15 Years of Physician Profiles: A Massachusetts Success Story

By Lynda Young, MD
MMS President

In our medical society’s 230-year history, we have a long list of firsts. But we can take special pride that we were the first in the nation to promote the public release of the disciplinary records of all actively practicing physicians in our state. Our approach became the model for states across the nation.

The profiles were developed principally to help patients choose their physician. In fact, during the state’s own testing of the program in the 1990s, it was clear it would achieve its purpose. Patients said they were most pleased to see the information about physicians’ practice location, office hours, credentials, and the health plans they accepted. Disciplinary records were almost secondary.

A article in the Boston Globe and other newspapers on the state Board of Registration in Medicine and its physician profiles asks some pointed questions about that system.

It questions why the records do not cover care delivered outside of hospitals. The program was written to report on disciplinary actions in hospital settings, because in those venues, due-process protections are provided to both the physician and the person filing the complaint. To our knowledge, in nursing homes, health clinics and other organizations, there are no such due-process rights. Due process must be a basic building block of any public reporting system.

The article also highlights the case of a physician who had a jury return a large verdict against her and in favor of a baby born with cerebral palsy. The underlying care took place in 1996, the physician was licensed in Wisconsin in 1999, and the jury verdict came in 2005.  The article suggests that the Massachusetts profiling system somehow is deceiving the public by not in 2012 having information about this case listed in perpetuity.

We would suggest that every state bears the responsibility of doing its own homework on every prospective licensee, particularly since any state licensing agency can retrieve any malpractice verdict from the National Practitioner Databank. It’s not a difficult task, since every physician has a unique identifier that does not change, even if the physician changes his or her name.

The article also suggests that the medical profession is lax in holding its members accountable for failing to discipline those who fail to meet the standards of good medical care. However, the article uses entirely suspect information to reach that conclusion, by noting that physicians refer their colleagues to the medical board an average 41 times each year.

Leaving aside the wholly subjective judgment about whether 41 is a high number or low number, the number paints a substantially incomplete picture of what the profession does. The number does not count the physicians whose issues were addressed in peer review, rigorous highly-structured peer counseling, or otherwise. What other profession holds itself to account to such a degree?

The article also cites Public Citizen, whose reports equate the number of annual disciplinary actions by state medical boards with its competence. For many reasons, that methodology is even more suspect. As noted in the Mass. Medical Law Report, state to state comparisons are almost meaningless.

Certainly, transparency can address much of what ails the health care delivery system – as long as the information is accurate and is fair to all stakeholders. The Massachusetts physician profile program currently passes both tests.

  1. I should preface this by saying that I retired in 1993, and enjoy my obsolescence (while still getting and perusing the NEJM weekly, and Vital Signs). I observe the convulsive upheavals in medicine with alarm – the ever increasing pressures and requirements for LMDs to work harder, longer, smarter, and more expensively. I found your comments interesting, and discouraging. Some specific points follow.

    Par. 2, “Disciplinary records were almost secondary.” : In my experience the records are not to be trusted, being a product of “the establishment” and thus likely to understate any understatable problems, and apparently also likely to be expunged after 10 years and to not include bad news from outside Mass. Hence, not being trusted, they are indeed “almost secondary.” And in addition, for a particular patient, the disciplinary record will be secondary, only worth checking if the targeted MD satisfies the other important criteria about location and specialty and hours, etc.
    Par. 4, “due process”: The due-process rights in a nursing home may not equal your wishes, but they may exist and I bet you have not investigated them thoroughly. And I wonder if the patient’s due process rights are being neglected as you preserve those of the physician.
    Par. 5, baby with CP: It is quite unclear to me if a patient in Wisconsin could access the National Database at all, or if the Wis. Board has an option of publicizing such info from Mass. that they might find in the National Database. Did anyone check on that? Your stand obfuscates; the idea is transparency – not only for the hypothetical Wisconsin patient, but also for the hypothetical Mass. patient. And if I interpret your paragraph right, the info about the 2005 court decision is missing from the 2012 Mass. records. Is that OK? I thought MMS was saying records should appear for 10 years. I’m not sure who is saying “in perpetuity”. I suggest 20 years. Note that child abuse cases are busy having their statute of limitations removed entirely, so “in perpetuity” will apply there.

    Par. 8, “paints a substantially incomplete picture of what the profession does”. The article was not aimed at “what the profession does.” It was aimed at both the lack of public information about medical errors, and you could say about “what the profession does not.” In context, perhaps the MMS needs more PR about “what the profession does,” info directed at informing the public that there is enough transparency now, if you wish. When I’ve looked up potential MDs to serve my own health needs, I have found the nearly complete lack of adverse notations in their public records fairly disappointing – there’s nothing, or nothing I can trust.

    Par. 8, you ask, “What other profession holds itself to account to such a degree?” That is a red herring. We like to think we hold ourselves to the highest degree of everything, but that is irrelevant. We need to keep asking, “How can we improve?”. One could also note that a lot of that holding of ourselves to account is the result of legislation requiring us to do so, in Mass., in the US, and even in the world.
    Last, you want the information to be “fair to all stakeholders.” Don’t forget the stakeholders who have little voice in all this, the patients themselves, especially those who feel they have been wronged and cannot or will not hire a lawyer.

    In sum, I think your comments are “feel good” for MMS readers, tending to support the status quo and not tending to encourage deeper self-study and improvement. I think there is room for improvement.

    While I’m venting, I will add another thought. Like several other professions notably public school and college teachers, we like to think we are all “above average”, like the citizens of Keillor’s Lake Wobegon. That is impossible, of course, and we as a profession need to admit that some MDs are practicing medicine that is at least “below average”, and perhaps even “poor”. The unasked and unresolved question is what we should do about these people. It would be bad in several ways to kick them out in an impossible attempt to render all the survivors “above average.” This group needs some kind of special attention = education, monitoring, mentoring – something to identify them and to help them stay productive, pay taxes, and not harm patients. The attempt to identify such teachers is being met with strong resistance by the teachers’ unions, but no one is really discussing the underlying issues of dealing with “below average” teachers – particularly what to do with them to help them stay active and not harm students.
    … I’ve been in both worlds, teaching college biology from 1967-1971 and practicing pathology from 1974-1993. The struggle to improve both professions is made more difficult by the need to move the old guard along somehow and get their support.

    … But thanks anyhow for stimulating a response from me! And keep up your work with MMS!

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