Medical Licensing Board Characteristics and Physician Discipline

The advent of managed care in the 1980s and 1990s increased scrutiny of the medical profession to such an extent that the medical establishment found it in its own self-interest to monitor doctors more carefully.

State medical licensing boards vary in their composition, their sources of funding, and their propensity to discipline physicians. From 1963-7 they disciplined about 0.06 percent of all licensed physicians in any given year. In 1981, the rate was 0.14 percent. By the mid-1990s, when more than 80 percent of physicians were affiliated with a managed care organization, the disciplinary rate had increased eight-fold.

In Medical Licensing Board Characteristics and Physician Discipline: An Empirical Analysis (NBER Working Paper No. 15140), co-authors Marc Law and Zeynep Hansen conclude that the medical board reforms created by the growth of managed care in the 1990s were so substantial that additional reforms aimed at improving the function of medical boards -- by increasing the degree of political or public oversight over them -- may not result in stricter regulation of physician conduct. The researchers argue that the advent of managed care in the 1980s and 1990s increased scrutiny of the medical profession to such an extent that "Medical boards and physician groups became more concerned with protecting the reputation of the medical profession and the quality of medical decisions. Accordingly, the medical establishment found it in its own self-interest to monitor doctors more carefully."

Using data from the Federation of State Medical Boards on the number of disciplinary actions per 1,000 licensed physicians from 1993 to 2003, the authors find no evidence to support the assertion that physician dominated boards are less likely to discipline physicians, or that having more medical board members who are not physicians makes physician discipline more likely. Boards that receive state funds are no more likely to discipline physicians than boards that are independently funded. In fact, the authors conclude that organizational autonomy is associated with higher rates of physician discipline.

-- Linda Gorman