Minn.: You’re mistaken
North Star State dismisses discipline ranking
When it comes to state medical boards disciplining doctors, the Public Citizen Health Research Group concluded that Alaska does the best job and Minnesota does the worst.
Not surprisingly, Robert Leach, executive director of the Minnesota Board of Medical Practice, dismissed the Public Citizen rankings.
“Minnesota is world-renowned for the healthcare it provides,” Leach said. “ I always ask people where they would rather go for healthcare: Alaska or Minnesota? People from all over the world come to Minnesota to get their healthcare at the Mayo Clinic.”
Each year, Public Citizen creates its rankings by taking a three-year average of the medical license revocations, surrenders, suspensions, probations and suspensions for each state compiled by the Federation of State Medical Boards, and divides that total by the state’s physician populations to come up with a “serious actions per 1,000 physicians” rating for each state and the District of Columbia. The federation’s data were released April 1 (April 5, p. 18).
Alaska had a 7.89 rating for 2009, and— for the fourth-straight year, was ranked first. Minnesota had a 1.07 rating, and— for the second year in a row—finished in 51st place.
“The methodology is flawed in so many ways,” Leach said, adding that it was “simplistic” and didn’t take into account the number of complaints a board receives and investigates. “That factor is left out of their equation.”
Sidney Wolfe, director the Public Citizen Health Research Group, said “it’s a given” that it’s a small fraction—even fewer than 1%—of doctors who are causing problems. “The question is not whether the practice of medicine in a state is better or worse,” Wolfe explained. “It’s whether the board is doing a good job of disciplining the same small fraction of doctors.”
In this year’s report, Public Citizen notes how Hawaii has gone from 51st place in 2003 to 10th place in 2009 and North Carolina went from 41st place to 12th place during the same period. “When you look at the numbers and see a board go from doing a bad job to doing a good job, it isn’t because there was a mass migration of bad doctors into the state,” Wolfe said.
In states with low rankings, Wolfe said one common factor is usually having “the state legislature asleep at the wheel.”
Leach, on the other hand, said the states with higher rankings typically are populated by “large numbers of physicians in private, solo practices with an ability to get into trouble.” In Minnesota, he said there are practically no solo practices left and that most physicians in the state are subject to daily peer review.
He also mentioned that Minnesota’s board, which consists of 11 physicians and five nonphysician “public” members, is a “quasi independent state agency” that receives its funding from license fees and is not dependent on the state Legislature for funding.
It also has the use of investigators from the state attorney general’s office. According to Leach, this is a setup that most states envy. “They would love to have the situation we have in Minnesota,” he said.
The states finishing just above Minnesota were South Carolina, with a 1.09 serious actions per 1,000 physicians rating in 2009; Wisconsin, at 1.59; New Hampshire, at 1.65; and Connecticut, at 1.8.
States finishing behind Alaska at the top of the list were North Dakota, with 6.01 serious actions per 1,000 physicians rating; Kentucky, at 5.67; Ohio, at 5.43; and Arizona, at 5.2.
Public Citizen also noted that Ohio was the only state among the 15 most-populous near the top, while large states like California and Florida continue to be ranked near the bottom, this year coming in 41st and 44th place, respectively.
To improve doctor discipline, Public Citizen recommends, among other things, that medical boards conduct proactive investigations in addition to reacting to complaints, rely on all available data—such as Medicare and Medicaid sanctions—and have independence from state medical societies.
Wolfe: “It isn’t because there was a mass migration of bad” docs.