THE FUTURE OF MEDICAL LICENSURE
Martin Crane, M.D. , Chair Massachusetts Board of Registration in Medicine
BOARD MISSION STATEMENT
To ensure that only qualified physicians are licensed to practice in the Commonwealth, and to support an environment that maximizes the high quality of health care in Massachusetts.
Organization of Agency
Physician Board Member Physician Board Member Physician Board Member Physician Board Member Physician Board Member Public Board Member Public Board Member
Consumer DPH Affairs
Executive Director
Enforcement Division
Division of Law & Policy
Patient Safety Programs
Licensing Division
Physician Profiles Unit
Consumer Protection
General Counsel
Investigation
Litigation Clinical Care
Physician Health
Data Repository
Patient Care Assessment Clinical Skills Analysis Liability Reform
Initial Licenses
Public Information
Renewals
Verifications Affiliation Agreements
Web Site
Call Center
PUBLIC INFORMATION
Virtually anything a consumer or a physician might want to know is available on the Board’s website:
WWW.MASSMEDBOARD.ORG
•Board Actions •Licensing information •Physician Change of Address Online •Complaint Forms & Instructions •Patient Care Assessment Alerts •New Licensees •Publications •FAQs
THE FUTURE OF MEDICAL LICENSURE
CURRENT PATH OF LICENSURE
Medical School Internship Residency (Limited License) COMLEX/USMLE Full License CME Credits Biennial Renewal Repeat Last 2 Steps as Necessary
EVOLVING PATH OF LICENSURE
Stronger education requirements More Comprehensive Evaluation Focus on Clinical Skills Emphasis on Patient Safety Licensure is a career-long process, not a single event
STRONGER EDUCATION REQUIREMENTS
Highlight Communication Skills Emphasize Working Within a Team Structure Teach Students to be Doctors, Not Just Scientists Incorporate Professionalism into the Curriculum – and Evaluation
MORE COMPREHENSIVE EVALUATION
ACGME “Core Competencies”
CORE COMPETENCIES
Patient Care Medical Knowledge Practice-Based Learning & Improvement Interpersonal Communication Skills Professionalism Systems-Based Practice
ACGME ELEMENTS of PROFESSIONALISM
Honesty/Integrity Reliability/Responsibility Respect for Others Compassion/Empathy Self-Improvement/Knowledge of Limits Communication/Collaboration Altruism/Advocacy
FOCUS ON CLINICAL SKILLS
Again – COMMUNICATION, First & Foremost On-Going Evaluation of Competency Staying Current with National Standards & Benchmarks
EMPHASIS ON PATIENT SAFETY
Individual Responsibility vs Systems/Process Failure
LICENSURE IS A CAREER-LONG PROCESS
On-Going Clinical Skills Evaluation Evaluation Will Be the Standard for Everyone, Not Just Those with Deficits Targeted CMEs
“Baseball – of all things – was an example of how an unscientific culture responds, or fails to respond, to scientific methods.”
Moneyball – Michael Lewis
PREDICTABILITY
Baseball
0
Expected Runs By Situation
Bases Occupied
1 .81 .50 .22 2 1.19 .67 .30 3 1.39 .98 .36 1,2 1.47 .94 .40 1,3 1.94 1.12 .53 2,3 1.96 1.56 .69 Full 2.22 1.64 .82
Outs
0 1 2
.46 .24 .10
*The sacrifice bunt *The stolen base *The intentional walk
“The Numbers Game” Alan Schwartz
PREDICTABILITY
Medicine
Consumer/Other Complaints Hospital Discipline Professional Liability Payments Discipline by Medical Board/Behavior in Medical School
From: “Disciplinary Action by Medical Boards & Prior Behavior in Medical School” – M.A. Papadakis
MEDICAL MALPRACTICE DATA
Massachusetts Medical Malpractice Data 1990-2003
5.40% of all physicians made a payment in 1990-1999 6.17% made a payment in 1994-2003
SIZE OF PAYMENTS
Over the 10-year period 1994-2003 the average payment was $360,000
In 2001 the average payment in the U.S. was $300,000. In Massachusetts it was $388,841 The number of payments over $1,000,000 grew from 5.9% to 8.5% of all payments (a 50% increase) Payments between $500,000 - $1,000,000 rose 19% Payments under $100,000 dropped 36.6%
TOTAL MALPRACTICE PAYMENTS
1994-2003
Amount Paid by Year Inflation-Adjusted Sum of Payments (2003 $s) 79,707,111 105,115,795 101,935,224 108,650,028 103,481,322 130,524,086 133,991,795 134,125,163 121,905,260 118,960,482
Year 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Sum of Payments Avg Payments Count 64,198,880 251,760 255 87,063,300 306,561 284 86,921,938 306,063 284 94,773,530 354,957 267 91,670,954 334,566 274 118,181,047 384,955 307 125,398,843 379,996 330 129,095,469 388,842 332 119,188,893 446,400 267 118,960,482 431,016 276
CPI 1.2416 1.2073 1.1727 1.1464 1.1288 1.1044 1.0685 1.0390 1.0228 1.0000
TOTAL MALPRACTICE PAYMENTS 1993-2004
Inflation-Adjusted Total Amount Paid by Year: 1994-2003
Amount (in 2003 $s)
$150,000,000.00 $100,000,000.00 $50,000,000.00 $0.00 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Year
TYPES OF OB/GYN PATIENT COMPLAINTS
580 Patient Complaints on Record
72
Communication Issues Substandard Care Office Staff/Policies Billing MISC.
281
68
159
Hospital Disc or Complaint Sexual/ Professional Boundaries
Other Jurisdiction Disc.
NUMBER OF COMPLAINTS PER OB/GYN
65
1 Complaint 2 Complaints 3 Complaints 4 Complaints 5 Complaints 6 Complaints 7 Complaints
81
192
8 Complaints 10 Complaints 11 Complaints
OUTLIERS
98 physicians had more than two paid claims
4.2% of the 2,307 physicians who made a payment. 1/4 of one percent of all physicians.
These 98 physicians were responsible for
388 ( 13.5%) of all paid claims. $133,988,105 (12.9%) of all dollars paid.
98 OUTLIERS
50 remain in active practice, of whom 9 have been disciplined by the Board.
48 NO LONGER IN PRACTICE
8 Revoked 9 Disciplinary Resignation 2 Suspended 4 Deceased 2 SOA issued, overturned 1 Letter of Concern 4 Formal Discipline
5 Formal Retirement
(1 after Discipline)
13 Did Not Renew
Recommendations
Better Communication of Performance/Quality Data Clinical Skills Assessment & Enhancement Comprehensive Training In Best Practices & New Technologies Targeted CME opportunities in Communication
BOARD OF REGISTRATION IN MEDICINE WEBSITE
HTTP://WWW.MASSMEDBOARD.ORG