ORIGINAL CONTRIBUTION
Characteristics of physicians disciplined
by the State Medical Board of Ohio
Steven W. Clay, DO
Robert R. Conatser, MS
Although physicians have been disciplined for a variety of
offenses by state medical boards across the United States,
limited information is available about the characteristics
of these physicians. To assess the characteristics of, offenses
committed by, and resulting disciplinary actions taken
against a consecutive series of disciplined physicians in the
state of Ohio, the authors conducted a case-control study
of all 308 physicians publicly disciplined by the State
Medical Board of Ohio (SMBO) from January 1997 to June
1999.
Subjects were matched with two groups of control
physicians—one matched by location only, and the second
matched for location, gender, practice type, and self-designated specialty. The main outcomes measured were disciplinary actions, offenses leading to state medical board
actions, and the characteristics of disciplined physicians.
Of 340 physicians disciplined during these 30 months
(approximately 0.37% per year), 308 committed 477 offenses
requiring 409 actions by the SMBO. The most common
offenses were impairment due to alcohol and/or drug use
(21%), inappropriate prescribing or drug possession (14%),
previous state actions (15%), negligence or incompetence
(7%), and drug-related charges (7%). Although offenders
were significantly less likely to be women (P .05; odds
ratio [OR], 0.46; 95% confidence interval [CI], 0.28–0.75), the
authors found no difference in the severity of disciplinary
action taken against offenders by gender (OR, 1.23; 95% CI,
0.54–2.82) or by type of medical training, ie, between osteopathic physicians and allopathic physicians (OR, 0.70;
95% CI, 0.39-1.26).
Compared with controls matched for location, gender,
practice type, and self-designated specialty, offenders were
significantly less likely to be board certified (OR, 0.65;
CI, 0.46–0.92) and significantly more likely to have been in
practice 20 or fewer years (OR, 1.51; 95% CI, 1.08–2.13).
Disciplinary actions in Ohio were more frequent,
Dr Clay is an associate professor in the department of geriatric medicine and
gerontology at the Ohio University College of Osteopathic Medicine, where
Mr Conatser is a research associate in the department of biomedical sciences.
Address correspondence to Steven W. Clay, DO, Department of Geriatric
Medicine and Gerontology, Ohio University College of Osteopathic Medicine,
355 Grosvenor Hall, Athens, OH 45701.
E-mail: [email protected]
more severe, and more often in response to impairment due
to alcohol and/or drug use and previous state actions than
previously reported. No difference in the severity of disciplinary action was noted between men and women or
between osteopathic and allopathic physicians.
(Key words: Ohio, osteopathic physicians, physician
intervention, severe disciplinary action, state medical
board, State Medical Board of Ohio)
A
ccording to the Federation of State Medical Boards of the
United States, “The primary responsibility and obligation of a state medical board is to protect consumers of health
care through proper licensing and regulation of physicians....”1
In 1998, state medical boards across the United States disciplined physicians with 4520 actions, including prejudicial
(ie, those involving revocation or suspension of license) and
nonprejudicial actions.1
Prevention and early intervention by state medical boards
may correct behavioral problems in physicians before the
public is put at risk and before trained physicians lose the
ability to and privilege of practicing medicine. However, prevention and early intervention require the identification of
those physicians at risk for subsequent disciplinary action.
Many studies have examined characteristics of physicians
whose behavior most often leads to disciplinary actions by
state medical boards, including impairment due to alcohol
and/or drug use,2-6 inappropriate prescribing or drug possession,7,8 mental and/or physical impairment,9 sexual and/or
inappropriate patient contact,10,11 fraud and misrepresentation of credentials,12,13 incompetence,14 and malpractice
claims.15,16
However, the aforementioned studies did not include
control subjects. In a Medline literature search from 1966 to
October 1999, only one study was found that compares disciplined physician characteristics with nondisciplined physician control groups.17 In their study of physicians disciplined
by the Medical Board of California, Morrison and Wickersham17 found that compared with controls, disciplined physicians were more likely to be:
men;
in medical practice more than 20 years; or
in specialized practice for anesthesiology, psychiatry, or
obstetrics and gynecology.
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ORIGINAL CONTRIBUTION
Further, when compared with controls, disciplined physicians
were less likely to be:
in internal medicine or pediatrics; or
board certified in their specialty.
The purpose of this project is to compare physicians disciplined by the SMBO with nondisciplined physician controls
from the same state. This study contributes to a better understanding of the characteristics of disciplined physicians and
allows comparison with data from the California study.
Methods
The methods used by Morrison and Wickersham17 in California were duplicated in this study and applied to Ohio
physicians and disciplinary actions taken by the SMBO. Physicians disciplined in Ohio were identified in the Formal Action
Mailing List, published monthly by the SMBO and also available on the SMBO Monthly Formal Actions Web page (see
http://www5.state.oh.us/med/mfal/mfal.htm).18 All formal disciplinary actions taken and recorded by the SMBO from January
1997 to June 1999 were used to obtain physicians’ identities,
practice locations, disciplinary actions taken, and the reasons
for SMBO action. Similarly, these records were used to determine whether the action was a result of a prior SMBO action
or the prior action of a state medical board in a different state.
Further characteristics of those disciplined, including self-designated specialty, length of time in practice, board certification,
and demographics, were obtained for osteopathic physicians
trained in osteopathic residency programs from the American Osteopathic Association’s (AOA) Yearbook and Directory of
Osteopathic Physicians, 1999,19 and for allopathic physicians—
and osteopathic physicians with allopathic residency training—
from the American Medical Association’s (AMA) 1998 Directory of Physicians in the United States.20
To allow for better comparison of data, offenses that were
reasons for disciplinary actions taken by the SMBO were
recorded following the methods used in the California study,
including (1) negligence or incompetence, (2) inappropriate prescribing or drug possession, (3) impairment due to alcohol
and/or drug use, (4) “legal crimes” (eg, tax fraud, kickbacks
and false worker’s compensation claims, and Medicare or
Medicaid fraud), (5) sexual and/or inappropriate patient contact, (6) mental and/or physical impairment, (7) other and/or
miscellaneous (eg, child support default), (8) other crime (eg,
unprofessional conduct), (9) probation violation of a previous
action, (10) unlicensed assistant or poor supervision, (11)
working for an unlicensed person or entity, and (12) misrepresenting credentials.17
In addition to these twelve offenses included in the California study, this study of physicians in Ohio includes two
offense types that are original to it, drug charge and continuing
medical education (CME) violation. The drug charge offense in this
study differs from the original classification “inappropriate
prescribing or drug possession” in that it represents an actual
legal charge. The CME violation offense differs from the orig-
inal classification for “misrepresenting credentials” in that it presents a specific, documented lack of required CME credits.
Location controls were found through the AOA’s Yearbook
and Directory of Osteopathic Physicians, 1999, or the AMA’s 1998
Directory of Physicians in the United States, and identical characteristics for each location were recorded. A second control
group, also identified from the aforementioned directories,
was matched for location, gender, practice type, and self-designated specialty. The above characteristics and demographics
were also recorded for this control group.
To compare data, statistical analyses were completed following the methods used in the California study.17 A multivariate analysis to identify factors associated with discipline was
done, and variables were kept binary to increase power. Variables included type of medical school attended (osteopathic or
allopathic), gender, country of graduation (United States or foreign), practice type (direct patient care or other), board certification (yes or no), time in practice (20 years or 20 years),
and self-designated specialty. Two specialties included in the
California study, dermatology and physical medicine, were not
included in this study because of low numbers.
The association between the type of offense and severity
of disciplinary action was tested using the Cochran-MantelHaenszel method.21 Data analyses were done using the SPSS
statistical analysis program (Version 9.0, SPSS Science, Chicago,
Ill). The level of statistical significance was .05.
Results
In 1998, 648,535 physicians were practicing medicine in the
United States. During this time, 26,818 (4.1%) physicians were
practicing in the state of Ohio. According to Danielle Bickers
and Suzanne Milam, disciplinary information assistants for
the SMBO (written communication, October 1999), the approximately 36,460 physicians licensed by the SMBO in 1998
included approximately 4350 (12%) osteopathic physicians
and 32,110 (88%) allopathic physicians.
The SMBO receives on average 3000 complaints annually regarding physicians in the state. In 1995, the major sources
of the 2959 complaints received included the public (38%),
SMBO staff (35%), state medical boards in different states (8%),
pharmacists (4%), and physicians (3%).22
During the 30 months from January 1997 to June 1999, the
SMBO received approximately 7500 complaints. After SMBO
investigation, the exclusion of nondisciplinary actions, and
follow-up reports on previous SMBO actions, court actions, and
disciplinary actions, 340 complaints against physicians
remained for these 30 months. This figure represents an annual
discipline rate of approximately 0.37%. After the exclusion of
complaints with missing data and those without controls, 409
actions taken against 308 disciplined physicians were recorded
for this study. The initial 340 disciplined physicians and the
remaining 308 subjects after exclusions were nearly identical
in type of medical school attended (80.9% osteopathic physicians vs. 81.2% allopathic physicians), gender (90.9% men vs.
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ORIGINAL CONTRIBUTION
Table 1
Demographic Characteristics of Physicians Disciplined
by the State Medical Board of Ohio, January 1997 to June 1999
Characteristic
All disciplined
physicians, No. (%)
(N = 340)
Osteopathic (DO)
Disciplined physicians
with controls, No. (%)
(N = 308)
65 (19)
58 (19)
Allopathic (MD)
275 (81)
250 (81)
Male
305 (90)
280 (91)
35 (10)
28 (9)
275 (81)
246 (80)
65 (19)
62 (20)
276 (81)
243 (79)
Female
US medical graduate
International medical graduate
Direct patient care
89.7% women), country of graduation (79.9% United States vs.
80.9% foreign), and practice type (78.9% direct patient care
vs. 81.2% other) (Table 1).
Of those disciplined, only 28 (9.1%) were women, 9 (2.9%)
were in training, 62 (20.1%) were international medical graduates, 250 (81.2%) were graduates of allopathic medical schools,
157 (51.0%) were specialty board certified, 243 (78.9%) were in
direct patient care, 130 (42.2%) were in practice for 20 or more
years, and 64 (20.8%) had moved to another state or locality.
Compared with location controls, disciplined physicians
were significantly less likely (P .05) to be women (odds
ratio [OR], 0.46; 95% confidence interval [CI], 0.28-0.75), but not
significantly more likely to be in direct patient care (OR, 1.05;
CI, 0.71-1.55).
Compared with controls matched for location, gender,
practice type, and self-designated specialty, disciplined physicians were significantly less likely to be board certified
(OR, 0.65; CI, 0.46-0.92) and significantly more likely to be in
practice fewer than 20 years (OR, 1.51; 95% CI, 1.08-2.13). Of
the specialties self-reported by these physicians, anesthesia, psychiatry, and surgery appeared to be overrepresented among
disciplined physicians, but due to low numbers in the study
population, this comparison did not reach statistical significance
(Table 2).
The 308 physicians were disciplined for a total of
477 offenses: 165 (54%) with one offense, 117 (38%) with two
offenses, and 26 (8%) with three offenses (Table 3). The most
common individual offenses included the following: 100 (21%)
with impairment due to alcohol and/or drug use, 66 (14%) with
inappropriate prescribing or drug possession, 48 (10%) with
previous actions by state medical boards in different states,
34 (7%) with negligence or incompetence, 33 (7%) with drug
charges, 27 (6%) with CME violations (ie, deficits), 24 (5%)
with other crimes, 24 (5%) with license renewal issues, 23 (5%)
with violation of previous SMBO probation, 21 (4%) with
mental and/or physical impairment, 18 (4%) with fraud or
kickbacks, 17 (4%) with sexual and/or inappropriate patient
contact, and 15 (3%) with unprofessional conduct or office
management issues.
When offenses are grouped by general category rather
than more specific offense type, their prevalence is as follows:
121 (25%) health-related offenses (ie, impairment due to alcohol
and/or drug use, mental and/or physical impairment);
99 (21%) drug or prescribing related crimes (ie, inappropriate
prescribing or drug possession, drug charge); 71 (15%) previous
state actions (ie, actions taken by state medical board in different
states and SMBO actions); 59 (12%) personal and professional
conduct offenses; 42 (9%) instances of fraud and other crimes,
34 (7%) negligence or incompetence issues; 26 (5%) credential
issues; 17 (44%) sexual and/or inappropriate patient contact;
and 8 (2%) miscellaneous offenses.
Of the 308 disciplined physicians, 277 (90%) were disciplined once, 24 (8%) were disciplined twice, and 7 (2%) were
disciplined three or more times. Disciplinary actions included
license revocation (12%), suspension (24%), summary and
automatic suspension (4%), probation and limitation (12%),
stayed revocation (3%), stayed suspension (1%), consent agreement (19%), license surrender or forced retirement (8%), license
denial (3%), proposed license denial before hearing (9%), and
reprimand (5%). When disciplinary actions are grouped as
severe (ie, resulting in actual loss of practice time) and not
severe, 64% of disciplined physicians received severe disciplinary action by the SMBO (Table 4).
No significant difference in severity of disciplinary action
was seen between osteopathic and allopathic offenders
(OR, 0.70; 95% CI, 0.39-1.26), male and female offenders
(OR, 1.23; 95% CI, 0.54-2.82), or single and multiple offenders
(OR, 1.52; 95% CI, 0.95-2.43). Although some disciplined physicians in this study had multiple offenses, severe disciplinary
action was most often associated with drug charges (88%),
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ORIGINAL CONTRIBUTION
Table 2
Characteristics of Physicians Disciplined by the State Medical Board of Ohio,
January 1997 to June 1999*
Disciplined group,
No. (%)
(N = 308)
Control group,
No. (%)
(N = 308)
Odds ratio
(95% CI)
Board certified
157 (51)
191 (62)
0.65 (0.46-0.92)†
Years of practice (20 y)
187 (61)
159 (52)
1.51 (1.08-2.13)†
62 (20)
59 (19)
1.04 (0.67-1.58)
Characteristic
International medical graduate
Self-designated
specialty‡
Family and general practice
79 (26)
65 (21)
———
Surgery
29 (9)
16 (5)
0.57 (0.28-1.17)
Internal medicine
52 (17)
55 (18)
1.31 (0.77-2.22)
Psychiatry
21 (7)
13 (4)
0.73 (0.33-1.60)
Obstetrics and gynecology
18 (6)
28 (9)
1.77 (0.89-3.52)
Pediatrics
7 (2)
14 (5)
———
Anesthesia
25 (8)
17 (6)
0.81 (0.39-1.67)
Ophthalmology
1 (0.3)
13 (4)
———
Radiology
9 (3)
14 (5)
———
Emergency medicine
16 (5)
13 (4)
———
Pathology
5 (2)
11 (4)
———
Neurology
8 (3)
2 (0.6)
———
Orthopedics
15 (5)
13 (4)
———
Other
20 (7)
24 (8)
———
* Controls matched for location (city and state), sex, and self-designated specialty. CI indicates confidence interval; dashes, data are not applicable.
† P .05
‡ This list of specialties does not include two specialties that were included in the 1998 California study, dermatology and physical medicine.
violations of previous SMBO actions (83%), inappropriate
prescribing or drug possession, CME violation (80%), office
mismanagement (80%), unprofessional conduct (80%), sexual
and/or inappropriate patient contact (76%), impairment due
to alcohol and/or drug use (74%), mental and/or physical
impairment (67%), other crime (67%), fraud or kickbacks
(66%), other offense (60%), and negligence or incompetence
(50%).
Of the 165 disciplined physicians with only one offense,
22% had SMBO action taken for impairment due to alcohol
and/or drug use (55% severe action); 20% for inappropriate
prescribing or drug possession (73% severe action); 10% for
CME violations (43% severe action); 7% for child support
default (100% severe action); 6% each for drug charges (86%
severe action) and negligence or incompetence (43% severe
action); and 4% each for mental and/or physical impairment
(57% severe action), fraud (50% severe action), and sexual
and/or inappropriate patient contact (80% severe action)
(Table 3).
Comment
During the 30 months from January 1997 to June 1999, the
SMBO took disciplinary actions against 340 physicians. Complete data on 409 actions regarding 477 offenses by 308 disciplined physicians allowed comparison to one control group
matched only by location, and another control group matched
for location, gender, practice type, and self-designated specialty.
The SMBO’s approximate rate of disciplinary action was
0.37% in contrast to the rate of 0.24% per year in California.
Female physicians represented 9% of those disciplined in
Ohio, identical to the percentage found in the California
study.17 However, in contrast with the California study data
that suggest more severe actions taken against female
offenders,17 no significant difference in type of offense or
severity of SMBO action was found among Ohio disciplined
physicians based on gender. Consistent with the California
study, lack of specialty certification was more likely in disciplined physicians than in control subjects.17 Although many
studies discuss physician specialty and subsequent disciplinary actions, actual certification has not been explored.4,6-8
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ORIGINAL CONTRIBUTION
Table 3
Principal Physician Offenses Leading to Disciplinary Action
by the State Medical Board of Ohio* and the Medical Board of California†
Ohio study, No. (%)
(N = 477)
California study, No. (%)
(N = 465)
Alcohol and/or other drug use, impairment
100 (21)
56 (12)
Inappropriate prescribing, drug possession
66 (14)
62 (13)
Previous state action
71 (15)
18 (4)
Negligence or incompetence
34 (7)
145 (31)
33 (7)
———
Continuing medical education
(CME) violation§
27 (6)
———
Misrepresenting credentials
26 (5)
9 (2)
Other crime
24 (5)
19 (4)
Mental and/or physical impairment
21 (4)
21 (5)
Fraud or kickback
18 (4)
48 (10)
Sexual and/or inappropriate patient contact
17 (4)
40 (9)
Other and/or miscellaneous
40 (8)
47 (10)
Offense‡
Drug
charge§
* Based on the authors’ case-control study of all 308 physicians publicly disciplined by the State Medical Board of Ohio
from January 1997 to June 1999.
† Source: Morrison J, Wickersham P. Physicians disciplined by a state medical board. JAMA. 1998;279:1889-1893.
‡ This list of offenses does not include two items that were included in the 1998 California study, “Unlicensed assistant,
poor supervision” and “Worked for unlicensed person or entity.”
§ Data for this type of offense were gathered in the Ohio study only.
This is the first case-controlled study to report on disciplined physicians and include the type of medical training
received (ie, osteopathic and allopathic). Although no significant differences in offense type or severity of disciplinary
action were seen between osteopathic and allopathic physicians, osteopathic physicians represented 19% of physicians
disciplined but only 12% of physicians licensed by Ohio,
according to Danielle Bickers and Suzanne Milam, disciplinary
information assistants for the SMBO (written communication, October 1999). The reason for this overrepresentation is
unknown but may involve differences in reporting rates.
Enborn and Thomas10 noted that osteopathic physicians in
Oregon were overreported for allegations of sexual misconduct, but they did not report an overrepresentation of osteopathic physicians in disciplinary actions taken by the Oregon
Board of Medical Examiners. However, Taragin et al16 reported
no difference in malpractice claim rates between osteopathic
and allopathic physicians from New Jersey during 10 years,
and Bohigian et al23 reported no overrepresentation of osteopathic physicians in the Missouri Physicians’ Health Program.
Differences in specialty may also be a factor as osteopathictrained physicians (about 12% of the total workforce of Ohio
physicians) represent 27% of Ohio family physicians.24 Shore4
found that although 21% of Oregon allopathic physicians
were in family medicine, they represented 35% of those
impaired. Furthermore, Stratas25 found general practitioners
and family physicians to be overrepresented in actions by the
North Carolina Medical Board. In this study, general practitioners and family physicians in Ohio represented 26% of disciplined physicians and 21% of controls.
International medical graduates were significantly less
likely to be disciplined compared with controls matched for
location, gender, practice type, and self-designated specialty.
This result is consistent with the California study, which found
international medical graduates to be underrepresented in
their subject group.17
In Ohio, physician health issues were the largest causes
of disciplinary action (25%), and impairment due to alcohol
and/or drug use was the single most frequently cited offense
(21%), whereas these offenses represented 17% and 12% of
such actions, respectively, in the California study.17 In a study
of 300 complaints to the Oregon Board of Medical Examiners,
Kofoed et al7 found 13% to be drug- and alcohol-related. Furthermore, a ratio of nearly 5:1 of impairment due to alcohol
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Table 4
Offenses Committed by Physicians Receiving Severe Disciplinary Action
by the State Medical Board of Ohio, January 1997 to June 1999
All offenders, No. (%)
(N = 308)
Individual offenders, No. (%)
(N = 165)
Health-related issues
88 (73)
25 (55)
Drug- or prescribing-related crimes
82 (83)
25 (76)
Previous state action
40 (56)
3 (75)
Offense
Personal and professional conduct
22 (69)
10 (67)
Fraud and other crimes
26 (64)
10 (55)
Negligence or incompetence
17 (50)
6 (43)
Credential issues
23 (59)
11 (42)
Sexual and/or inappropriate
patient contact
13 (76)
4 (80)
3 (38)
2 (40)
315* (66)
96 (58)
Miscellaneous
Total
* The total number of offenses committed is greater than 308 because multiple offenses were committed
by individual offenders.
and/or drug use to mental and/or physical impairment in
Ohio was much higher than the approximate 2:1 reported
elsewhere.4,17 One possible explanation for these differences is
that public concern about drug and alcohol abuse in physicians
may be more significant in the Midwest than on the West
Coast, where the aforementioned studies were done. Similar
rates of physical and mental causes of disciplinary actions
were found in Ohio (4%) and California (5%), implying consistency among state medical board actions in the United
States.17 Further study is needed to confirm this hypothesis.
One fifth (21%) of disciplinary actions in Ohio occurred
as a result of drug-related offenses, including either a drug
charge (7%) or inappropriate prescribing or drug possession
(14%), which compares with the 13% rate of inappropriate
prescribing or drug possession found in the California study.17
Kofoed et al7 found that 51% of complaints to the Oregon
Board of Medical Examiners related to inappropriate prescribing, of which only 50 of the 130 physicians involved went
on to receive board action. Of the Oregon physicians investigated for this offense, 53% were in family practice or general
practice.
The third most frequent group of offenses (15%) was a violation of a previous action by a state medical board in a different state (10%) or by the SMBO (5%). In the California
study, only 3% of disciplinary actions were the result of this
type of violation.17 Similarly, Post26 found the number of such
offenses in New York to be less than 0.5%. One explanation for
this difference is that the SMBO may closely monitor physi-
cians for violations of previous actions taken by state medical
boards in different states due to a local concern about disciplined physicians moving from state to state to avoid the consequences of past behavior.
Negligence and incompetence represented only 7% of
the causes for Ohio actions, whereas these offenses were
reported at 31% in the California study.17 Kusserow et
al27found only a minimal contribution of this to state medical
board actions nationally, and Post26 found it represented 28%
of the actions by the New York State Board for Professional
Medical Conduct. These striking differences are difficult to
explain but may result from differences in the definitions
used by state medical boards, or by multiple types of offenses
classified under the more general term incompetence.
Legal crimes, another cause for disciplinary actions in
Ohio, represented 9% of offenses, including fraud or kickbacks (4%) and other crimes (5%). The California study17
found a similar number of other crimes (4%) but more than
twice the percentage of disciplinary actions as a result of fraud
or kickbacks (10%). Post26 found that 24% of actions taken by
the New York State Board for Professional Medical Conduct
involved fraud. An actual decline in physician-related fraud
since the 1980s or variations in state medical boards’ working
definitions for these types of offenses might explain the large
variations found in recorded disciplinary actions. Further
study is needed to establish the cause of such wide variations
in the reporting of legal crimes.
Violations of CME requirements were the cause for 6% of
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SMBO disciplinary actions. Although the California study17 did
not include a category for this type of offense, Stratas25 found
this cause to represent less than 1% of disciplinary actions
taken by the North Carolina Medical Board. Offenses related
to misrepresenting credentials, license renewal violations, and
failure to report reportable offenses contributed to 5% of
SMBO actions, whereas credentialing issues represented only
2% of actions in the California study.17 In 1988, Schaffer et
al28 found no difference in falsification of clinical credentials
between US and international medical graduates, also finding
that no single medical specialty predominated in this type of
offense.
Sexual and/or inappropriate patient contact represented
only 4% of Ohio offenses and 9% of California offenses.17
According to data collected by the Public Citizen’s Health
Research Group,11 sex-related offenses represented between
2.1% and 5.2 % of disciplinary orders between 1989 and 1994
in the United States.
Other offenses cited by the SMBO for which data in California are not available included unprofessional office conduct
or poor supervision (5%) and child support default (1%). We
are not aware of any other state medical board in the United
States that disciplines physicians for child support default.
Severe disciplinary action comprised 64% of SMBO
actions, affecting 196 physicians, whereas in the California
study, 35% of these physicians received severe disciplinary
action. Severe action occurred in 88% of disciplined physicians with a drug charge and 80% of physicians with inappropriate prescribing or drug possession, whereas these
offenses were reported at a rate of less than 41% in the California study.17 Offenses that were the result of mental and/or
physical impairment led to severe disciplinary action in 79%
of SMBO actions and 67% of California actions. Fraud or kickbacks and sexual and/or inappropriate patient contact offenses
led to severe action in 66% and 76% of physicians disciplined
in Ohio but only 54% and 42% of those disciplined in California, respectively.17
In Ohio, severe disciplinary action was ordered in 56% of
probation violations, 44% of disciplined physicians with previous state disciplinary actions, and 83% of disciplined physicians with violations of previous SMBO actions. Similarly,
the Medical Board of California took severe action against
58% of disciplined physicians with probation violations.17
Of disciplined physicians with negligence or incompetence offenses, 50% received severe action by the SMBO, while
less than 41% of those disciplined for the same type of offense
in California received severe action.17 Ohio physicians disciplined for health-related problems received severe disciplinary
action for offenses that resulted from mental and/or physical impairment (67%) and impairment due to alcohol and/or
drug use (74%). In contrast, 76% of SMBO-disciplined physicians—but only 41% of California-disciplined physicians—
received severe disciplinary action for sexual and/or inappropriate patient contact.17 In Ohio, 44% of disciplined
physicians with a CME requirement offense received severe
action in the form of short suspensions (Table 4).
Overall, the SMBO appeared to be evenhanded in disciplinary actions taken against osteopathic and allopathic physicians, men and women, and direct patient care and nonpatient care physicians. Disciplinary actions taken by the
SMBO were more frequent and more severe than those taken
by the Medical Board of California, and they were in response
to more health-related impairment offenses due to alcohol
and/or drug use and previous state medical board actions. Disciplined physicians in Ohio were younger than those in the
California study, suggesting earlier intervention. Further, the
specialties of anesthesiology, psychiatry, and surgery, though
not statistically significant, may have been overrepresented.
Women were clearly underrepresented, and physicians
without board certification were overrepresented. International medical graduates were not overrepresented. Osteopathic physicians may have been overrepresented, but further
study is needed to confirm this impression.
Irvine notes that the public expects the medical profession
to “...show its determination to confront poor practice and
end the secrecy that surrounds it...[and]...be tough on serious
misconduct....”29 As the medical profession learns more about
those physicians who require disciplinary action due to misconduct, incompetence, or impairment, we may be better able
to meet the public’s expectations and intervene earlier to conserve the valuable resource of trained physicians.
Acknowledgments
The authors thank Danielle Bickers and Suzanne Milam of the State
Medical Board of Ohio for their assistance in data collection for the
preparation of this study.
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