DOI: 10.1097/acm.0000000000003046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Passing the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) serves as a licensing requirement, yet there is limited understanding between this high-stakes exam and performance outcomes. This study examined the relationship between COMLEX-USA scores and disciplinary actions received by osteopathic physicians. METHOD Data for osteopathic physicians (N = 26,383) who graduated from medical school between 2004 and 2013 were analyzed using multinomial logistic regression to assess the relationship between COMLEX-USA scores and placement into one of 3 disciplinary action categories relative to no action received, controlling for years in practice and gender. RESULTS Less than 1% of physicians in this study (n = 187) had a disciplinary action(s). Controlling for all COMLEX-USA levels, years in practice, and gender, higher Level 3 scores were associated with significant decreased odds for all action categories: revoked licensed (odds ratio [OR] = 0.51, 95% confidence interval [CI] 0.36, 0.72; P < .001), imposed limitations to practice (OR = 0.59, 95% CI 0.41, 0.84; P < .01), and other action imposed (OR = 0.48, 95% CI 0.33, 0.69; P < .001), relative to not receiving an action. In these same models, higher Level 2 Performance Evaluation Biomedical/Biomechanical Domain scores decreased the odds for an action that revoked a license (OR = 0.75, 95% CI 0.58, 0.98; P < .05) and imposed limitations to practice (OR = 0.64, 95% CI 0.49, 0.84; P < .001). CONCLUSIONS These findings provide evidence that the COMLEX-USA delivers useful information regarding the likelihood of a practitioner receiving state board disciplinary actions.
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Affiliation(s)
- William L Roberts
- W.L. Roberts is director, Psychometrics/Research, Clinical Skills Testing, National Board of Osteopathic Medical Examiners, Conshohocken, Pennsylvania; ORCID: https://orcid.org/0000-0001-6175-8059. G.A. Gross is vice president, Clinical Skills Testing, National Board of Osteopathic Medical Examiners, Conshohocken, Pennsylvania. J.R. Gimpel is president and chief executive officer, National Board of Osteopathic Medical Examiners, Conshohocken, Pennsylvania. L.L. Smith is senior psychometrician, Clinical Skills Testing, National Board of Osteopathic Medical Examiners, Conshohocken, Pennsylvania. K. Arnhart is senior research analyst, Research and Data Integration, Federation of State Medical Boards, Euless, Texas. X. Pei is senior research analyst, Research and Data Integration, Federation of State Medical Boards, Euless, Texas. A. Young is assistant vice president, Research and Data Integration, Federation of State Medical Boards, Euless, Texas
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Zhou Y, Sun H, Macario A, Keegan MT, Patterson AJ, Minhaj MM, Wang T, Harman AE, Warner DO. Association Between Participation and Performance in MOCA Minute and Actions Against the Medical Licenses of Anesthesiologists. Anesth Analg 2020; 129:1401-1407. [PMID: 31274598 DOI: 10.1213/ane.0000000000004268] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In January 2016, as part of the Maintenance of Certification in Anesthesiology (MOCA) program, the American Board of Anesthesiology launched MOCA Minute, a web-based longitudinal assessment, to supplant the former cognitive examination. We investigated the association between participation and performance in MOCA Minute and disciplinary actions against medical licenses of anesthesiologists. METHODS All anesthesiologists with time-limited certificates (ie, certified in 2000 or after) who were required to register for MOCA Minute in 2016 were followed up through December 31, 2016. The incidence of postcertification prejudicial license actions was compared between those who did and did not register and compared between registrants who did and did not meet the MOCA Minute performance standard. RESULTS The cumulative incidence of license actions was 1.2% (245/20,006) in anesthesiologists required to register for MOCA Minute. Nonregistration was associated with a higher incidence of license actions (hazard ratio, 2.93 [95% confidence interval {CI}, 2.15-4.00]). For the 18,534 (92.6%) who registered, later registration (after June 30, 2016) was associated with a higher incidence of license actions. In 2016, 16,308 (88.0%) anesthesiologists met the MOCA Minute performance standard. Of those not meeting the standard (n = 2226), most (n = 2093, 94.0%) failed because they did not complete the required 120 questions. Not meeting the standard was associated with a higher incidence of license actions (hazard ratio, 1.92 [95% CI, 1.36-2.72]). CONCLUSIONS Both timely participation and meeting performance standard in MOCA Minute are associated with a lower likelihood of being disciplined by a state medical board.
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Affiliation(s)
- Yan Zhou
- From the The American Board of Anesthesiology, Raleigh, North Carolina
| | - Huaping Sun
- From the The American Board of Anesthesiology, Raleigh, North Carolina
| | - Alex Macario
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Mark T Keegan
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Mohammed M Minhaj
- Department of Anesthesia & Critical Care, The University of Chicago, Chicago, Illinois
| | - Ting Wang
- From the The American Board of Anesthesiology, Raleigh, North Carolina
| | - Ann E Harman
- From the The American Board of Anesthesiology, Raleigh, North Carolina
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
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Landess J. State Medical Boards, Licensure, and Discipline in the United States. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 17:337-342. [PMID: 32047378 DOI: 10.1176/appi.focus.20190020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Medical practice acts and state medical boards have evolved since their conception in the mid-19th century. Today, state medical boards are usually responsible for a variety of functions, with the main function being the detection and discipline of unprofessional and unethical conduct by physicians and other medical professionals. In this article, a brief history of medical licensing and regulation is first provided, with an overview of the structure and process of state medical boards, and how they vary across states. Next, common causes for medical board complaints are discussed, with a focus on complaints against psychiatrists. Last, the author provides general medical-legal considerations that a psychiatrist should contemplate if he or she is the subject of a medical board complaint.
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Does Performance on the American Board of Physical Medicine and Rehabilitation Initial Certification Examinations Predict Future Physician Disciplinary Actions? Am J Phys Med Rehabil 2019; 98:1079-1083. [PMID: 31232708 DOI: 10.1097/phm.0000000000001250] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of the study was to determine the relationship between performance on the American Board of Physical Medicine and Rehabilitation primary certification examinations and the risk of subsequent disciplinary actions by state medical boards over a physician's career. The hypothesis is that physicians who do not pass either or both of the two initial specialty certification examinations are at higher risk of disciplinary action from a state medical licensing board. DESIGN This is a retrospective cohort study that analyzed board certification examination data from all physicians who completed physical medicine and rehabilitation residency between 1968 and 2017. RESULTS Matching examination and license data were available for 9889 physical medicine and rehabilitation physicians, who received a total of 547 disciplinary action reports through the Federation of State Medical Boards. The results showed a significant correlation between failing an American Board of Physical Medicine and Rehabilitation certification examination and the risk of subsequent disciplinary action by a state medical board. Failure to pass either the written (Part I) or oral (Part II) examination increased the risk of subsequent disciplinary action by 5.77-fold (P < 0.0001, 95% confidence interval = 4.07-8.18). CONCLUSIONS Physicians in physical medicine and rehabilitation who do not pass initial certification examinations and become board certified are at higher risk of disciplinary action from a state medical licensing board throughout their careers.
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Caballero JA, Brown SP. Engagement, not personal characteristics, was associated with the seriousness of regulatory adjudication decisions about physicians: a cross-sectional study. BMC Med 2019; 17:211. [PMID: 31771585 PMCID: PMC6880351 DOI: 10.1186/s12916-019-1451-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/24/2019] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Outcomes of processes questioning a physician's ability to practise -e.g. disciplinary or regulatory- may strongly impact their career and provided care. However, it is unclear what factors relate systematically to such outcomes. METHODS In this cross-sectional study, we investigate this via multivariate, step-wise, statistical modelling of all 1049 physicians referred for regulatory adjudication at the UK medical tribunal, from June 2012 to May 2017, within a population of 310,659. In order of increasing seriousness, outcomes were: no impairment (of ability to practise), impairment, suspension (of right to practise), or erasure (its loss). This gave adjusted odds ratios (OR) for: age, race, sex, whether physicians first qualified domestically or internationally, area of practice (e.g. GP, specialist), source of initial referral, allegation type, whether physicians attended their outcome hearing, and whether they were legally represented for it. RESULTS There was no systematic association between the seriousness of outcomes and the age, race, sex, domestic/international qualification, or the area of practice of physicians (ORs p≥0.05), except for specialists who tended to receive outcomes milder than suspension or erasure. Crucially, an apparent relationship of outcomes to age (Kruskal-Wallis, p=0.009) or domestic/international qualification (χ2,p=0.014) disappeared once controlling for hearing attendance (ORs p≥0.05). Both non-attendance and lack of legal representation were consistently related to more serious outcomes (ORs [95% confidence intervals], 5.28 [3.89, 7.18] and 1.87 [1.34, 2.60], respectively, p<0.001). CONCLUSIONS All else equal, personal characteristics or first qualification place were unrelated to the seriousness of regulatory outcomes in the UK. Instead, engagement (attendance and legal representation), allegation type, and referral source were importantly associated to outcomes. All this may generalize to other countries and professions.
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Affiliation(s)
- Javier A Caballero
- General Medical Council, 350 Euston Rd, London, NW1 3JN, UK. .,University of Manchester, Faculty of Biology, Medicine and Health, Oxford Rd, Manchester, M13 9PT, UK. .,The University of Sheffield, Dept of Psychology, Western Bank, Sheffield, S10 2TN, UK.
| | - Steve P Brown
- General Medical Council, 350 Euston Rd, London, NW1 3JN, UK
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Association between Performance in a Maintenance of Certification Program and Disciplinary Actions against the Medical Licenses of Anesthesiologists. Anesthesiology 2019; 129:812-820. [PMID: 29965814 DOI: 10.1097/aln.0000000000002326] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
WHAT WE ALREADY KNOW ABOUT THIS TOPIC WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: In 2000, the American Board of Anesthesiology (Raleigh, North Carolina) began issuing time-limited certificates requiring renewal every 10 yr through a maintenance of certification program. This study investigated the association between performance in this program and disciplinary actions against medical licenses. METHODS The incidence of postcertification prejudicial license actions was compared (1) between anesthesiologists certified between 1994 and 1999 (non-time-limited certificates not requiring maintenance of certification) and those certified between 2000 and 2005 (time-limited certificates requiring maintenance of certification); (2) within the non-time-limited cohort, between those who did and did not voluntarily participate in maintenance of certification; and (3) within the time-limited cohort, between those who did and did not complete maintenance of certification requirements within 10 yr. RESULTS The cumulative incidence of license actions was 3.8% (587 of 15,486). The incidence did not significantly differ after time-limited certificates were introduced (hazard ratio = 1.15; 95% CI, 0.95 to 1.39; for non-time-limited cohort compared with time-limited cohort). In the non-time-limited cohort, 10% (n = 953) voluntarily participated in maintenance of certification. Maintenance of certification participation was associated with a lower incidence of license actions (hazard ratio = 0.60; 95% CI, 0.38 to 0.94). In the time-limited cohort, 90% (n = 5,329) completed maintenance of certification requirements within 10 yr of certificate issuance. Not completing maintenance of certification requirements (n = 588) was associated with a higher incidence of license actions (hazard ratio = 4.61; 95% CI, 3.27 to 6.51). CONCLUSIONS These findings suggest that meeting maintenance of certification requirements is associated with a lower likelihood of being disciplined by a state licensing agency. The introduction of time-limited certificates in 2000 was not associated with a significant change in the rate of license actions.
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Chaperone Use in Plastic and Reconstructive Surgery Outpatient Clinics: The Patient Perspective. Ann Plast Surg 2019; 83:e68-e71. [PMID: 31268948 DOI: 10.1097/sap.0000000000001927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Patient perspectives on chaperone use during examinations, especially in surgical subspecialties, are understudied. We aimed to identify specific patient cohorts that desire the presence of chaperones and compare patient and surgeon perspectives, all in an effort to improve quality of care. METHODS AND MATERIALS We prospectively administered a 15-question survey to all patients visiting 2 plastic surgery outpatient clinics between January 2015 and April 2016. Data on demographics, types of procedures (cosmetic or reconstructive), area of examination (sensitive or nonsensitive), views on chaperone use, type of chaperone, and instances of inappropriate behavior by surgeons were collected. Univariate analysis was performed after stratifying patients on their individual desire to have a chaperone. Subsequently, multivariate regression models were constructed to identify individual patient cohorts independently more likely to require a chaperone. RESULTS A total of 398 participants were surveyed. There were 58.3% female and 41.7% male respondents; of whom 41.8% were 55 years or older and 8.1% were younger than 24 years. Ninety percent of all patients were receiving care for a reconstructive procedure. Most (77%) were being examined over a nonsensitive area. Overall, 82.1% preferred not to have a chaperone present during examinations. Most (72.6%) felt the sex of the examining physician was inconsequential to their need for a chaperone. Most (54.8%) preferred either a family member or a friend to be the chaperone. Only 1.8% (n = 7) experienced inappropriate behavior, of whom 77% (n = 5) noted the absence of a chaperone while being examined. On multivariate analysis, younger patients and examination over a sensitive area were independently associated with a higher odd of requiring a chaperone (odds ratios, 3.4 [95% confidence interval, 1.3-8.9; P = 0.016] and 3.9 [95% confidence interval, 1.9-6.7; P < 0.001], respectively). CONCLUSIONS Most patients did not want a chaperone during examinations. Younger patients and those having a sensitive area examined were independently more likely to desire a chaperone. Patients preferred having their family member or friend as their chaperone. Given the major differences in perceptions, plastic surgeons should consider selectively using chaperones rather than the carte blanche use of chaperones with every patient.
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Rosengart TK, Doherty G, Higgins R, Kibbe MR, Mosenthal AC. Transition Planning for the Senior Surgeon. JAMA Surg 2019; 154:647-653. [DOI: 10.1001/jamasurg.2019.1159] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Todd K. Rosengart
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Gerard Doherty
- Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert Higgins
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Melina R. Kibbe
- Departments of Surgery and Biomedical Engineering, University of North Carolina, Chapel Hill
- Editor, JAMA Surgery
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Peabody MR, Young A, Peterson LE, O'Neill TR, Pei X, Arnhart K, Chaudhry HJ, Puffer JC. The Relationship Between Board Certification and Disciplinary Actions Against Board-Eligible Family Physicians. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:847-852. [PMID: 30768464 DOI: 10.1097/acm.0000000000002650] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE Lack of specialty board certification has been reported as a significant physician-level predictor of receiving a disciplinary action from a state medical board. This study investigated the association between family physicians receiving a disciplinary action from a state medical board and certification by the American Board of Family Medicine (ABFM). METHOD Three datasets were merged and a series of logistic regressions were conducted examining the relationship between certification status and disciplinary actions when adjusting for covariates. Data were available from 1976 to 2017. Predictor variables were gender, age, medical training degree type, medical school location, and the severity of the action. RESULTS Of the family physicians in this sample, 95% (114,454/120,443) had never received any disciplinary action. Having ever been certified was associated with a reduced likelihood of ever receiving an action (odds ratio [OR] = 0.35; 95% confidence interval [CI] = 0.30, 0.40; P < .001), and having held a prior but not current certification at the time of the action was associated with an increase in receiving the most severe type of action (OR = 3.71; 95% CI = 2.24, 6.13; P < .001). CONCLUSIONS Disciplinary actions are uncommon events. Family physicians who had ever been ABFM certified were less likely to receive an action. The most severe actions were associated with decreased odds of being board certified at the time of the action. Receiving the most severe action type increased the likelihood of physicians holding a prior but not current certification.
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Affiliation(s)
- Michael R Peabody
- M.R. Peabody is senior psychometrician, American Board of Family Medicine, Lexington, Kentucky. A. Young is assistant vice president, Research and Data Integration, Federation of State Medical Boards, Euless, Texas. L.E. Peterson is vice president of research, American Board of Family Medicine, and assistant professor, Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, Kentucky. T.R. O'Neill is vice president of psychometric services, American Board of Family Medicine, Lexington, Kentucky. X. Pei is senior research analyst, Federation of State Medical Boards, Euless, Texas. K. Arnhart is senior research analyst, Federation of State Medical Boards, Euless, Texas. H.J. Chaudhry is president and chief executive officer, Federation of State Medical Boards, Euless, Texas. J.C. Puffer is president and chief executive officer emeritus, American Board of Family Medicine, Lexington, Kentucky
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Birkeland S, Bogh SB. Malpractice litigation, workload, and general practitioner retirement. Prim Health Care Res Dev 2019; 20:e23. [PMID: 32799978 PMCID: PMC6476390 DOI: 10.1017/s1463423618000816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 09/18/2018] [Accepted: 10/04/2018] [Indexed: 11/07/2022] Open
Abstract
We investigated the association between general practitioner (GP) stress factors, including involvement in malpractice litigation or high workload levels during 2007 and ensuing retirement in a sample of Danish GPs. The case file and register information of 739 GPs were examined. Hazard ratios (HRs) were estimated for all causes of retirement from 2007 to 2016. During the study period, 34% of GPs had ceased to practice (n = 260). The HR for retirement was higher with increasing age (HR = 1.19 per year) and lower if practicing in a clinic with a greater number of GPs (HR = 0.47) but no statistically significant association was found between retirement and litigation or higher workload. Knowledge on factors influencing GPs' decision on whether to continue working is important to ensure sustainable primary care provision.
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Affiliation(s)
- Søren Birkeland
- Centre for Quality and Department of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
| | - Søren Bie Bogh
- Centre for Quality and Department of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
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Chen A, Blumenthal DM, Jena AB. Characteristics of Physicians Excluded From US Medicare and State Public Insurance Programs for Fraud, Health Crimes, or Unlawful Prescribing of Controlled Substances. JAMA Netw Open 2018; 1:e185805. [PMID: 30646294 PMCID: PMC6324355 DOI: 10.1001/jamanetworkopen.2018.5805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Each year, billions of dollars are wasted owing to health care fraud, waste, and abuse. Efforts to detect fraud have been increasing, yet we have little information about physicians who have been excluded from Medicare and state public insurance programs for fraud, health crimes, or the unlawful prescribing of controlled substances. OBJECTIVE To examine the characteristics of physicians excluded from Medicare and state public insurance programs for fraud, health crimes, or unlawful prescribing of controlled substances. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study considered all physicians excluded from Medicare and state public insurance programs between 2007 and 2017. The study matched exclusion data to a comprehensive, cross-sectional database of US physicians assembled by Doximity, an online networking service for US physicians. The share of physicians excluded in each state was examined and linear trends of exclusions over time were estimated. Using physician-level multivariable logistic regression models, exclusions (binary variable) were assessed as a function of physician characteristics. MAIN OUTCOMES AND MEASURES Exclusions for fraud, health crimes (defined legally as criminal penalties for acts involving federal health care programs), and substance abuse; and physician characteristics, including age, sex, allopathic vs osteopathic degree, medical school attended, ranking of that medical school, medical school faculty affiliation, practice state, practice location, and specialty. RESULTS Between 2007 and 2017, 2222 physicians (0.29%) were temporarily or permanently excluded from Medicare and state public insurance programs. Fraud, health crimes, and substance abuse exclusions increased, on average, 20% per year (equivalent to 48 [95% CI, 40.4-56.0] convictions/year from a base of 236 convictions in 2007 to 670 convictions in 2017 [an increase of approximately 200% from 2007 to 2017]). Exclusion rates were highest in the West and Southeast. West Virginia had the highest exclusion rate, with 5.77 exclusions per 1000 physicians (32 exclusions among 5720 physicians), while Montana had 0 exclusions during this period. Male physicians, physicians with osteopathic training, older physicians, and physicians in specific specialties (eg, family medicine, psychiatry, internal medicine, anesthesiology, surgery, and obstetrics/gynecology) were more likely to be excluded. CONCLUSIONS AND RELEVANCE The number of physicians excluded from participation in Medicare and state public insurance reimbursement owing to fraud, waste, and abuse increased between 2007 and 2017. Several physician characteristics, including being a male, older age, and osteopathic training, were significantly and positively associated with exclusion. Our results highlight the potential value of using physician characteristics in conjunction with information on medical claims filed by physicians to help identify adverse physician behavior.
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Affiliation(s)
- Alice Chen
- Sol Price School of Public Policy, University of Southern California, Los Angeles
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
| | - Daniel M. Blumenthal
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Devoted Health Inc, Waltham, Massachusetts
| | - Anupam B. Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Boston
- National Bureau of Economic Research, Cambridge, Massachusetts
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The American Board of Internal Medicine Maintenance of Certification Examination and State Medical Board Disciplinary Actions: a Population Cohort Study. J Gen Intern Med 2018; 33. [PMID: 29516388 PMCID: PMC6082195 DOI: 10.1007/s11606-018-4376-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Some have questioned whether successful performance in the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) program is meaningful. The association of the ABIM Internal Medicine (IM) MOC examination with state medical board disciplinary actions is unknown. OBJECTIVE To assess risk of disciplinary actions among general internists who did and did not pass the MOC examination within 10 years of initial certification. DESIGN Historical population cohort study. PARTICIPANTS The population of internists certified in internal medicine, but not a subspecialty, from 1990 through 2003 (n = 47,971). INTERVENTION ABIM IM MOC examination. SETTING General internal medicine in the USA. MAIN MEASURES The primary outcome measure was time to disciplinary action assessed in association with whether the physician passed the ABIM IM MOC examination within 10 years of initial certification, adjusted for training, certification, demographic, and regulatory variables including state medical board Continuing Medical Education (CME) requirements. KEY RESULTS The risk for discipline among physicians who did not pass the IM MOC examination within the 10 year requirement window was more than double than that of those who did pass the examination (adjusted HR 2.09; 95% CI, 1.83 to 2.39). Disciplinary actions did not vary by state CME requirements (adjusted HR 1.02; 95% CI, 0.94 to 1.16), but declined with increasing MOC examination scores (Kendall's tau-b coefficient = - 0.98 for trend, p < 0.001). Among disciplined physicians, actions were less severe among those passing the IM MOC examination within the 10-year requirement window than among those who did not pass the examination. CONCLUSIONS Passing a periodic assessment of medical knowledge is associated with decreased state medical board disciplinary actions, an important quality outcome of relevance to patients and the profession.
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Jeyalingam T, Matelski JJ, Alam AQ, Liu JJ, Goldberg H, Klemensberg J, Bell CM. The Characteristics of Physicians Who are Re-Disciplined by Medical Boards: A Retrospective Cohort Study. Jt Comm J Qual Patient Saf 2018; 44:361-365. [PMID: 29793887 DOI: 10.1016/j.jcjq.2017.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/22/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Physician misconduct adversely affects patient safety and is therefore of societal importance. Little work has specifically examined re-disciplined physicians. A study was conducted to compare the characteristics of re-disciplined to first-time disciplined physicians. METHODS A retrospective review of Canadian physicians disciplined by medical boards between 2000 and 2015 was conducted. Physicians were divided into those disciplined once and those disciplined more than once. Differences in demographics, transgressions, and penalties were evaluated. RESULTS There were 938 disciplinary events for 810 disciplined physicians with 1 in 8 (n = 101, 12.5%) being re-disciplined. Re-disciplined physicians had up to six disciplinary events in the study period and 4 (4.0%) had events in more than one jurisdiction. Among those re-disciplined, 94 (93.1%) were male, 34 (33.7%) were international medical graduates, and 88 (87.1%) practiced family medicine (n = 59, 58.4%), psychiatry (n = 11, 10.9%), surgery (n = 9, 8.9%), or obstetrics/gynecology (n = 9, 8.9%). The proportion of obstetrician/gynecologists was higher among re-disciplined physicians (8.9% vs. 4.2%, p = 0.048). Re-disciplined physicians had more mental illness (1.7% vs. 0.1%, p = 0.01), unlicensed activity (19.2% vs. 7.2%, p <0.01), and less sexual misconduct (20.1% vs. 27.9%, p = 0.02). License suspension occurred more frequently among those re-disciplined (56.8% vs. 48.0%, p = 0.02) as did license restriction (38.4% vs. 26.7%, p <0.01). License revocation was not different between cohorts (10.9% vs. 13.5%, p = 0.36). CONCLUSION Re-discipline is not uncommon and underscores the need for better identification of at-risk individuals and optimization of remediation and penalties. The distribution of transgression argues for a national disciplinary database that could improve communication between jurisdictional medical boards.
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Wenghofer E, Boal P, Floyd N, Lee J, Woodard R, Norcross W. Improving Charting Skills of Physicians in Monitored Practice. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2018; 38:244-249. [PMID: 30204641 DOI: 10.1097/ceh.0000000000000221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The Physician Enhancement Program (PEP) is an in-practice monitoring program for physicians with potential dyscompetency issues. One component of PEP is a monthly chart audit. The purpose of our study was to determine if physicians' charting skills improve through their participation in PEP. METHODS The sample included physicians who participated in PEP for at least 6 months regardless of specialization, age, or gender (n = 77). PEP chart audits evaluate seven different aspects of chart and care quality, including legibility, organization, history, assessment/formulation, treatment, physical examination, and overall chart quality. Each aspect of charting is scored on a Likert-type scale from a score of 1 to 9. We conducted pair-matched t tests of the mean item scores for the 1st versus 6th, 12th, 18th, and 24th month in PEP for all chart elements except legibility. We also compared the size of the paired differences by month 1 scores for overall chart quality mean score to determine if the magnitude of change varied by starting point. RESULTS There was significant improvement (P < .002) across the 6 chart quality elements per physician at months 6, 12, 18, and 24. Physicians who started below Q1 for overall chart quality mean showed most improvement, whereas those who started above Q3 had insignificant change as they had little room to improve. DISCUSSION PEP participants demonstrated improved charting skills for each chart quality element evaluated. PEP is an effective form of physician education resulting in physician behavior changes, especially for those physicians who need it the most.
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Affiliation(s)
- Elizabeth Wenghofer
- Dr. Wenghofer: Professor, School of Rural and Northern Health, Laurentian University, Sudbury, ON Canada, and Research Director, Physician Assessment and Clinical Education (PACE) Program, University of California San Diego, San Diego, CA. Mr. Boal: Associate Director, PACE Program, University of California San Diego, San Diego, CA. Mr. Floyd: Administrative Director, Physician Education Program (PEP), PACE Program, University of California San Diego, San Diego, CA. Ms. Lee: Office Manager, PACE Program, University of California San Diego, San Diego, CA. Mr. Woodard: Information Systems Analyst III, PACE Program, University of California San Diego, San Diego, CA. Dr. Norcross: Clinical Professor of Family Medicine and Director, PACE Program, University of California San Diego, San Diego, CA
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Cuddy MM, Young A, Gelman A, Swanson DB, Johnson DA, Dillon GF, Clauser BE. Exploring the Relationships Between USMLE Performance and Disciplinary Action in Practice: A Validity Study of Score Inferences From a Licensure Examination. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1780-1785. [PMID: 28562454 DOI: 10.1097/acm.0000000000001747] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE Physicians must pass the United States Medical Licensing Examination (USMLE) to obtain an unrestricted license to practice allopathic medicine in the United States. Little is known, however, about how well USMLE performance relates to physician behavior in practice, particularly conduct inconsistent with safe, effective patient care. The authors examined the extent to which USMLE scores relate to the odds of receiving a disciplinary action from a U.S. state medical board. METHOD Controlling for multiple factors, the authors used non-nested multilevel logistic regression analyses to estimate the relationships between scores and receiving an action. The sample included 164,725 physicians who graduated from U.S. MD-granting medical schools between 1994 and 2006. RESULTS Physicians had a mean Step 1 score of 214 (standard deviation [SD] = 21) and a mean Step 2 Clinical Knowledge (CK) score of 213 (SD = 23). Of the physicians, 2,205 (1.3%) received at least one action. Physicians with higher Step 2 CK scores had lower odds of receiving an action. A 1-SD increase in Step 2 CK scores corresponded to a decrease in the chance of disciplinary action by roughly 25% (odds ratio = 0.75; 95% CI = 0.70-0.80). After accounting for Step 2 CK scores, Step 1 scores were unrelated to the odds of receiving an action. CONCLUSIONS USMLE Step 2 CK scores provide useful information about the odds a physician will receive an official sanction for problematic practice behavior. These results provide validity evidence supporting current interpretation and use of Step 2 CK scores.
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Affiliation(s)
- Monica M Cuddy
- M.M. Cuddy is measurement scientist, Center for Advanced Assessment, National Board of Medical Examiners, Philadelphia, Pennsylvania. A. Young is assistant vice president, Research and Data Integration, Federation of State Medical Boards, Euless, Texas. A. Gelman is professor, Departments of Statistics and Political Science, Columbia University, New York, New York. D.B. Swanson is vice president, Academic Programs and Services, American Board of Medical Specialties, Chicago, Illinois, and professor (honorary appointment), Department of Medical Education, University of Melbourne Medical School, Melbourne, Australia. D.A. Johnson is senior vice president, Assessment Services, Federation of State Medical Boards, Euless, Texas. G.F. Dillon is vice president, Licensure, National Board of Medical Examiners, Philadelphia, Pennsylvania. B.E. Clauser is vice president, Center for Advanced Assessment, National Board of Medical Examiners, Philadelphia, Pennsylvania
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Wier J. Protecting the Public: An Investigation of Midwives Perceptions of Regulation and the Regulator. Midwifery 2017. [DOI: 10.1016/j.midw.2017.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Effectiveness of Written and Oral Specialty Certification Examinations to Predict Actions against the Medical Licenses of Anesthesiologists. Anesthesiology 2017; 126:1171-1179. [PMID: 28383325 DOI: 10.1097/aln.0000000000001623] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The American Board of Anesthesiology administers written and oral examinations for its primary certification. This retrospective cohort study tested the hypothesis that the risk of a disciplinary action against a physician's medical license is lower in those who pass both examinations than those who pass only the written examination. METHODS Physicians who entered anesthesiology training from 1971 to 2011 were followed up to 2014. License actions were ascertained via the Disciplinary Action Notification Service of the Federation of State Medical Boards. RESULTS The incidence rate of license actions was relatively stable over the study period, with approximately 2 to 3 new cases per 1,000 person-years. In multivariable models, the risk of license actions was higher in men (hazard ratio = 1.88 [95% CI, 1.66 to 2.13]) and lower in international medical graduates (hazard ratio = 0.73 [95% CI, 0.66 to 0.81]). Compared with those passing both examinations on the first attempt, those passing neither examination (hazard ratio = 3.60 [95% CI, 3.14 to 4.13]) and those passing only the written examination (hazard ratio = 3.51 [95% CI, 2.87 to 4.29]) had an increased risk of receiving an action from a state medical board. The risk was no different between the latter two groups (P = 0.81), showing that passing the oral but not the written primary certification examination is associated with a decreased risk of subsequent license actions. For those with residency performance information available, having at least one unsatisfactory training record independently increased the risk of license actions. CONCLUSIONS These findings support the concept that an oral examination assesses domains important to physician performance that are not fully captured in a written examination.
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Kreiner PW, Strickler GK, Undurraga EA, Torres ME, Nikitin RV, Rogers A. Validation of prescriber risk indicators obtained from prescription drug monitoring program data. Drug Alcohol Depend 2017; 173 Suppl 1:S31-S38. [PMID: 28363317 DOI: 10.1016/j.drugalcdep.2016.11.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 10/04/2016] [Accepted: 11/03/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Prescription opioids are commonly overprescribed. However, validated measures of inappropriate controlled substance prescribing are lacking. This study examined associations between prescriber risk indicators developed as part of a public health surveillance project and medical board disciplinary actions against prescribers. METHODS We compiled 12 prescriber risk indicators using data from the Maine prescription drug monitoring program (PDMP) for 2010. We used logistic regression models to assess the relative likelihood of the top 1%, 2%, 5%, and 10% of prescribers on each risk indicator having been subject to medical board disciplinary actions, those citing inappropriate prescribing, or those involving license suspension or revocation, during 2010-2014, controlling for prescriber medical specialty and gender. RESULTS The top 1% of prescribers for number of patients, opioid prescriptions per day, and opioid dosage prescribed per day had a greater likelihood of medical board disciplinary actions citing inappropriate prescribing, relative to a matched sample of other (non-top 1%) prescribers. Of the 56 prescribers in the top 1% for opioid prescriptions per day, nine (16.1%) were sanctioned for inappropriate prescribing, compared with 11 of 224 (0.5%) in the comparison group. The top 2% of prescribers for opioid dosage per day, and average distance patients travel to prescriber, had a greater likelihood of actions involving license suspension, revocation, or denial for renewal. CONCLUSIONS Measures derived from PDMP data may be useful in assessing levels of inappropriate prescribing of controlled substances in a population of prescribers, and in evaluating changes associated with efforts to influence prescriber behavior.
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Affiliation(s)
- Peter W Kreiner
- PDMP Center of Excellence, Schneider Institutes for Health Policy, Brandeis University, 415 South Street, Waltham, MA 02453-2728, United States.
| | - Gail K Strickler
- PDMP Center of Excellence, Schneider Institutes for Health Policy, Brandeis University, 415 South Street, Waltham, MA 02453-2728, United States
| | - Eduardo A Undurraga
- PDMP Center of Excellence, Schneider Institutes for Health Policy, Brandeis University, 415 South Street, Waltham, MA 02453-2728, United States
| | - Maria E Torres
- PDMP Center of Excellence, Schneider Institutes for Health Policy, Brandeis University, 415 South Street, Waltham, MA 02453-2728, United States
| | - Ruslan V Nikitin
- PDMP Center of Excellence, Schneider Institutes for Health Policy, Brandeis University, 415 South Street, Waltham, MA 02453-2728, United States
| | - Anne Rogers
- Maine Office of Substance Abuse, 11 State House Station, 41 Anthony Avenue, Augusta, ME 04333, United States
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Alam A, Matelski JJ, Goldberg HR, Liu JJ, Klemensberg J, Bell CM. The Characteristics of International Medical Graduates Who Have Been Disciplined by Professional Regulatory Colleges in Canada: A Retrospective Cohort Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:244-249. [PMID: 27603039 DOI: 10.1097/acm.0000000000001356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE This study evaluated the proportion and characteristics of international medical graduates (IMGs) who have been disciplined by professional regulatory colleges in Canada in comparison with disciplined North American medical graduates (NAMGs). METHOD The authors compiled a database of the nature of professional misconduct and penalties incurred by disciplined physicians from January 2000 to May 2015 using public records. They compared discipline data for IMGs versus those for NAMGs, and calculated risk ratios (RRs) and 95% confidence intervals (CIs) for select outcomes. RESULTS There were 794 physicians disciplined; 922 disciplinary cases during the 15-year study period. IMGs composed an average of 23.4% (standard deviation = 1.1%) of the total physician population and represented one-third of disciplined physicians and discipline cases. The overall disciplinary rate for all Canadian physicians was 8.52 cases per 10,000 physician years (95% CI [7.77, 9.31]). This rate per group was higher for IMGs than for NAMGs (12.91 [95% CI (11.50, 14.43)] vs. 8.16 [95% CI (7.53, 8.82)] cases per 10,000 physician years, P < .01, and RR 1.58 (95% CI [1.38, 1.82]). IMGs were disciplined at significantly higher rates than NAMGs if they were trained in South Africa (RR 1.73 [95% CI (1.14, 2.51), P < .01), Egypt (RR 3.59 [95% CI (2.18, 5.52)], P < .01), or India (RR 1.66 [95% CI (1.01, 2.55)], P = .03). CONCLUSIONS IMGs are disciplined at a higher rate than NAMGs. Future initiatives should be focused to delineate the exact cause of this observation.
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Affiliation(s)
- Asim Alam
- A. Alam is staff anesthesiologist and transfusion medicine specialist, Department of Anesthesia, Sunnybrook Health Sciences Centre and Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada. J.J. Matelski is a biostatistician, Division of General Internal Medicine, Toronto General Hospital, Toronto, Ontario, Canada. H.R. Goldberg is a medical student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. J.J. Liu is a general medical internist, Division of General Internal Medicine, University Health Network and Department of Medicine, University of Toronto, Ontario, Canada. J. Klemensberg is a medical student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. C.M. Bell is a general medical internist, Division of Internal Medicine, Mt. Sinai Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Lillvis DF, McGrath RJ. Directing Discipline: State Medical Board Responsiveness to State Legislatures. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2017; 42:123-165. [PMID: 27729446 DOI: 10.1215/03616878-3702794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
State medical boards are increasingly responsible for regulating medical and osteopathic licensure and professional conduct in the United States. Yet, there is great variation in the extent to which such boards take disciplinary action against physicians, indicating that some boards are more zealous regulators than others. We look to the political roots of such variation and seek to answer a simple, yet important, question: are nominally apolitical state medical boards responsive to political preferences? To address this question, we use panel data on disciplinary actions across sixty-four state medical boards from 1993 through 2006 and control for over-time changes in board characteristics (e.g., composition, independence, budgetary status), regulatory structure, and resources. We show that as state legislatures become more liberal [conservative], state boards increasingly [decreasingly] discipline physicians, especially during unified government and in the presence of highly professional legislatures. Our conclusions join others in emphasizing the importance of state medical boards and the contingent nature of political control of state regulation. In addition, we emphasize the roles that oversight capacity and strategy play in offsetting concerns regarding self-regulation of a powerful organized interest.
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Abstract
Residents have the rights and responsibilities of both students and employees. Dismissal of a resident from a training program is traumatic and has lasting repercussions for the program director, the faculty, the dismissed resident, and the residency. A review of English language literature was performed using PUBMED and OVID databases, using the search terms, resident dismissal, resident termination, student dismissal, student and resident evaluation, legal aspects of education, and remediation. The references of each publication were also reviewed to identify additional appropriate citations. If the Just Cause threshold has been met, educators have the absolute discretion to evaluate academic and clinical performance. Legal opinion has stated that it is not necessary to wait until a patient is harmed to dismiss a resident. Evaluations should be standard and robust. Negative evaluations are not defamatory as the resident gave consent to be evaluated. Provided departmental and institutional polices have been followed, a resident can be dismissed without a formal hearing. Residencies are entitled to modify academic requirements and dismissal is not considered a breach of contract. Although there is anxiety regarding resident dismissal, the courts have uniformly supported faculty having this role. When indicated, failure to dismiss a resident also places the program director and the faculty at risk for educational malpractice.
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Affiliation(s)
- Paul J. Schenarts
- Department of Surgery, University of Nebraska, College of Medicine, Omaha, Nebraska
| | - Sean Langenfeld
- Department of Surgery, University of Nebraska, College of Medicine, Omaha, Nebraska
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Spittal MJ, Studdert DM, Paterson R, Bismark MM. Outcomes of notifications to health practitioner boards: a retrospective cohort study. BMC Med 2016; 14:198. [PMID: 27908294 PMCID: PMC5134271 DOI: 10.1186/s12916-016-0748-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/11/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Medical boards and other practitioner boards aim to protect the public from unsafe practice. Previous research has examined disciplinary actions against doctors, but other professions (e.g., nurses and midwives, dentists, psychologists, pharmacists) remain understudied. We sought to describe the outcomes of notifications of concern regarding the health, performance, and conduct of health practitioners from ten professions in Australia and to identify factors associated with the imposition of restrictive actions. METHODS We conducted a retrospective cohort study of all notifications lodged with the Australian Health Practitioner Regulation Agency over 24 months. Notifications were followed for 30-54 months. Our main outcome was restrictive actions, defined as decisions that imposed undertakings, conditions, or suspension or cancellation of registration. RESULTS There were 8307 notifications. The notification rate was highest among doctors (IR = 29.0 per 1000 practitioner years) and dentists (IR = 41.4) and lowest among nurses and midwives (IR = 4.1). One in ten notifications resulted in restrictive action; fewer than one in 300 notifications resulted in suspension or cancellation of registration. Compared with notifications about clinical care, the odds of restrictive action were higher for notifications relating to health impairments (drug misuse, OR = 7.0; alcohol misuse, OR = 4.6; mental illness, OR = 4.1, physical or cognitive illness, OR = 3.7), unlawful prescribing or use of medications (OR = 2.1) and violation of sexual boundaries (OR = 1.7). The odds were higher where the report was made by another health practitioner (OR = 2.9) or employer (OR = 6.9) rather than a patient or relative. Nurses and midwives (OR = 1.8), psychologists (OR = 4.5), dentists (OR = 4.7), and other health practitioners (OR = 5.3) all had greater odds of being subject to restrictive actions than doctors. CONCLUSIONS Restrictive actions are the strongest measures health practitioner boards can take to protect the public from harm and these actions can have profound effects on the livelihood, reputations and well-being of practitioners. In Australia, restrictive actions are rarely imposed and there is variation in their use depending on the source of the notification, the type of issue involved, and the profession of the practitioner.
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Affiliation(s)
- Matthew J Spittal
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, 3010, Australia.
| | - David M Studdert
- Stanford University School of Medicine and Stanford Law School, 117 Encina Commons, Stanford, CA, 94305, USA
| | - Ron Paterson
- Auckland Law School, The University of Auckland, Private Bay 92019, Auckland, 1142, New Zealand.,Melbourne Law School, The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Marie M Bismark
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, 3010, Australia
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Affiliation(s)
- Allen Kachalia
- From Brigham & Women's Hospital, Harvard Medical School, Boston, MA (A.K.); Stanford University School of Medicine and Stanford Law School, CA (M.M.M., D.M.S.); and University of Michigan Medical School, Ann Arbor (B.K.N.).
| | - Michelle M Mello
- From Brigham & Women's Hospital, Harvard Medical School, Boston, MA (A.K.); Stanford University School of Medicine and Stanford Law School, CA (M.M.M., D.M.S.); and University of Michigan Medical School, Ann Arbor (B.K.N.)
| | - Brahmajee K Nallamothu
- From Brigham & Women's Hospital, Harvard Medical School, Boston, MA (A.K.); Stanford University School of Medicine and Stanford Law School, CA (M.M.M., D.M.S.); and University of Michigan Medical School, Ann Arbor (B.K.N.)
| | - David M Studdert
- From Brigham & Women's Hospital, Harvard Medical School, Boston, MA (A.K.); Stanford University School of Medicine and Stanford Law School, CA (M.M.M., D.M.S.); and University of Michigan Medical School, Ann Arbor (B.K.N.)
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Coverdale JH, Roberts LW, Balon R, Beresin EV, Louie AK, Guerrero APS, Brenner AM, McCullough LB. Professional Integrity and the Role of Medical Students in Professional Self-Regulation. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2016; 40:525-529. [PMID: 27020936 DOI: 10.1007/s40596-016-0534-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/14/2016] [Indexed: 06/05/2023]
Affiliation(s)
| | | | | | | | | | | | - Adam M Brenner
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Dineen KK, DuBois JM. BETWEEN A ROCK AND A HARD PLACE: CAN PHYSICIANS PRESCRIBE OPIOIDS TO TREAT PAIN ADEQUATELY WHILE AVOIDING LEGAL SANCTION? AMERICAN JOURNAL OF LAW & MEDICINE 2016; 42:7-52. [PMID: 27263262 PMCID: PMC5494184 DOI: 10.1177/0098858816644712] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Prescription opioids are an important tool for physicians in treating pain but also carry significant risks of harm when prescribed inappropriately or misused by patients or others. Recent increases in opioid-related morbidity and mortality has reignited scrutiny of prescribing practices by law enforcement, regulatory agencies, and state medical boards. At the same time, the predominant 4D model of misprescribers is outdated and insufficient; it groups physician misprescribers as dated, duped, disabled, or dishonest. The weaknesses and inaccuracies of the 4D model are explored, along with the serious consequences of its application. This Article calls for development of an evidence base in this area and suggests an alternate model of misprescribers, the 3C model, which more accurately characterizes misprescribers as careless, corrupt, or compromised by impairment.
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Freeman BD. Is It Time to Rethink Postgraduate Training Requirements for Licensure? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:20-22. [PMID: 26445079 DOI: 10.1097/acm.0000000000000881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Approaches to postgraduate medical training have evolved substantially in recent years, reflecting the complexity of the educational mission. Residency programs seek to produce clinicians who achieve board certification as an attestation of their competency. Certification criteria are established by the American Board of Medical Specialties, are consistent from state to state, and include periods of supervised instruction ranging from as few as three years (for primary care specialties) to much longer for selected disciplines. In contrast, minimum postgraduate training criteria necessary for licensure as an independent practitioner are established by state medical boards and vary significantly among and within jurisdictions. In most states, licenses can be granted to individuals who have completed as little as one year of postgraduate training. The discrepancy between the minimum time commitment necessary to become a competent physician and that to be licensed as an independent practitioner has implications for health care quality and safety. Data are lacking as to the number of licenses issued nationally to individuals who have only partially completed residency training and the nature of practices they pursue. Extrapolating from available evidence, these individuals may very well provide care inferior to those who have satisfied training requirements for certification eligibility and be more prone to problematic behavior resulting in disciplinary action. Efforts to establish more rigorous licensure criteria will require dialog between members of the academic community, professional organizations, state medical boards, and legislatures. The recently proposed Interstate Medical Licensure Compact may serve as a prototype for achieving this goal.
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Affiliation(s)
- Bradley D Freeman
- B.D. Freeman is professor of surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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Hawkins RE, Welcher CM, Stagg Elliott V, Pieters RS, Puscas L, Wick PH. Ensuring Competent Care by Senior Physicians. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2016; 36:226-231. [PMID: 27584000 DOI: 10.1097/ceh.0000000000000080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The increasing number of senior physicians and calls for increased accountability of the medical profession by the public have led regulators and policymakers to consider implementing age-based competency screening. Some hospitals and health systems have initiated age-based screening, but there is no agreed upon assessment process. Licensing and certifying organizations generally do not require that senior physicians pass additional assessments of health, competency, or quality performance. Studies suggest that physician performance, on average, declines with increasing years in medical practice, but the effect of age on an individual physician's competence is highly variable. Many senior physicians practice effectively and should be allowed to remain in practice as long as quality and safety are not endangered. Stakeholders in the medical profession should consider the need to develop guidelines and methods for monitoring and/or screening to ensure that senior physicians provide safe and effective care for patients. Any screening process needs to achieve a balance between protecting patients from harm due to substandard practice, while at the same time ensuring fairness to physicians and avoiding unnecessary reductions in workforce.
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Affiliation(s)
- Richard E Hawkins
- Dr. Hawkins: Vice President, Medical Education Outcomes, American Medical Association, Chicago, IL. Ms. Welcher: Senior Policy Analyst, Medical Education Outcomes, American Medical Association, Chicago, IL. Ms. Stagg Elliott: Technical Writer, Medical Education Outcomes, American Medical Association, Chicago, IL. Dr. Pieters: Professor of Radiation Oncology and Pediatrics, University of Massachusetts Medical School, Worcester, MA. Dr. Puscas: Associate Professor of Surgery, Duke University School of Medicine, Durham, NC. Dr. Wick: Assistant Professor, Psychiatry Department, Senior Behavioral Health Outpatient Services, University of Texas Health Northeast, Tyler, TX
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Verhoef LM, Weenink JW, Winters S, Robben PBM, Westert GP, Kool RB. The disciplined healthcare professional: a qualitative interview study on the impact of the disciplinary process and imposed measures in the Netherlands. BMJ Open 2015; 5:e009275. [PMID: 26608639 PMCID: PMC4663436 DOI: 10.1136/bmjopen-2015-009275] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE It is known that doctors who receive complaints may have feelings of anger, guilt, shame and depression, both in the short and in the long term. This might lead to functional impairment. Less is known about the impact of the disciplinary process and imposed measures. Previous studies of disciplinary proceedings have mainly focused on identifying characteristics of disciplined doctors and on sentencing policies. Therefore, the aim of this study is to explore what impact the disciplinary process and imposed measures have on healthcare professionals. DESIGN Semistructured interview study, with purposive sampling and inductive qualitative content analysis. PARTICIPANTS 16 healthcare professionals (9 medical specialists, 3 general practitioners, 2 physiotherapists and 2 psychologists) that were sanctioned by the disciplinary tribunal. SETTING The Netherlands. RESULTS Professionals described feelings of misery and insecurity both during the process as in its aftermath. Furthermore, they reported to fear receiving new complaints and provide care more cautiously after the imposed measure. Factors that may enhance psychological and professional impact are the publication of measures online and in newspapers, media coverage, the feeling of treated as guilty before any verdict has been reached, and the long duration of the process. CONCLUSIONS This study shows that the disciplinary process and imposed measures can have a profound psychological and professional impact on healthcare professionals. Although a disciplinary measure is meant to have a corrective effect, our results suggest that the impact that is experienced by professionals might hamper optimal rehabilitation afterwards. Therefore, organising emotional support should be considered during the disciplinary process and in the period after the verdict.
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Affiliation(s)
- Lise M Verhoef
- Scientific Institute for Quality of Health Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jan-Willem Weenink
- Scientific Institute for Quality of Health Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sjenny Winters
- Scientific Institute for Quality of Health Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Paul B M Robben
- Institute of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
- Department of Research and Innovation, Health Care Inspectorate, Utrecht, The Netherlands
| | - Gert P Westert
- Scientific Institute for Quality of Health Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rudolf B Kool
- Scientific Institute for Quality of Health Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
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Warner DO, Berge K, Sun H, Harman A, Hanson A, Schroeder DR. Risk and Outcomes of Substance Use Disorder among Anesthesiology Residents: A Matched Cohort Analysis. Anesthesiology 2015; 123:929-36. [PMID: 26263431 PMCID: PMC4573227 DOI: 10.1097/aln.0000000000000810] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The goal of this work is to evaluate selected risk factors and outcomes for substance use disorder (SUD) in physicians enrolled in anesthesiology residencies approved by the Accreditation Council for Graduate Medical Education. METHODS For each of 384 individuals with evidence of SUD while in primary residency training in anesthesiology from 1975 to 2009, two controls (n = 768) who did not develop SUD were identified and matched for sex, age, primary residency program, and program start date. Risk factors evaluated included location of medical school training (United States vs. other) and anesthesia knowledge as assessed by In-Training Examination performance. Outcomes (assessed to December 31, 2013, with a median follow-up time of 12.2 and 15.1 yr for cases and controls, respectively) included mortality and profession-related outcomes. RESULTS Receiving medical education within the United States, but not performance on the first in-training examination, was associated with an increased risk of developing SUD as a resident. Cases demonstrated a marked increase in the risk of death after training (hazard ratio, 7.9; 95% CI, 3.1 to 20.5), adverse training outcomes including failure to complete residency (odds ratio, 14.9; 95% CI, 9.0 to 24.6) or become board certified (odds ratio, 10.4; 95% CI, 7.0 to 15.5), and adverse medical licensure actions subsequent to residency (hazard ratio, 6.8; 95% CI, 3.8 to 12.2). As of the end of follow-up, 54 cases (14.1%) were deceased compared with 10 controls (1.3%); 28 cases and no controls died during residency. CONCLUSION The attributable risk of SUD to several adverse outcomes during and after residency training, including death and adverse medical license actions, is substantial.
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Affiliation(s)
- David O. Warner
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
- American Board of Anesthesiology, Raleigh, North Carolina
| | - Keith Berge
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
| | - Huaping Sun
- American Board of Anesthesiology, Raleigh, North Carolina
| | - Ann Harman
- American Board of Anesthesiology, Raleigh, North Carolina
| | - Andrew Hanson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Unwin E, Woolf K, Wadlow C, Potts HWW, Dacre J. Sex differences in medico-legal action against doctors: a systematic review and meta-analysis. BMC Med 2015; 13:172. [PMID: 26268807 PMCID: PMC4535538 DOI: 10.1186/s12916-015-0413-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/30/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The relationship between male sex and poor performance in doctors remains unclear, with high profile studies showing conflicting results. Nevertheless, it is an important first step towards understanding the causes of poor performance in doctors. This article aims to establish the robustness of the association between male sex and poor performance in doctors, internationally and over time. METHODS The electronic databases MEDLINE, EMBASE, and PsycINFO were searched from inception to January 2015. Backward and forward citation searching was performed. Journals that yielded the majority of the eligible articles and journals in the medical education field were electronically searched, along with the conference and poster abstracts from two of the largest international medical education conferences. Studies reporting original data, written in English or French, examining the association between sex and medico-legal action against doctors were included. Two reviewers independently extracted study characteristics and outcome data from the full texts of the studies meeting the eligibility criteria. Study quality was assessed using the Newcastle-Ottawa scale. A random effect meta-analysis model was used to summarize and assess the effect of doctors' sex on medico-legal action. Extracted outcomes included disciplinary action by a medical regulatory board, malpractice experience, referral to a medical regulatory body, complaints received by a healthcare complaints body, criminal cases, and medico-legal matter with a medical defence organisation. RESULTS Overall, 32 reports examining the association between doctors' sex and medico-legal action were included in the systematic review (n=4,054,551), of which 27 found that male doctors were more likely to have experienced medico-legal action. 19 reports were included in the meta-analysis (n=3,794,486, including 20,666 cases). Results showed male doctors had nearly two and a half times the odds of being subject to medico-legal action than female doctors. Heterogeneity was present in all meta-analyses. CONCLUSION Male doctors are more likely to have had experienced medico-legal actions compared to female doctors. This finding is robust internationally, across outcomes of varying severity, and over time.
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Affiliation(s)
- Emily Unwin
- UCL Medical School, University College London, Royal Free Hospital, London, NW3 2PF, UK.
| | - Katherine Woolf
- UCL Medical School, University College London, Royal Free Hospital, London, NW3 2PF, UK.
| | - Clare Wadlow
- UCL Medical School, University College London, Royal Free Hospital, London, NW3 2PF, UK.
| | - Henry W W Potts
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK.
| | - Jane Dacre
- Royal College of Physicians, 11 St Andrews Place, London, NW1 4LE, UK.
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Liu JJ, Alam AQ, Goldberg HR, Matelski JJ, Bell CM. Characteristics of Internal Medicine Physicians Disciplined by Professional Colleges in Canada. Medicine (Baltimore) 2015; 94:e937. [PMID: 26131839 PMCID: PMC4504618 DOI: 10.1097/md.0000000000000937] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Physician misconduct is of serious concern to patient safety and quality of care. Currently, there are limited data on disciplinary proceedings involving internal medicine (IM) physicians.The aim of this study was to investigate the number and nature of disciplinary cases among IM physicians compared with those of other disciplined physicians.Our retrospective study reviewed information from all provincial Colleges of Physicians and Surgeons (CPS) and compiled a database of all disciplined physicians from 2000 to 2013 in Canada. Disciplinary rate differences (RDs) were calculated for IM physicians and compared with other physicians.From 2000 to 2013, overall disciplinary rates were low (9.6 cases per 10,000 physician years). There were 899 disciplinary cases, 49 of which involved 45 different IM physicians. IM physicians comprised 10.8% of all disciplined physicians and were disciplined at a lower rate than non-IM physicians, incurring 5.18 fewer cases per 10,000 physician years than other physicians (95% confidence interval [CI] 3.62-6.73; P < 0.001). They were significantly less likely to be disciplined for: unprofessional conduct (RD 1.16; CI 0.45-1.87; P = 0.001); unlicensed activity (RD 0.78; CI 0.37-1.19; P < 0.001); standard of care issues (RD 1.37; CI 0.49-2.26; P = 0.002); sexual misconduct (RD 1.65; CI 0.90-2.40; P < 0.001); miscellaneous (RD 0.80; CI 0.11-1.50; P = 0.020); mental illness (RD 0.06; CI 0.01-0.12; P = 0.025); inappropriate prescribing (RD 0.74; CI 0.15-1.33; P = 0.010); and criminal conviction (RD 0.33; CI 0.00-0.65; P = 0.048). No significant differences were found with respect to unclear violations, fraudulent behavior/prevarication, or offenses involving drugs/alcohol (all RDs less than 0.32). IM physicians were also less likely to incur the following penalties: voluntary license surrender (RD 0.53; CI 0.37-0.69; P < 0.001); suspension (RD 2.39; CI 1.26-3.51; P < 0.001); retraining/assessment (RD 1.58; CI 0.77-2.39; P < 0.001); restriction (RD 1.60; CI 0.74-2.46; P < 0.001); other (RD 0.52; CI 0.07-0.97; P = 0.030); formal reprimand (RD 2.78; CI 1.77-3.79; P < 0.001); or fine (RD 3.28; CI 1.89-4.67; P < 0.001). No significant differences were found with respect to revocation or mandated counseling/rehabilitation (all RDs less than 0.46).Generally, disciplinary rates among physicians were low. Compared with other physicians, IM physicians have significantly lower disciplinary rates overall and are less likely to incur the majority of disciplinary offenses and penalties.
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Affiliation(s)
- Jessica J Liu
- From the Department of Medicine, University Health Network (JJL); Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (AQA); Institute of Human Nutrition, Columbia University College of Physicians and Surgeons, New York, New York (HRG); Department of Biostatistics, Dalla Lana School of Public Health (JJM); Department of Medicine (CMB); Institute for Health Policy Management and Evaluation, University of Toronto (CMB); and Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada (CMB)
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43
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Spittal MJ, Bismark MM, Studdert DM. The PRONE score: an algorithm for predicting doctors' risks of formal patient complaints using routinely collected administrative data. BMJ Qual Saf 2015; 24:360-8. [PMID: 25855664 PMCID: PMC4453507 DOI: 10.1136/bmjqs-2014-003834] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/20/2015] [Indexed: 11/24/2022]
Abstract
Background Medicolegal agencies—such as malpractice insurers, medical boards and complaints bodies—are mostly passive regulators; they react to episodes of substandard care, rather than intervening to prevent them. At least part of the explanation for this reactive role lies in the widely recognised difficulty of making robust predictions about medicolegal risk at the individual clinician level. We aimed to develop a simple, reliable scoring system for predicting Australian doctors’ risks of becoming the subject of repeated patient complaints. Methods Using routinely collected administrative data, we constructed a national sample of 13 849 formal complaints against 8424 doctors. The complaints were lodged by patients with state health service commissions in Australia over a 12-year period. We used multivariate logistic regression analysis to identify predictors of subsequent complaints, defined as another complaint occurring within 2 years of an index complaint. Model estimates were then used to derive a simple predictive algorithm, designed for application at the doctor level. Results The PRONE (Predicted Risk Of New Event) score is a 22-point scoring system that indicates a doctor's future complaint risk based on four variables: a doctor's specialty and sex, the number of previous complaints and the time since the last complaint. The PRONE score performed well in predicting subsequent complaints, exhibiting strong validity and reliability and reasonable goodness of fit (c-statistic=0.70). Conclusions The PRONE score appears to be a valid method for assessing individual doctors’ risks of attracting recurrent complaints. Regulators could harness such information to target quality improvement interventions, and prevent substandard care and patient dissatisfaction. The approach we describe should be replicable in other agencies that handle large numbers of patient complaints or malpractice claims.
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Affiliation(s)
- Matthew J Spittal
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Marie M Bismark
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - David M Studdert
- Center for Health Policy/PCOR, Stanford University Medical School, Stanford, California, USA Stanford Law School, Stanford, California, USA
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Abstract
Professionalism is a core competency of physicians. Clinical knowledge and skills (and their maintenance and improvement), good communication skills, and sound understanding of ethics constitute the foundation of professionalism. Rising from this foundation are behaviors and attributes of professionalism: accountability, altruism, excellence, and humanism, the capstone of which is professionalism. Patients, medical societies, and accrediting organizations expect physicians to be professional. Furthermore, professionalism is associated with better clinical outcomes. Hence, medical learners and practicing physicians should be taught and assessed for professionalism. A number of methods can be used to teach professionalism (e.g. didactic lectures, web-based modules, role modeling, reflection, interactive methods, etc.). Because of the nature of professionalism, no single tool for assessing it among medical learners and practicing physicians exists. Instead, multiple assessment tools must be used (e.g. multi-source feedback using 360-degree reviews, patient feedback, critical incident reports, etc.). Data should be gathered continuously throughout an individual's career. For the individual learner or practicing physician, data generated by these tools can be used to create a "professionalism portfolio," the totality of which represents a picture of the individual's professionalism. This portfolio in turn can be used for formative and summative feedback. Data from professionalism assessments can also be used for developing professionalism curricula and generating research hypotheses. Health care leaders should support teaching and assessing professionalism at all levels of learning and practice and promote learning environments and institutional cultures that are consistent with professionalism precepts.
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Affiliation(s)
- Paul S. Mueller
- Consultant, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA; Professor of Medicine and Professor of Biomedical Ethics at the Mayo Clinic College of Medicine, Rochester, MN, USA; Associate Editor of NEJM Journal Watch General Medicine
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Sherertz RJ, Karchmer TB. Surgical Site Infection as a Surrogate Marker of Physician Impairment. Infect Control Hosp Epidemiol 2015; 30:1120-2. [DOI: 10.1086/647982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Our report details an implant-associated outbreak of surgical site infections related to the adverse effects of treatment for hepatitis C virus infection administered to surgeon X. During the 12-month period of this outbreak, 14 (9.5%) of 148 of surgeon X's patients developed a surgical site infection, a rate of SSI that was 8-fold higher than the rate during the 14-month baseline period or the 14-month follow-up period (P = .001), and higher than the rate among peer surgeons (P = .02).
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46
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Hoff G, Hirsch NJ, Means JJ, Streyffeler L. A Call to Include Medical Humanities in the Curriculum of Colleges of Osteopathic Medicine and in Applicant Selection. J Osteopath Med 2014; 114:798-804. [DOI: 10.7556/jaoa.2014.154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Medicine stands at a crossroad. Disruptive physician behavior has increased, and patient satisfaction has decreased. A growing body of knowledge demonstrates that the medical humanities assist in the creation of compassionate, resilient physicians. Incorporating medical humanities into the medical school curriculum promotes the development of compassionate, culturally sensitive physicians, and also encourages the development of resilience in health care professionals at a time when internal and external pressures on physicians are increasing.
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47
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Unwin E, Woolf K, Wadlow C, Dacre J. Disciplined doctors: does the sex of a doctor matter? A cross-sectional study examining the association between a doctor's sex and receiving sanctions against their medical registration. BMJ Open 2014; 4:e005405. [PMID: 25104057 PMCID: PMC4127941 DOI: 10.1136/bmjopen-2014-005405] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES To examine the association between doctors' sex and receiving sanctions on their medical registration, while controlling for other potentially confounding variables. DESIGN Cross-sectional study. SETTING The General Medical Council (GMC)'s List of Registered Medical Practitioners (LRMP) database of doctors practising in the UK. POPULATION All doctors on the GMC's LRMP on 29 May 2013. The database included all doctors who are or have been registered to practise medicine in the UK since October 2005. The exposure of interest was doctor's sex. Confounding variables included years since primary medical qualification, world region of primary medical qualification and specialty. OUTCOME MEASURES Sanctions on a doctor's medical registration. Sanction types included warnings, undertakings, conditions, suspension or erasure from the register. Binary logistic regression modelling, controlling for confounders, described the association between the doctor's sex and sanctions on a doctor's medical registration. RESULTS Of the 329,542 doctors on the LRMP, 2697 (0.8%) had sanctions against their registration, 516 (19.1%) of whom were female. In the fully adjusted model, female doctors had nearly a third of the odds (OR: 0.37, 95% CI: 0.33 to 0.41) of having sanctions compared to male doctors. There was evidence that the association varies with specialty, with female doctors who had specialised as general practitioners being the least likely to receive sanctions compared with their male colleagues (OR: 0.26, 95% CI: 0.22 to 0.31). CONCLUSIONS Female doctors have reduced odds of receiving sanctions on their medical registration when compared with their male colleagues. This association remained after adjustment for the confounding factors. These results are representative of all doctors registered to practise in the UK. Further exploration of why doctors' sex may impact their professional performance is underway.
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Affiliation(s)
- Emily Unwin
- UCL Medical School, Royal Free Hospital, London, UK
| | | | - Clare Wadlow
- UCL Medical School, Royal Free Hospital, London, UK
| | - Jane Dacre
- UCL Medical School, Royal Free Hospital, London, UK
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Baxter AD, Boet S, Reid D, Skidmore G. The aging anesthesiologist: a narrative review and suggested strategies. Can J Anaesth 2014; 61:865-75. [PMID: 24985937 PMCID: PMC4160565 DOI: 10.1007/s12630-014-0194-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 06/10/2014] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To address an aging anesthesia workforce, we review the relevant changes and implications associated with age in order to stimulate discussion at the individual, local, and national levels regarding appropriate changes in practice aimed at protecting patient safety. PRINCIPAL FINDINGS In a 2013 survey of Canadian Anesthesiologists, 22% were aged 55-64 yr, 7% were aged 65-74 yr, and 3% were older than 74 yr. Clinical abilities decline with age, making older anesthesiologists more likely than their younger colleagues to be associated with adverse patient events. Anesthesiologists older than 65 yr in Ontario, Quebec, and British Columbia had 50% more cases involving litigation and almost twice the number of cases involving severe patient injury compared with anesthesiologists younger than 51 yr of age. In the absence of overt deterioration in skills, decisions about reducing activities and retirement are left largely to individuals despite their limited ability to self-assess competence. This state of affairs may contribute to the increased incidence of adverse events and poor patient outcomes. CONCLUSIONS Provincial regulatory bodies have peer assessment programs to evaluate physicians at random, following a complaint, and at certain ages, but all have limitations. Simulation has been used widely for training and assessment in the aviation industry as well as in automobile driving exams. Simulation can assess crisis recognition and management, which is crucial in anesthesiology and not well assessed by other methods, and could assist elderly anesthesiologists during the pre-retirement phase of their careers. A standardized schedule for winding down would have advantages for physicians, their department, and their patients. A suggested schedule might include no further on-call duties for those aged 60 yr and older, no further high-acuity cases for those aged 65 yr and older, and retirement from operating room (OR) clinical practice (with possible continuation of non-OR clinical or other non-clinical activities, if desired) at age 70 yr. These timelines could be extended with satisfactory performance in annual simulation sessions involving assessment and practice in crisis management.
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Affiliation(s)
- Alan D Baxter
- The Department of Anesthesiology, Faculty of Medicine, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, ON, K1H 8L6, Canada,
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Roberts NK, Dorsey JK, Wold B. Unprofessional behavior by specialty: a qualitative analysis of six years of student perceptions of medical school faculty. MEDICAL TEACHER 2014; 36:621-625. [PMID: 24787525 DOI: 10.3109/0142159x.2014.899690] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Unprofessional behavior has well documented negative effects both on the clinical care environment and on the learning environment. If unprofessional behavior varies by department or specialty, this has implications both for faculty development and for undergraduate and graduate level training. AIMS We sought to learn which unprofessional behaviors were endemic in our school, and which were unique to particular departments. METHODS Students graduating from medical school between 2007 and 2012 were asked to complete a questionnaire naming the most professional and least professional faculty members they encountered in during school. For the least professional faculty members, they were also asked to provide information about the unprofessional behavior. RESULTS Students noted several types of unprofessional behavior regardless of the department faculty were in; however, there were some behaviors only noted in individual departments. The unprofessional behavior profiles for Surgery and Obstetrics/Gynecology were markedly similar, and were substantially different from all other specialties. CONCLUSION Undergraduate, graduate, and faculty education focused on unprofessional behavior that may occur in various learning environments may provide a feasible, practical, and an effective approach to creating a culture of professional behavior throughout the organization.
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Grace ES, Wenghofer EF, Korinek EJ. Predictors of physician performance on competence assessment: Findings from CPEP, the Center for Personalized Education for Physicians. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:912-919. [PMID: 24871243 DOI: 10.1097/acm.0000000000000248] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To identify factors associated with physician performance in a comprehensive competence assessment. METHOD The authors conducted a retrospective analysis of 683 physicians referred for assessment at the Center for Personalized Education for Physicians from 2000 to 2010, who were evaluated as either safe or unsafe to return to practice. Multivariate logistic regression was used to determine factors predictive of unsafe assessment outcome. Covariates included personal characteristics (e.g., age), practice context (e.g., solo practice), and referral information (e.g., previous board license action). RESULTS Older physicians were more likely to have unsafe assessment outcomes (odds ratio [OR] = 1.07; P < .001). Board-certified individuals were less likely to have poor assessment outcomes (OR = 0.40; P = .003) than uncertified individuals. Physicians in solo practice were more likely (OR = 2.15; P = .037) to be deemed unsafe than physicians in other settings. Physicians with a practice scope that matched their training were less likely (OR = 0.29; P = .023) to have unsafe assessment outcomes than those whose did not. Physicians with current or previous board action (suspension, revocation, limitation, or stipulation) were more likely to be deemed unsafe (OR = 2.47; P = .003) than those without. CONCLUSIONS Findings suggest that important predictors of physician performance on competence assessment include personal characteristics, practice context, and reasons for assessment referral. These findings have implications for development of policies and programs designed to assess risk of poor physician performance and quality of care improvement efforts through organizational/practice design or remedial education.
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Affiliation(s)
- Elizabeth S Grace
- Dr. Grace is medical director, Center for Personalized Education for Physicians (CPEP), Denver, Colorado. Dr. Wenghofer is associate professor, School of Rural and Northern Health, Laurentian University, Sudbury, Ontario, Canada, and associate professor, Northern Ontario School of Medicine, Sudbury, Ontario, Canada. Ms. Korinek is chief executive officer, Center for Personalized Education for Physicians (CPEP), Denver, Colorado
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