A recent study of medical board clinician disciplinary action has revealed that the percentage of clinicians who are disciplined or have to pay a medical malpractice claim is 4 times more in some states than in others.

The study, published in BMJ Quality & Safety, is the first to evaluate this issue. Data for the study came from the National Practitioner Data Bank (NPDB) which has been collecting data on state medical board actions from all 50 states and the District of Columbia since 1986. The NPDB includes information about clinician punishments ranging from minor fines to major actions, including medical license revocation. It also includes information on payments made by clinicians in response to malpractice suits.

For the study, researchers looked at NPDB data from 2010 to 2014, combined it with data on the total number of clinicians practicing in each state, and calculated an adjusted yearly state rate of all medical board disciplinary actions per 1,000 clinicians.

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The researchers found that there are 3.75 disciplinary actions each year per 1,000 clinicians for the United States as a whole. But when they looked at the states individually, the researchers found wide disparity in the number of disciplinary actions. For example, in Delaware (one of the states which ranked highest in disciplinary actions) there are 7.93 disciplinary actions per 1,000 clinicians compared with 2.13 per 1,000 clinicians in Massachusetts.

The researchers also found that across the country there are 1.15 major disciplinary actions (resulting in license revocation or the like) per 1,000 clinicians, but some states had much higher rates. For example, Delaware had 2.71 very serious disciplinary actions per 1,000 clinicians, whereas New York had only 0.64 per 1,000 clinicians.

Researchers believe that variations in how state medical boards act towards violations is the reason for the disparity. “In one state the punishment for a particular violation could be a fine, while in another state you could lose your license for doing the same thing,” said researcher Elena Byhoff, MD, from the Department of Medicine at the University of Michigan.

The researchers concluded by stating that “there is a significant, 4-fold variation in the annual rate of medical board physician disciplinary action by state in the [United States]. When indicated, state medical boards should consider policies aimed at improving standardization and coordination to provide consistent supervision to physicians and ensure public safety.”