State Licensing Boards Research Articles

A Broader Vision of Advocacy

A Broader Vision of Advocacy

The Physician as Patient: A Clinical Handbook for Mental Health Professionalsby Michael F. Myers, M.D., and Glen O. Gabbard, M.D. Arlington, Va, American Psychiatric Publishing, 2008, 252 pp., $46.00.

The Physician as Patient: A Clinical Handbook for Mental Health Professionalsby Michael F. Myers, M.D., and Glen O. Gabbard, M.D. Arlington, Va, American Psychiatric Publishing, 2008, 252 pp., $46.00.

Pay Reform Could Bring NH Initiatives

Pay Reform Could Bring NH Initiatives

Performance during Internal Medicine Residency Training and Subsequent Disciplinary Action by State Licensing Boards

Physicians who are disciplined by state licensing boards are more likely to have demonstrated unprofessional behavior in medical school. Information is limited on whether similar performance measures taken during residency can predict performance as practicing physicians. To determine whether performance measures during residency predict the likelihood of future disciplinary actions against practicing internists. Retrospective cohort study. State licensing board disciplinary actions against physicians from 1990 to 2006. 66,171 physicians who entered internal medicine residency training in the United States from 1990 to 2000 and became diplomates. Predictor variables included components of the Residents' Annual Evaluation Summary ratings and American Board of Internal Medicine (ABIM) certification examination scores. 2 performance measures independently predicted disciplinary action. A low professionalism rating on the Residents' Annual Evaluation Summary predicted increased risk for disciplinary action (hazard ratio, 1.7 [95% CI, 1.3 to 2.2]), and high performance on the ABIM certification examination predicted decreased risk for disciplinary action (hazard ratio, 0.7 [CI, 0.60 to 0.70] for American or Canadian medical school graduates and 0.9 [CI, 0.80 to 1.0] for international medical school graduates). Progressively better professionalism ratings and ABIM certification examination scores were associated with less risk for subsequent disciplinary actions; the risk ranged from 4.0% for the lowest professionalism rating to 0.5% for the highest and from 2.5% for the lowest examination scores to 0.0% for the highest. The study was retrospective. Some diplomates may have practiced outside of the United States. Nondiplomates were excluded. Poor performance on behavioral and cognitive measures during residency are associated with greater risk for state licensing board actions against practicing physicians at every point on a performance continuum. These findings support the Accreditation Council for Graduate Medical Education standards for professionalism and cognitive performance and the development of best practices to remediate these deficiencies.

Medical Education Reform Efforts and Failures of U.S. Medical Schools, 1870-1930

The dramatic decline in the number of US medical schools in the early twentieth century has been traced to a medical education reform movement that gained momentum after the Civil War. The major parties to reform-the universities themselves, the Association of American Medical Colleges (AAMC), state licensing boards, the American Medical Association (AMA), and Flexner-had different interests and strategies, however, and scholars have continued to debate the impact each had on the decline. To isolate the independent effects that the temporally intertwined forces for reform had on medical school failures, this study applies statistical survival analysis to an extensive and unique data set on medical schools operating in the United States between 1870 and 1930. Contrary to the views of some scholars, the results indicate that schools closed in response to critical evaluations published by the Illinois State Board of Health in the nineteenth century and the AMA and Flexner in the twentieth century. Additionally, the results indicate that schools were less likely to have failed if they adopted certain reforms implemented at leading schools or joined the AAMC, and were more likely to have failed if their state's licensing regulations mandated lengthier premedical and medical training.

Counting Difficulties: Retained Instruments, Sponges, and Needles

Patients in whom a sponge or instruments is left after surgery may suffer complications including pain, infection, abscess, or intestinal obstruction. Consequences or retained items for surgical team members may include malpractice lawsuits and adverse actions from the National Practitioner Data Bank and state licensing board. Adherence to AORN recommended practices for counting and facility counting policies can protect both patients and practitioners.

Real Scenarios and Complementary Lectures: A Classroom Training Approach to Increase Counselor Awareness, Knowledge, and Skill

The purpose of this article is to describe a classroom approach for training counseling students in the area of cross‐cultural competence. The authors describe real scenarios that form the foundation for an intensive classroom discussion and lecture format regarding cultural awareness, knowledge, and skills.

Acting on Our Values: Do Social Workers Volunteer?

Volunteer activity among social workers is explored in this article. Anecdotal evidence suggests social workers are not major contributors of volunteer time. The overriding research questions of this descriptive-exploratory study are to what extent do social workers engage in volunteer activities, what factors influence their decisions to volunteer, and what are the types of activities in which they engage. Volunteerism is defined as giving of one's talent, time, and energy to individuals, groups, communities, or organizations without compensation. A 27-item survey specific to this study was devised. Mailing lists were procured from state licensing boards representing two states in each of 10 federal regions. Random sampling was used to proportionally sample 5 percent of approximately 77,000 licensed social workers; useable surveys numbered 1,544 from a sampling pool of 3,850, yielding a 40 percent response rate. The findings demonstrate that social workers have volunteered in the past but no longer choose to do so. Respondents believe that other people should give and volunteer but that social workers give enough through their poorly paid jobs and poor working conditions. Implications suggest that the very professionals who might serve as community role models potentially have the reverse influence in regard to promoting volunteerism.

Accuracy May Be Casualty in Online Physician Reviews

Accuracy May Be Casualty in Online Physician Reviews

Maintenance of Certification: How Will It Affect Pathology Practice?

Maintenance of Certification: How Will It Affect Pathology Practice?

Adverse Events in the Manipulation of Pediatric Patients: Flaws in a Systematic Review

To the Editor .— The issue of chiropractic pediatrics is of much greater concern than the specific dangers outlined by Vohra et al.1 Pediatric chiropractic is taught in every chiropractic school in North America. The main textbook, Pediatric Chiropractic ,2 is 775 pages long; it lists every pediatric condition, from ear infections to epilepsy to attention-deficit disorders, that is diagnosed by chiropractors, and a chiropractic treatment, mostly highest neck manipulation, is proposed for each. Chiropractic authorities offer courses all over North America whereby a chiropractor can be certified as a specialist in pediatrics. The title granted is the FICPA, which stands for Fellow of the International Chiropractic Pediatric Association (see www.icpa4kids.com, www.icapediatrics.com, and www.chiropediatrics.com). Chiropractic pediatrics is fully supported by every state and provincial chiropractic licensing board and by the National Board of Chiropractic Examiners.3 All of them consider pediatric chiropractics to be acceptable as a standard of care and support pediatric chiropractic treatment fully. …

Teaching Spiritual Care in a Public Institution: Legal Implications, Standards of Practice, and Ethical Obligations

This article reviews the status of teaching spiritual care in a public institution of higher education. The resurgence of interest in spiritual care across the United States has spurred interest and expanded theories of spirituality within the nursing profession. Nursing education rose to the challenge of teaching spiritual care theories and interventions to students, despite the absence of policy to guide educators. However, differences between public and private educational institutions have led to variations in the teaching of spiritual care. In addition to the legal implications stemming from the need for separation of church and state, nurses must also be aware of their ethical obligations in order to teach spiritual care concepts appropriately. The accrediting agencies for nursing education programs and hospitals, as well as state licensure boards, foster high expectations for nurses to provide spiritual care. A call for research and policy development to guide nurse educators is also addressed in this article.

Outcomes of a Monitoring Program for Physicians with Mental and Behavioral Health Problems

Most states have programs that provide structured monitoring for physicians with substance use disorders (SUDs). In recent years, the Massachusetts Medical Society's Physician Health Services (PHS) program has used a similarly structured approach to monitor physicians with other mental and behavioral health (MBH) problems. The objective of this study was to determine the outcomes of the PHS monitoring programs for SUDs and MBH problems, compare their overall success rates, and identify correlates of success. Data were extracted from the PHS administrative database for physicians presenting between January 1, 1993 and May 31, 2003. Variables included gender, age, specialty, type of monitoring contract (SUD vs MBH), and state licensing board involvement. Dates of contract openings and closings were used to categorize cases as successful completion, relapse, or other. Of 58 physicians with MBH contracts, 43 (74%) completed successfully, 7 (12%) relapsed, and 8 (14%) did not complete for other reasons. Of 120 total physicians with SUD contracts, 90 (75%) completed successfully, 10 (8%) relapsed, and 20 (17%) did not complete for other reasons. Successful completion of SUD contracts was significantly associated with licensing board involvement (84% vs 66%, p = 0.04). Survival analysis indicated that time to relapse was significantly shorter for women compared to men on both MBH and SUD contracts (log rank test for equality of survival distribution p < 0.001 for MBH and p = 0.001 for SUD). This study suggests that physicians with MBH problems can be monitored in a similar fashion as physicians with SUDs, and with similarly positive outcomes. However, greater attention should be given to services for women in physician health monitoring programs.

Impaired Physicians: Role of the Occupational Psychiatrist

&lt;P&gt;Until the early 1970s, physician impairment in the United States was not widely recognized by organized medicine as a serious concern. This changed with the publication in 1972 of a report by the American Medical Association Council on Mental Health, which focused on the “sick physician” who was impaired by substance use, age, psychiatric, or medical illness to the degree that he/she was unable to practice medicine with reasonable skill and safety. In an effort to advocate for its physicians, while also ensuring patient safety, most state licensing boards and medical societies in the United States responded by establishing physician health programs (PHP), which were dedicated to identifying, treating, and monitoring impaired physicians. The focus was on rehabilitation and physician advocacy.&lt;/P&gt; &lt;H4&gt;ABOUT THE AUTHOR&lt;/H4&gt; &lt;P&gt;Julia M. Reade, MD, is an Instructor in Psychiatry and a Licensed Staff Psychiatrist at Massachusetts General Hospital.&lt;/P&gt; &lt;P&gt;Address correspondence to: Julia M. Reade, MD; 321 Walnut Street, #423, Newtonville, MA 02460.&lt;/P&gt; &lt;P&gt;The author disclosed no relevant financial relationship.&lt;/P&gt;

Advocacy, Action Plans Lead to Success: State Association/ASHA Partnerships Focus on Personnel Standards and Strategies

Advocacy, Action Plans Lead to Success: State Association/ASHA Partnerships Focus on Personnel Standards and Strategies

Social Work Ethics Audits in Health Care Settings: A Case Study

In recent years social workers in health care settings have paid increased attention to ethical issues and decision making. Along with members of allied health professions, social workers have enhanced their understanding of ethical challenges related to organ transplantation, the use of artificial organs, end-of-life decisions, genetic engineering, aggressive treatment of seriously impaired infants and frail elders, abortion, managed care, and the protection of participants in research protocols (Congress, 1998; Foster, 1995; Loewenberg & Dolgoff, 1996; Reamer, 1985, 2006). Most recently, various health care professions have begun to recognize the relevance of ethics (Cohen-Almagor, 2000; Reamer, 2001a). Risk management is a concept that emerged in the 1960s; originally, the concept referred to efforts to minimize business-related losses resulting from accidents, theft, and negligence (Vaughan & Vaughan, 2000). Over time, risk management has broadened in scope to include many other settings and contexts, including various health professions. A broad range of health agencies now pay considerable attention to steps they can take to minimize the likelihood of harm to clients and staff, prevent ethics complaints (filed with professional associations and state licensing and regulatory boards), and prevent lawsuits alleging some form of ethics-related negligence (for example, conflicts of interest, inappropriate dual relationships or boundary violations, unethical delivery of services, mishandling of confidential information, and unethical termination of services (Barker & Branson, 2000; Houston-Vega & Nuehring, 1997; Reamer, 1998, 2003; Strom-Gottfried, 1999). This article describes a practical strategy--the Social Work Ethics Audit--that promotes ethical practice in health settings and minimizes ethics-related risks. THE SOCIAL WORK ETHICS AUDIT The Social Work Ethics Audit (SWEA) (Reamer, 2001b) provides social workers and their agencies with an easy-to-use tool to examine their ethics-related practices, policies, and procedures; ensure quality; and promote ethics-related risk management. SWEA provides social workers with a tool to help them identify pertinent ethical issues in their practice settings, review and assess the adequacy of their current practices, design a practical strategy to modify current practices as needed, and monitor the implementation of this quality assurance strategy. The audit is especially useful to administrators whose agencies seek accreditation and to supervisors who want to structure their ethics-related discussions with supervisees. SWEA includes a structured instrument and protocol that facilitate this comprehensive assessment. The audit focuses on specific ethical risks found in human services settings: client rights, confidentiality and privacy, informed consent, high-risk interventions, boundary issues, conflicts of interest, documentation, defamation of character, client records, supervision, staff development and training, consultation and referral, fraud, termination of services, practitioner impairment, and evaluation and research. The ethics audit involves six key steps: (1) form an audit committee; (2) using the topical outline, identify specific ethics-related issues on which to focus; (3) gather forms, policies, regulations, and other documents required for the audit; (4) assess multiple topics in 16 discrete risk areas and assign a score on a four-point scale indicating no risk, minimal risk, moderate risk, or high risk; (5) develop a comprehensive, detailed action plan for each risk area that warrants attention, starting with high-risk areas; and (6) establish a mechanism to follow up on each task to ensure its completion and monitor its implementation. (SWEA is accompanied by a computer disk that facilitates the audit process.) The assessment of each risk area is divided into two sections: policies and procedures. …

State Association Leaders Gather in Oregon for Policy Workshop, State President’s Meeting

You have accessThe ASHA LeaderASHA News1 Jul 2006State Association Leaders Gather in Oregon for Policy Workshop, State President’s Meeting Eileen Crowe Eileen Crowe Google Scholar More articles by this author https://doi.org/10.1044/leader.AN1.11092006.4 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In State association leaders traveled to Portland, OR, for the ASHA’s annual State Policy Workshop. Now in its 22nd year, the ASHA workshop provides state and federal updates to participants and opportunities for networking with state association leaders. Presenters included ASHA President Alex Johnson and Vice President for Governmental and Social Policies De Anne Owre. Attendees participated in a role-playing session to explore solutions to personnel vacancies in the schools and came up with a number of suggestions: using promotional brochures to provide information on the professions to high school students via guidance counselors attending guidance counselor conventions having colleges and universities host focused career fairs promoting speech-language pathology assistants at the university level as an employment option after four years providing better treatment facilities examining workload as part of retention including articles in The ASHA Leader on job sharing offering distance education programs for those with bachelor’s degrees to obtain their master’s degree As in past years, participants had the opportunity to explore in greater detail issues they identified as priorities in their states. Recruitment and retention of SLPs and audiologists in schools, shortages/funding in university settings, reimbursement, and personnel issues in health care topped the list of topics selected for workshop roundtable sessions. CSAP Meets The State Policy Workshop was followed by the spring meeting of the Council of State Association Presidents (CSAP). At this meeting, states have the opportunity to share successes and challenges during the popular “Bring, Brag, and Moan” session. During this session, CSAP members reported on numerous activities in their states associations including the following: Arizona has increased attendance of audiologists at their convention. Arkansas is working on acquiring funding for salary supplement legislation. Florida is concerned that Medicaid reform will threaten to restrict access or eliminate speech, language, and hearing services to children. Georgia has seen a significant increase in student membership. Idaho is planning a joint conference in the fall of 2007 with the Montana, Wyoming, and Utah state speech-language-hearing associations. Illinois has established a foundation to provide scholarship and research grants. Maryland succeeded in passing a bill for licensure reimbursement for all school-based SLPs working in the state, and they had their first “Swap & Shop” where you could display gently used items for $10 a table. Minnesota worked on the passage of a telepractice policy and is working with the Department of Education to establish guidelines for a pilot project. Nebraska hosted a successful legislative breakfast which half of all state senators attended. New Hampshire is developing a public relations campaign aimed at educating consumers so they are able to make informed decisions about speech-language services. New York has been invited by the state licensure board to serve on a committee that is conducting a study of personnel shortages. Ohio celebrated its 60 years as a state association. Pennsylvania’s past president is now on the state licensure board. Texas celebrated 50 years as a state association and has made the continuing education application process available online. Next year’s State Policy Workshop will be held in Little Rock, AR, May 17–18, 2007. Author Notes Eileen Crowe, is the director of state association relations. for more information contact her at [email protected] or at 800-498-2071, ext. 4221. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 11Issue 9July 2006 Get Permissions Add to your Mendeley library History Published in print: Jul 1, 2006 Metrics Current downloads: 60 Topicsasha-topicsleader_do_tagasha-article-typesleader-topicsCopyright & Permissions© 2006 American Speech-Language-Hearing AssociationLoading ...

Contesting Anticompetitive Actions Taken in the Name of the State: State Action Immunity and Health Care Markets

The so-called state action doctrine is a judicially created formula for resolving conflicts between federal antitrust policy and state policies that seem to authorize conduct that antitrust law would prohibit. Against the background of recent commentaries by the federal antitrust agencies, this article reviews the doctrine and discusses its application in the health care sector, focusing on the ability of states to immunize anticompetitive actions by state licensing and regulatory boards, hospital medical staffs, and public hospitals, as well as anticompetitive mergers and agreements. Although states are free, as sovereign governments, to restrict competition, the state action doctrine requires that "the state itself" make the decision to do so. Partly on the basis of problems in the political environment, the article criticizes courts for using a mere "foreseeability" test to decide whether a state legislature sufficiently authorized competitors to act in contravention of clear federal policy: "Few things are more foreseeable than that a trade or profession empowered to regulate itself will produce anticompetitive regulations."

State Legislative Scorecard

You have accessThe ASHA LeaderPolicy Analysis1 Jun 2006State Legislative Scorecard Charlie Diggs Charlie Diggs Google Scholar More articles by this author https://doi.org/10.1044/leader.PA3.11082006.4 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In The legislative year is winding down for the majority of state legislatures, and audiologists, speech-language pathologists, and their state speech-language-hearing associations can point to many statehouse successes. Audiology Licensure In Alabama and Georgia, new applicants for an audiology license will need a doctoral degree effective Jan. 1, 2007, due to legislation signed by Govs. Bob Riley and Sonny Perdue on March 10 and May 5, respectively. Indiana, New Mexico, Ohio, and Oklahoma already have passed legislation for a similar requirement, demonstrating that a total of six states have anticipated ASHA’s 2012 mandate for a doctoral degree in audiology for its Certificate of Clinical Competence (CCC). Telepractice The new Georgia law also establishes restrictions on the practice of audiology and speech-language pathology through telecommunications and information technologies that transmit information or data. The use of such technology is considered the practice of audiology or speech-language pathology in the state and requires a full Georgia license subject to the regulations of the licensing board. The requirement will not apply to an audiologist or SLP in another state or country who provides consultation at the request of a state-licensed individual; to an audiologist or SLP licensed in another state or country who provides consultation without compensation and does not “alter[ing], adjust[ing], [or] manipulate[ing] hearing aid device controls”; or to consultation services to a graduate school located in the state and recognized by the board. The requirement of a full state license is consistent with the position of the National Council of State Boards of Examiners for Speech-Language Pathology and Audiology, a confederation of state licensing board representatives that supports the work of licensing boards and assists them in the regulation of audiology and speech-language pathology practice. Salary Supplement As reported in the May 2 issue, West Virginia school SLPs and audiologists who hold ASHA’s Certificate of Clinical Competence (CCC) will be eligible July 1 to receive a $2,500 annual salary supplement as well as reimbursement for certification application fees. Nationally certified guidance counselors in the schools are also included in this new law. During the first year of implementation, salary supplements will be limited to a combined total of no more than 100 SLPs, audiologists, and counselors. In each subsequent fiscal year, up to 100 additional qualified recipients may receive the supplement. Criteria for selection of the particular individuals who will receive the supplement in a given year will be established by regulation and must prioritize the length of time certification has been held and the years of experience of the certificate holder. West Virginia’s success brings to 10 the number of states that have enacted salary supplement legislation for school audiologists and/or school SLPs that is comparable to that received by master teachers certified by the National Board for Professional Teaching Standards. Delaware, Indiana, Mississippi, Missouri, and Nevada also provide a supplement. Arkansas, Louisiana, and Oklahoma have approved the supplement in principle but need state funds in order to implement the supplement. Rhode Island will pay for CCC application fees only. Loan Forgiveness In Wyoming, SLPs were specifically included in a list of health care providers with a state license who would be eligible for the loan repayment program from the state health department if they practice in underserved areas. Such a professional may not receive more than $10,000 per year in loan re-payment. One-third of state legislatures are still in session. A more comprehensive report on state activity will appear in an early fall edition of The ASHA Leader after more legislatures have adjourned for the year. Author Notes Charlie Diggs, director, state & consumer advocacy, can be reached at [email protected]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 11Issue 8June 2006 Get Permissions Add to your Mendeley library History Published in print: Jun 1, 2006 Metrics Downloaded 116 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2006 American Speech-Language-Hearing AssociationLoading ...

Reports to the National Practitioner Data Bank involving dentists, 1990–2004

While the National Practitioner Data Bank (NPDB) contains reports relating to dentists, an analysis of these data has not been published. The authors analyze 47,441 reports to the NPDB relating to malpractice payments, licensure actions and adverse actions against dentists from Sept. 1, 1990, to Sept. 30, 2004. A total of 13.2 percent of all NPDB reports were related to dentists. Of these, 73.7 percent resulted from malpractice actions and the remaining 26.3 percent were from adverse actions. While the number of large payments increased over this period, the median payment remained relatively stable. Dental malpractice settlements and judgments generally have kept pace with inflation over the past decade. Dentists should be aware that the NPDB retains reports of adverse actions and malpractice settlements and judgments indefinitely. These reports are available to hospitals evaluating their credentials, state licensing boards and certain health care entities (for example, health maintenance organizations and preferred provider organizations) entering into an employment or other relationship with them.