In the five-plus years I’ve served on the North Carolina Medical Board, the agency has taken remarkable steps to improve both the quality and quantity of information provided to the public and the profession.
Over the past few years, the Board revamped its website, introduced an email version of this newsletter and established a presence on Facebook. To allow the public to follow Board business more easily, the Board posts meeting agendas—including committee agendas—on the Web. The Board also provides notices, disciplinary reports and numerous other items via automated subscriptions, as well as on the Board’s website. Significantly, the Board now routinely includes non-Board member stakeholders on work groups and task forces to help shape Board policy. The Board has never been more transparent or engaging.
Yet despite all of the progress and emphasis on transparency, many licensees still believe that the Board is “out to get” licensees or use its disciplinary authority to unfairly bully and boss. For example, the Board recently fielded a public information request that wondered whether the Medical Board might take public action against African American licensees at a greater rate than white licensees.
Race, ethnicity and/or sex never enter into our deliberations, so we’d never reviewed the numbers in quite that way, but we were more than willing to take a look. Analysis of Board actions found that in 2011 about 11 percent of complaints made against African Americans resulted in public action, while 10 percent of complaints against whites resulted in public action. Our analysis, which included five years of data, found that those rates have been relatively constant over time. Based on these findings, we found no evidence of racial bias in Board decisions regarding public actions.
Most licensees will never be the subject of a Medical Board investigation, let alone receive disciplinary action, so it’s not surprising there are so many misconceptions about the disciplinary process. Put simply, I believe the Board has taken all reasonable measures to ensure that the review process is colorblind and resistant to most forms of bias. Very little identifying information is provided to Board members and staff who review cases. Each case summary is labeled with the licensee’s name, location (city, state), date of birth, date of licensure and specialty. Aside from what can be inferred from a licensee’s name, there is no opportunity for the reviewer to know the licensee’s race or ethnicity. In relatively rare situations, the licensee under investigation is a personal or professional acquaintance of a Board member (and therefore his or her race is known). In those situations, the ethical rules we follow require the Board member to decide whether he or she can remain objective while participating in discussions and decisions regarding that licensee. If not, the Board member must recuse him- or herself.
Some regulatory Boards have chosen to make the entire case review process blind. This is done by using case numbers to identify the licensee, not a name. However, a completely blind review system makes identifying potential conflicts of interest difficult and creates a huge administrative burden to redact medical records and other documents. In the absence of any evidence that using a licensee name results in unfair treatment, the NCMB has seen no reason to proceed with such a system.
So how does the Board decide when to pursue public action against a licensee? First of all, many issues that come before the Board do not rise to the level of public action. In fact, more than 60 percent of disciplinary cases opened by the Board in a given year are closed with no formal action. To determine if public action might be appropriate, each member of the Board and staff who takes part in the multistep case review process forms his or her best recommendation based on the evidence available. Patient statements, medical records, licensee statements, outside peer reviews and other investigative findings comprise the evidence. After all evidence is reviewed and any additional information is gathered to resolve questions that arise, the senior staff of the Board makes a recommendation to the Board’s Disciplinary Committee. The case is then completely and thoroughly reviewed by a Board member who serves on this committee and this Board member determines whether the case should be discussed by the entire committee or if the recommendation of the senior staff is acceptable. Any other member of the Disciplinary Committee may also put the case into discussion. The Committee then makes a recommendation to the entire Board. Additional discussion may occur at the full Board level and then a final Board action is taken to pursue, or not, a public action against the licensee.
I’m well aware that a public action embarrasses a licensee and may have other professional ramifications. Believe me, the Board derives no pleasure from taking these actions. Nonetheless, there are dozens of situations each year in which the Board determines that public action is necessary and appropriate to protect the public and preserve the integrity of the profession. Should the Board fail to meet these obligations, the profession may lose its privilege of self-regulation. Every Board member understands the grave responsibility we have to ensure both protection for the people of North Carolina and fairness to our licensees.
Human nature being what it is, there will always be skepticism about the Board’s motives and actions. Perhaps the presentation of additional details about the public outcomes of the Board’s disciplinary work will help illuminate the process. On the facing page, you’ll find a selection of statistics gleaned from an analysis of five years’ worth of Board actions data. Demographics do not relate to licensee behavior or performance, so we have no intention to use this information in any official capacity. For now, I hope you’ll think there’s some value in having the Board open yet another window into how it does business.
This infographic is a graphic representation of data collected by the Board, including demographic data for total physician and physician assistant population as of January 2013, and disciplinary data for physicians and PAs with public Board actions in the past five years (2007-2011). Keep in mind, about 3 percent of the active licensee population has one or more public actions.
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William A. Walker, MD
Facts about your new Board president
City: Charlotte, NC
Appointed: Nov. 1, 2007 | Term ends: Oct. 31, 2013
Specialty: Colon and Rectal Surgery
Certification: American Board of Colon & Rectal Surgery;
American Board of Surgery
Personal: Wife, Lynn; two adult children
