State Medical Licensing Boards Research Articles

Confronting Medical Diploma Mills: State Licensing Boards, Legislatures, and the Limits of Medical Authority in the 1920s.

In the standard story of the rise of professional authority in medicine in the 1920s, state medical licensing boards were partners in a coalition, led by the American Medical Association, to radically improve medical education. Boards obtained state laws that limited admission to licensing examinations to graduates of schools approved by the AMA, thus bringing about the rapid demise of low-quality schools by about 1925. The reality at the state level was quite different, however. Medical examining boards containing homeopaths, eclectics, and sometimes osteopaths could be far from reliable partners. Passing laws to benefit the medical profession was exceedingly difficult and dependent on local medical politics. Through the lens of a major medical diploma mill scandal revealed by a journalist in 1923, this paper examines reform efforts in three states greatly affected by the scandal: Missouri, where the scandal originated, Connecticut, and Massachusetts. In each of these states, graduates of low-quality schools as well as fake doctors from diploma mills were able to take a state examination and practice. This paper argues that the AMA, far from being the major player in the elimination of inadequate schools, could set standards but had to stay on the sidelines.

Regulators Collaborate to Digitize CME for America’s Doctors

ABSTRACT Since 2010, the Accreditation Council for Continuing Medical Education (ACCME®) has maintained a database, the Program and Activity Reporting System (PARS), as a central repository for information about accredited education providers and their activities. The database has been expanded with the goal of creating an integrated, centralized data system. The ACCME collaboration since 2015 with specialty certifying boards served as a proof of concept that creating a centralized system that facilitates the free flow of data can provide value to physicians and medical regulatory boards. In 2018, ACCME undertook a pilot project that expanded reporting of credit for certifying boards to also include reporting of continuing medical education (CME) credit for 3 state medical licensing boards. Based on the success and lessons learned from the pilot, the ACCME decided to invest in building a new version of PARS to include any state medical licensing boards that chose to use the data. Launched in November 2021, the new PARS enables accredited organizations to enter CME credit data for all US physicians. Physicians may access their data via CMEPassport.org. By leveraging the power of a common database, regulatory bodies can demonstrate accountability, integrity, and transparency; reduce burdens on physicians; facilitate physicians’ commitment to lifelong learning; transform the perception of CME from a checkbox exercise to a currency for change; and contribute to advancing clinician practice and healthcare improvement for patients and communities throughout the country.

Comparison of State Medical Licensing Board Disclosures Regarding Resident Performance for United States Allopathic, Osteopathic, and Foreign Medical Graduates.

While recent streamlining of the graduate medical education process signals an important change from the traditional dichotomy between doctors of osteopathic medicine (DOs) and US-trained doctors of medicine (USMDs), this new uniformity does not continue into the process for licensure, including state medical licensing verification of training (VOT) forms for DOs, MDs, and foreign medical graduates (FMGs). Wide variability remains. To document the differences in the performance metrics program that directors are required to disclose to state medical licensing boards for DOs and FMGs compared with USMDs. VOT forms were collected from all osteopathic and allopathic licensing boards for all US states, Washington DC, and US territories. The authors then reviewed VOT forms for questions pertaining to trainee performance only in states where VOT forms differed for DOs, USMDs, and FMGs. Licensing board questions were categorized as relating to disciplinary action, documents placed on file, resident actions, and nondisciplinary actions by the program. Fifty-six states and territories were included in the study (50 US states; Washington, DC; and 5 US territories). Most states and territories (46; 82.1%) used the same VOT form for DOs and USMDs. All states and territories except New York used the same form for FMGs and USMDs (55; 98.2%). Of the 14 states with an osteopathic board, Nevada used Federation Credentials Verification Service (FCVS) for DOs only, and 8 states used a unique osteopathic VOT form. Of these 8 osteopathic boards, 3 VOT forms did not ask any questions regarding resident performance during training. Of the remaining 5 forms, all asked about disciplinary actions. Ten states and 1 territory (US Virgin Islands) required the FCVS for both USMDs and FMGs, but not for DOs, while New York required FCVS only for FMGs. Nevada required FCVS only for DOs. Although VOT requirements for FMGs and USMDs were mostly the same within states, performance metric question sets varied greatly from state to state and within states for osteopathic vs allopathic licensing boards. Implementation of a standardized VOT form for all applicants that includes academic performance metrics may help ensure that medical licensure is granted to all physicians who demonstrate academic competency during training, regardless of their degree.

Osteopathic Medical Licensing Compliance With the Americans With Disabilities Act of 1990.

Physicians have an increased rate of depression and suicide compared with nonphysician peers. State medical licensure questions about mental health deter physicians from seeking mental health care. Several previous studies have examined state medical licensing board compliance with the Americans with Disabilities Act (ADA) of 1990, but none have included osteopathic licensing boards. To evaluate compliance of state osteopathic medical licensing boards with ADA requirements regarding mental health. State medical licensing applications for 51 states, including the District of Columbia (DC), and 16 states with osteopathic licensing entities were reviewed for ADA compliance in questions about mental health. In states where both osteopathic and allopathic applications were available, questions and compliance were compared. Fourteen of 51 states (including DC) were grossly out of compliance with ADA statutes. In states where osteopathic and allopathic licensing were both available, 7 of 16 asked different mental health questions of osteopathic physicians than their allopathic physician counterparts. Of those 7 states, 6 of the osteopathic boards were out of compliance with ADA, while their allopathic counterparts were either compliant or intermediately compliant. To improve physician wellbeing, corrective action must be taken to create ADA-compliant language in medical licensing so physicians can seek treatment for mental health conditions without discrimination by licensing boards. Osteopathic physicians should be aware that there is a discrepancy in state licensure compliance compared with allopathic requirements in some states.

Emerging Technologies and the Future of Assisted Reproductive Technology

Emerging technologies such as artificial intelligence are rapidly making their way into fertility clinics around the world. Clinicians, patients, and their families may potentially benefit from rapid advances in the AI field through applications including AI-based embryo selection. Yet, regulation to encourage benefits and diminish risks in AI tools for ART remains underdeveloped, which is unsurprising given its recent entry into the market. Fertility practitioners can play an active role in the regulatory environment for innovative ARTs including AI-based embryo selection — complementing federal regulatory agencies, state medical licensing boards, professional organizations, and civil society entities.

Does Performance on the American Board of Physical Medicine and Rehabilitation Initial Certification Examinations Predict Future Physician Disciplinary Actions?

The aim of the study was to determine the relationship between performance on the American Board of Physical Medicine and Rehabilitation primary certification examinations and the risk of subsequent disciplinary actions by state medical boards over a physician's career. The hypothesis is that physicians who do not pass either or both of the two initial specialty certification examinations are at higher risk of disciplinary action from a state medical licensing board. This is a retrospective cohort study that analyzed board certification examination data from all physicians who completed physical medicine and rehabilitation residency between 1968 and 2017. Matching examination and license data were available for 9889 physical medicine and rehabilitation physicians, who received a total of 547 disciplinary action reports through the Federation of State Medical Boards. The results showed a significant correlation between failing an American Board of Physical Medicine and Rehabilitation certification examination and the risk of subsequent disciplinary action by a state medical board. Failure to pass either the written (Part I) or oral (Part II) examination increased the risk of subsequent disciplinary action by 5.77-fold (P < 0.0001, 95% confidence interval = 4.07-8.18). Physicians in physical medicine and rehabilitation who do not pass initial certification examinations and become board certified are at higher risk of disciplinary action from a state medical licensing board throughout their careers.

Mandated State Medical Licensing Board Disclosures Regarding Resident Performance.

State medical licensing boards ask program directors (PDs) to complete verification of training (VOT) forms for licensure. While residency programs use Accreditation Council for Graduate Medical Education core competencies, there is no uniform process or set of metrics that licensing boards use to ascertain if academic competency was achieved. We determined the performance metrics PDs are required to disclose on state licensing VOT forms. VOT forms for allopathic medical licensing boards for all 50 states, Washington, DC, and 5 US territories were obtained via online search and reviewed. Questions were categorized by disciplinary action (investigated, disciplined, placed on probation, expelled, terminated); documents placed on file; resident actions (leave of absence, request for transfer, unexcused absences); and non-disciplinary actions (remediation, partial or no credit, non-renewal, non-promotion, extra training required). Three individuals reviewed all forms independently, compared results, and jointly resolved discrepancies. A fourth independent reviewer confirmed all results. Most states and territories (45 of 56) accept the Federation Credentials Verification Service (FCVS), but 33 states have their own VOT forms. Ten states require FCVS use. Most states ask questions regarding probation (43), disciplinary action (41), and investigation (37). Thirty-four states and territories ask about documents placed on file, 36 ask about resident actions, and 7 ask about non-disciplinary actions. Eight states' VOT forms ask no questions regarding resident performance. Among the states and territories, there is great variability in VOT forms required for allopathic physicians. These forms focus on disciplinary actions and do not ask questions PDs use to assess resident performance.

Recertification Exam Performance in General Surgery is Associated With Subsequent Loss of License Actions.

To measure associations between first-time performance on the American Board of Surgery (ABS) recertification exam with subsequent state medical licensing board disciplinary actions. Time-limited board certification has been criticized as unnecessary. Few studies have examined the relationship between recertification exam performance and outcomes. Retrospective analysis of loss-of-license action rates for general surgeons who were initially certified by the ABS from 1976 to 2005 and attempted to take a surgery recertification exam. Disciplinary actions from 1976 to 2016 were obtained from the Disciplinary Action Notification System through the American Board of Medical Specialties. A total of 14,169 general surgeons attempted to pass the surgery recertification exam. The rate of loss-of-license actions was significantly higher for surgeons who failed their first exam attempt [incidence rate 3.41, 95% confidence interval (CI) 2.27-4.56] than those who passed on their first attempt (incidence rate .01, 95% CI 0.87-1.14). A Cox proportional-hazards regression model found that the adjusted hazard rate for loss-of-license actions for surgeons who failed their first recertification exam were significantly higher than those who passed their first attempt after adjusting for multiple surgeon characteristics (adjusted hazard rate 2.98, 95% CI 1.85-4.81). Failing the first recertification exam attempt was associated with a greater rate of subsequent loss-of-license actions. These results suggest that demonstrating sufficient surgical knowledge is a significant predictor of future loss-of-license actions.

Physicians Look to Disrupt Longtime Regulatory Tradition for APRNs

In June 2017, at the American Medical Association’s (AMA’s) House of Delegates meeting, an amendment to a resolution impacting regulation of advanced practice registered nurses (APRNs) failed by a margin of 254-204, exposing not only a divide among AMA delegates, but a growing and continuing threat to the autonomy of APRNs ( Basen, 2017 Basen R. AMA does not want PA autonomy. MedPage Today. 2017, June 15http://www.healthleadersmedia.com/technology/ama-does-not-want-pa-autonomy?nopaging=1 Google Scholar ). The amendment called for placing “APRNs under state medical board and regulatory control, with AMA developing model state legislation” ( Basen, 2017 Basen R. AMA does not want PA autonomy. MedPage Today. 2017, June 15http://www.healthleadersmedia.com/technology/ama-does-not-want-pa-autonomy?nopaging=1 Google Scholar ). The underlying resolution was a measure opposing physician assistants from creating their own regulatory boards ( American Medical Association, 2017 American Medical Association House of Delegates handbook: 2017 annual meeting. Author, Chicago, IL2017https://www.ama-assn.org/sites/default/files/media-browser/public/hod/a17-handbookandaddendum-updated.pdf Google Scholar ). The amendment pertaining to APRNs stated that “AMA will adopt policy that APRNs are subject to the jurisdiction of state medical licensing and regulatory boards for the regulation and discipline of APRNs in their performance of medical acts and that AMA will develop model state legislation in support of states to accomplish this policy” ( American Association of Physician Assistants, 2017 American Association of Physician Assistants New AMA policy opposes autonomous PA boards [Press release]. https://www.aapa.org/pas-connect/2017/06/new-ama-policy-opposes-autonomous-state-pa-boards/Date: 2017, June 14 Google Scholar ). The physician assistant measure, however, was successful ( American Association of Physician Assistants, 2017 American Association of Physician Assistants New AMA policy opposes autonomous PA boards [Press release]. https://www.aapa.org/pas-connect/2017/06/new-ama-policy-opposes-autonomous-state-pa-boards/Date: 2017, June 14 Google Scholar ). The AMA House of Delegates discussion mirrors legislative efforts by medical societies across the country. Even without AMA-sanctioned model legislation, physician groups have been advocating for moving regulatory authority over APRNs to state boards of medicine (BOMs) from boards of nursing (BONs), where these professionals have long been regulated. Most of these efforts, however, have gone the way of the AMA measure, while proposals calling for the removal of physician and BOM oversight have been successful.

A Census of Actively Licensed Physicians in the United States, 2016

An accurate understanding of the demographic and state medical licensure characteristics of physicians in the United States is critical for health care workforce planning. Overall changes in the nation's population demographics, state and federal medical regulatory policies and dynamics surrounding the ongoing health care reform debate further highlight the need to have an up-to-date census of actively licensed physicians across all medical specialties. This article uses data received by the Federation of State Medical Boards (FSMB) from the nation's state medical and osteopathic licensing boards to report and summarize key features of actively licensed physicians in the United States and the District of Columbia. Our biennial census, current through the end of 2016, identifies a total of 953,695 actively licensed allopathic and osteopathic physicians serving a national population of 323 million people. This represents a net physician-increase of 12% from the 2010 census. From 2010 to 2016, the actively licensed U.S. physician-to-population ratio increased from 277 physicians per 100,000-population to 295 physicians per 100,000-population. Females now make up one-third of all licensed physicians, with osteopathic physicians and Caribbean medical graduates continuing to demonstrate substantial increases in both their absolute numbers and as a percentage of all actively licensed physicians from the 2010 to 2016 time period.

The Use of COMLEX-USA and USMLE for Residency Applicant Selection

(Abstracted from J Grad Med Educ, 8(3):358–363, 2016) The Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) and the United States Medical Licensing Examination (USMLE) are recognized by all state medical licensing boards in the United States. Moreover, the Federation of State Medical Boards has supported the validity of both examinations for medical licensure.

The Use of COMLEX-USA and USMLE for Residency Applicant Selection.

The Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) and the United States Medical Licensing Examination (USMLE) are recognized by all state medical licensing boards in the United States, and the Federation of State Medical Boards has supported the validity of both examinations for medical licensure. Many osteopathic medical students take both examinations. The purpose of this study was to investigate performance on COMLEX-USA Level 1 and USMLE Step 1 of students from colleges of osteopathic medicine where the majority of students took both examinations. Data were collected on the entering classes of 2010 and 2011. Relationships between the COMLEX-USA Level 1 and the USMLE Step 1 were quantified using Pearson correlations. The correlation between outcomes on the 2 examinations was evaluated using the phi coefficient. A contingency table was constructed to look at first-attempt outcomes (pass/fail). Data for 2010 and 2011 were collected from 3 osteopathic medical schools, with 795 of 914 students (87%) taking both examinations. The correlation between first-attempt COMLEX-USA Level 1 and USMLE Step 1 scores was statistically significant across and within all 3 schools. The overall correlation was r(795) = 0.84 (P < .001). Pass/fail status on the 2 examinations was moderately correlated (φ = 0.39, P < .01). Our study found a strong association between COMLEX Level 1 and USMLE Step 1 performance. Additional studies to accurately compare scores on these examinations are warranted.

Deciding whether to refer a colleague to a physician health program.

Physicians should exercise caution in referring a possibly impaired colleague to a physician health program (PHP), given that PHPs work closely with their state medical societies or licensing boards but often receive little oversight.

Expert Witness Testimony in Ophthalmology Malpractice Litigation

To examine the relative qualifications of expert witnesses testifying on behalf of plaintiffs vs defendants in ophthalmology malpractice litigation. Correlational and descriptive study; analysis of expert witness and physician demographic data available on several databases. The Westlaw legal database was searched for ophthalmologist expert witness testimony from January 2006 to June 2014. Physician demographic data were used as the main outcome measures, including length of experience, scholarly impact (as measured by the h-index), practice setting, and fellowship training status and were obtained from state medical licensing board sites and online medical facility and practice sites. H-indices were obtained from the Scopus database. Defendant and plaintiff expert witnesses had comparable mean years of experience (32.9 and 35.7, respectively) (P= .12) and scholarly impact (h-index= 8.6 and 8.3, respectively) (P= .42). Cases tended to resolve on the side of the expert witness with the higher h-index (P= .04). Significantly higher proportions of defendant witnesses were in academic practice (P < .05) and underwent fellowship training (P < .001). Ophthalmologist expert witnesses testifying for both plaintiffs and defendants had over 30 years of experience and high scholarly impact. Practitioners testifying on behalf of plaintiffs were statistically less likely to work in an academic setting and have subspecialty training. Scholarly impact of expert witnesses appeared to affect trial outcomes. Surgical societies should stringently police for appropriate expert witness testimony given by both plaintiff and defense experts in malpractice litigation.

A143: Barriers to Referral to Pediatric Rheumatology among General Pediatricians in the Upper Midwest

Background/Purpose:Access to pediatric rheumatology (PR) care is limited. An average of 28 fellows graduate from PR training programs annually, and there are 224 board‐certified pediatric rheumatologists in the United States. Eleven states have no pediatric rheumatologist and 24 states have two or fewer. Furthermore, the mean distance to a certified pediatric rheumatologist is 60 miles. The impact that limited access to PR has on general pediatricians has not been studied.Methods:A web‐based survey was emailed to general pediatricians practicing in Minnesota (MN), North Dakota (ND), and South Dakota (SD). The email databases were obtained from the MN and ND state medical licensing boards and from the SD chapter of the American Academy of Pediatrics. The goal of the survey was to define barriers to access to PR care and the consequences of limited access. Basic descriptive analysis was performed and responses were summarized.Results:The overall response rate was 15.3% (93/609). Responders were younger than non‐responders (mean age 48 yo versus 53 yo, p = 0.0006) and had been in practice a shorter period of time (mean 22 y versus 27 y, p = 0.0051). Forty percent (37/92) of the clinics were urban, 40% (37/92) suburban, and 20% (18/92) rural. Twenty‐nine percent (27/92) of respondents' clinics were at least two hours by car from a pediatric rheumatologist, and 9% (8/92) were more than 6 hours away. Ninety‐two percent (85/92) had referred a patient to PR at least once, but 89% (83/93) had experienced a situation at least once in which they considered a referral to PR but ultimately did not. Reasons for not referring varied. When asked, “In cases in which you considered a PR referral but did not refer a patient to a pediatric rheumatologist, please indicate your reasons for doing so. (Select all that apply),” many had referred to other subspecialists instead: 29% (24/83) to pediatric infectious disease, 20% (17/83) to adult rheumatology, and 12% (10/83) to pediatric orthopedics, while 34% (28/83) managed the patient themselves. Although not a pre‐specified choice in the survey, 9% (3/32) of pediatricians added wait‐time as the reason for not referring to PR. Thirty‐five percent (32/60) had referred a pediatric patient to an adult rheumatologist, most commonly for distance (47%), while physician preference was never selected as a reason.Conclusion:Pediatricians often refer children with possible rheumatic disease to specialists other than PR due to reasons of distance and wait‐time. Referral to adult rheumatologists occurs, but not based on pediatrician preference. These findings suggest that the PR workforce is inadequate to meet demand, at least in the Upper Midwest. Interventions are needed to improve access to care in PR.

Medical Licensing and Discipline in America: A History of the Federation of State Medical Boards by David A. Johnson, Humayun J. Chaudhry (review)

Reviewed by: Medical Licensing and Discipline in America: A History of the Federation of State Medical Boards by David A. Johnson, Humayun J. Chaudhry Joel D. Howell David A. Johnson and Humayun J. Chaudhry. Medical Licensing and Discipline in America: A History of the Federation of State Medical Boards. New York: Lexington Books, 2012. xx + 357 pp. Ill. $37.99 (paperbound, 978-0-7391-7439-5), $85.00 (cloth, 978-0-7391-7438-8). Founded in 1912 from the merger of the National Confederation of State Medical Examining and Licensing Boards and the American Confederation of Reciprocating Examining and Licensing Boards, the Federation of State Medical Boards held its first meeting in 1913. Over the next century this board has played an important but generally underappreciated role in the history of U.S. medicine. This volume traces the history of the federation from its origins up to almost the present day. Both authors are employed by the board (as president and CEO, and as a vice-president); the volume has a celebratory tone throughout. References are largely taken from a very careful reading of the organization’s records. There is quite a bit of information here, which makes for dense reading at times. A concluding bibliographical essay provides useful guidance to some historical literature. The federation’s original goal was to set standards for medical licensure, and to do so they had to grapple with the challenges of both shifting educational standards and consistency of interstate licensure in a rapidly changing system of physician practice regulation. After a period of relative inaction from the early 1930s until the early 1950s, the federation gained new energy from initiatives designed to produce a model Medical Practice Act and the creation (in 1956) of the Educational Commission for Foreign Medical Graduates (ECFMG). The federation continues to play an important role in the world of medical regulation, serving as the major centralized source of information for both verifying physician credentials and documenting physician disciplinary sanctions. One of most important changes to physician regulation over the past century has been the decision to place a time limit on specialty certification. The federation is now engaged in discussions about what processes ought to be mandated for maintenance of physician licensure. Historians of medicine who wish to engage with the past century of licensing regulation will find this a useful volume. [End Page 207] Joel D. Howell University of Michigan, Ann Arbor Copyright © 2014 The Johns Hopkins University Press

Comparison of plaintiff and defendant expert witness qualification in malpractice litigation in neurological surgery

Expert witnesses provide a valuable societal service, interpreting complex pieces of evidence that may be misunderstood by nonmedical laypersons. The role of medical expert witness testimony and the potential professional repercussions, however, have been controversial in the medical community. The objective of the present analysis was to characterize the expertise of neurological surgeons testifying as expert witnesses in malpractice litigation. Malpractice litigation involving expert testimony from neurological surgeons was obtained using the WestlawNext legal database. Data pertaining to duration of a surgeon's practice, scholarly impact (as measured by the h index), practice setting, and the frequency with which a surgeon testifies were obtained for these expert witnesses from various online resources including the Scopus database, online medical facility and practice sites, and state medical licensing boards. Neurological surgeons testifying in 326 cases since 2008 averaged over 30 years of experience per person (34.5 years for plaintiff witnesses vs 33.2 for defense witnesses, p = 0.35). Defense witnesses had statistically higher scholarly impact than plaintiff witnesses (h index = 8.76 vs 5.46, p < 0.001). A greater proportion of defense witnesses were involved in academic practice (46.1% vs 24.4%, p < 0.001). Those testifying on behalf of plaintiffs were more likely to testify multiple times than those testifying on behalf of defendants (20.4% vs 12.6%). Practitioners testifying for either side tend to be very experienced, while those testifying on behalf of defendants have significantly higher scholarly impact and are more likely to practice in an academic setting, potentially indicating a greater level of expertise. Experts for plaintiffs were more likely to testify multiple times. Surgical societies may need to clarify the necessary qualifications and ethical responsibilities of those who choose to testify.

Prescribing Bill Dies in Illinois Legislature

Back to table of contents Previous article Next article Government NewsFull AccessPrescribing Bill Dies in Illinois LegislatureKen HausmanKen HausmanSearch for more papers by this authorPublished Online:12 Jun 2013https://doi.org/10.1176/appi.pn.2013.6b7AbstractIllinois psychologists are unsuccessful in their legislative push to expand their scope of practice to include the right to prescribe.The push by Illinois psychologists and their legislative allies to permit the state’s doctoral-level psychologists to prescribe medication has come to an end for now, as the lead sponsor of the bill in the Illinois House of Representatives, Rep. John Bradley (D), withdrew it from consideration in committee. A companion bill on the issue had passed the state Senate. The session ended June 1 with no further action on the scope-of-practice expansion.Matt Gibson/ShutterstockThe Illinois Psychiatric Society (IPS) and APA were active in leading the opposition to the bill, as was the Illinois State Medical Society. The legislation would have permitted psychologists to prescribe, with oversight of their prescribing credentials and activities coming from the state’s psychological licensing board rather than from the medical licensing board. In Louisiana and New Mexico, where laws have already been enacted to allow psychologists to prescribe psychoactive medications, regulations put them under the purview of the state medical licensing board (Psychiatric News, March 15).The bill also said that the Illinois Psychological Association would provide 20 percent of the training psychologists would need to qualify for prescribing privileges in the state, a provision that Lisa Rone, M.D., an IPS representative to the APA Assembly and former IPS president, called “an appalling conflict of interest” because the state psychological association stood to reap financial gains if the bill had become law.APA provided a grant to the IPS to fight the legislation. In its campaign to defeat the prescribing bill, the IPS rallied its members with a legislative alert urging them to register their opposition with their state representatives. It said, in part, “Please remind your state legislator that there can be NO shortcuts when it comes to patient safety.” IPS President-elect Linda Gruenberg, M.D., told Psychiatric News that the district branch fought very hard to defeat this proposal out of a serious concern for its impact on patient safety and will remain vigilant should the bill reappear in the legislature. She noted that it can still be resurrected this year during a veto session scheduled for late November and early December. In a June 2 letter to members of the IPS, APA President Jeffrey Lieberman, M.D., and President-elect Paul Summergrad, M.D., thanked Illinois psychiatrists for their “tireless and successful efforts….to defeat psychologist prescribing in the most recent session of the Illinois legislature.” They added, “While we know that this issue can still resurface later in the year, we are very grateful for your extraordinary efforts.” They also indicated that APA stands ready to assist in future efforts should this or a similar bill be introduced in the future. ■ ISSUES NewArchived

Physician Medicare fraud: characteristics and consequences

PurposeCriminal Medicare and/or Medicaid fraud costs taxpayers $60‐250 billion annually. This paper aims to outline the characteristics of physicians who have been convicted of such fraud.Design/methodology/approachThe names of convicted physicians were first gathered from public databases (primarily, the OIG exclusion list). The names were further cross‐checked and verified with other public records. Details regarding demographics and the particulars of the fraud were obtained by searching court documents, media reports, the internet, and records maintained by the American Medical Association and state medical licensing boards. The paper categorizes these doctors by: age, gender, geographic location, medical school attended, and medical specialty, and compares these demographics to those of the medical profession as a whole. The paper then identifies: the specific Medicare fraud these physicians were charged with; length of prison sentence and/or probation imposed; amount of fines assessed and/or restitution ordered; and professional sanctions imposed.FindingsPhysicians convicted of criminal Medicare and/or Medicaid fraud tend to be male (87 percent), older (average age of 58), and international medical graduates (59 percent). Family practitioners and psychiatrists are overrepresented. The amount of fraud averaged $1.4 million per convicted physician. Surprisingly, despite the fact that 40 percent of such fraud compromised patient care and safety, 37 percent of physicians convicted of felony fraud served no jail time, 38 percent of physicians with fraud convictions continue to practice medicine, and 21 percent were not suspended from medical practice for a single day despite their fraud convictions.Practical implicationsThe paper makes several practical recommendations including: running as many claims as possible through predictive modeling software to detect fraud before claims are paid; developing metrics on the average rate of diagnoses and procedures by specialty to be used in the predictive modeling software; incorporating the basics of ethical billing and the consequences of fraud convictions into the medical school curriculum and testing this knowledge on the USMLE; and encouraging and/or pressuring state medical boards to hold physicians more accountable for fraud.Originality/valueThe paper categorizes doctors convicted of Medicare and/or Medicaid fraud and makes specific recommendations regarding physician training, licensing and discipline, to reduce the amount of Medicare fraud perpetrated by doctors in the future.

Illinois Senate Gets Bill on Psychologist Prescribing

Illinois Senate Gets Bill on Psychologist Prescribing