Articles
What moves the needle? Factors that influence NCMB decisions and policy
One thing I’ve learned in more than five years of service on the North Carolina Medical Board is that EVERYONE has an opinion—often a strong one—about the Board and how it goes about its work. Let’s face it, as the regulator of more than 40,000 physicians, physician assistants and other medical professionals, the NCMB holds their livelihoods in its hands and that isn’t something that endears the Board to the typical licensee. Many naturally prefer an arms-length relationship with the Board that involves little beyond their license. The less contact with the Medical Board the better, right?
Unfortunately, this approach often means that licensees remain in the dark about important aspects of the Board’s work, which can lead to wrong and even damaging assumptions. I’ve heard colleagues opine that the Board is unfair, overly aggressive, or that its handling of disciplinary matters does not always seem consistent. Sometimes, the individuals raising concerns do not have accurate or complete information. In this article, I want to pull back the curtain and give you a glimpse into how the Board approaches it disciplinary and policy work in hopes of clearing some misconceptions.
The primary influences on Board decisions are:
1. The Board’s makeup
2. Precedent
3. Licensee input
4. The law
First and foremost, it’s essential to understand that the Medical Board is not a static institution. Members are appointed by the Governor for a three-year term, with the possibility to “re-up” for a second consecutive term, or six years of total service. Moreover, Board Member terms are staggered so that the Board always has a mix of more experienced members and less experienced members. In other words the membership of the Board is constantly evolving, which of course influences the collective Board’s perspective—on disciplinary matters, on policy matters and on subtler points such as the appropriate role of the Medical Board’s staff. Simply put, different Board Members have different priorities and sensitivities. Matters that are of the utmost significance to one Board Member may be of less interest to others. This is one reason Board priorities shift over time, as Board leadership changes and as members come and go. If you don’t agree with the Board’s decisions and priorities, you might consider applying for a seat on the NCMB yourself. With physician members rotating on and off every few years, opportunities to serve arise with some frequency.
Conversely, the staff of the Medical Board is quite stable. Many staff members have served the Board for 10, 20 or, in a few instances, even 30 years. As such, the staff is an essential source of institutional memory and, in the context of disciplinary cases, the keepers of Board “precedent.” In evaluating and discussing disciplinary cases, Board Members often call upon members of the staff to summarize how similar matters have been handled in the past. Now, that doesn’t mean the Board always adheres to precedent, but it is an important starting point for many disciplinary matters. After considering precedent, the Board typically then considers both aggravating (harm caused to others, prior occurrences of similar behavior or prior disciplinary history) and mitigating (corrective action taken, no prior history of problems) factors before coming to a decision about how to resolve a particular case.
A third factor that influences decisions is various types of input from licensees. You are most likely aware that the Board routinely solicits feedback from licensees with regard to matters of policy. This feedback includes testimony and other input from the North Carolina Medical Society, the NC Academy of Physician Assistants and other professional groups, roundtable discussions that include representatives from stakeholder groups, and direct surveys of licensees such those conducted in connection with the recent policy changes pertaining to treating and prescribing to self or family.
Licensees who are the subject of Board investigations are also provided ample opportunity to tell “their side” of the story. When the Board investigates complaints from patients or others, licensees are contacted and asked to provide a detailed response (there are some exceptions — licensees are typically not required to respond to cases when the conduct alleged does not violate the Medical Practice Act, though they are notified of the complaint.) During the investigative process, licensees may be invited to the Board offices to participate in a confidential interview with members of the Board. Even when the Board votes to issue charges against a licensee, the licensee in question has the right to a conference with one or more members of the Board prior to the issuance of those charges. Each of these opportunities for contact between licensee and Board represent a chance for the licensee to defend his or her actions and conduct.
Finally, Board actions and decisions must stay within the framework set forth by our legislature. This can be fraught with conflict since the law is frequently open to interpretation. Grey zones abound, but the Board’s mission as prescribed by law remains clear—We stand for the benefit and protection of the people of North Carolina.
As our environment evolves, we must evolve as well — electronic medical records, telemedicine, distance learning, hospitalists, urgent care centers and concierge medicine all present unique challenges and questions. The Board is actively pondering some of these issues now. It is natural, when you are part of an institution such as the North Carolina Medical Board, to defend the status quo. I pledge to do my best not to fall into that trap. And with that pledge, I offer a challenge to you: To be an active part of your Medical Board. Send us your suggestions and together we will find solutions to our knottiest issues.
Facts about your new Board president
City: Greenville, NC
Appointed: Nov. 1, 2008 | Term ends: Oct. 31, 2014
Specialty: Otorhinolaryngology (ENT surgery)
Certification: American Board of Otolaryngology; American
Academy of Facial Plastic and Reconstructive Surgery
Personal: Married to Jill Camnitz, Dr Camnitz has two adult children, a daughter and a son.
Unfortunately, this approach often means that licensees remain in the dark about important aspects of the Board’s work, which can lead to wrong and even damaging assumptions. I’ve heard colleagues opine that the Board is unfair, overly aggressive, or that its handling of disciplinary matters does not always seem consistent. Sometimes, the individuals raising concerns do not have accurate or complete information. In this article, I want to pull back the curtain and give you a glimpse into how the Board approaches it disciplinary and policy work in hopes of clearing some misconceptions.
The primary influences on Board decisions are:
1. The Board’s makeup
2. Precedent
3. Licensee input
4. The law
First and foremost, it’s essential to understand that the Medical Board is not a static institution. Members are appointed by the Governor for a three-year term, with the possibility to “re-up” for a second consecutive term, or six years of total service. Moreover, Board Member terms are staggered so that the Board always has a mix of more experienced members and less experienced members. In other words the membership of the Board is constantly evolving, which of course influences the collective Board’s perspective—on disciplinary matters, on policy matters and on subtler points such as the appropriate role of the Medical Board’s staff. Simply put, different Board Members have different priorities and sensitivities. Matters that are of the utmost significance to one Board Member may be of less interest to others. This is one reason Board priorities shift over time, as Board leadership changes and as members come and go. If you don’t agree with the Board’s decisions and priorities, you might consider applying for a seat on the NCMB yourself. With physician members rotating on and off every few years, opportunities to serve arise with some frequency.
Conversely, the staff of the Medical Board is quite stable. Many staff members have served the Board for 10, 20 or, in a few instances, even 30 years. As such, the staff is an essential source of institutional memory and, in the context of disciplinary cases, the keepers of Board “precedent.” In evaluating and discussing disciplinary cases, Board Members often call upon members of the staff to summarize how similar matters have been handled in the past. Now, that doesn’t mean the Board always adheres to precedent, but it is an important starting point for many disciplinary matters. After considering precedent, the Board typically then considers both aggravating (harm caused to others, prior occurrences of similar behavior or prior disciplinary history) and mitigating (corrective action taken, no prior history of problems) factors before coming to a decision about how to resolve a particular case.
A third factor that influences decisions is various types of input from licensees. You are most likely aware that the Board routinely solicits feedback from licensees with regard to matters of policy. This feedback includes testimony and other input from the North Carolina Medical Society, the NC Academy of Physician Assistants and other professional groups, roundtable discussions that include representatives from stakeholder groups, and direct surveys of licensees such those conducted in connection with the recent policy changes pertaining to treating and prescribing to self or family.
Licensees who are the subject of Board investigations are also provided ample opportunity to tell “their side” of the story. When the Board investigates complaints from patients or others, licensees are contacted and asked to provide a detailed response (there are some exceptions — licensees are typically not required to respond to cases when the conduct alleged does not violate the Medical Practice Act, though they are notified of the complaint.) During the investigative process, licensees may be invited to the Board offices to participate in a confidential interview with members of the Board. Even when the Board votes to issue charges against a licensee, the licensee in question has the right to a conference with one or more members of the Board prior to the issuance of those charges. Each of these opportunities for contact between licensee and Board represent a chance for the licensee to defend his or her actions and conduct.
Finally, Board actions and decisions must stay within the framework set forth by our legislature. This can be fraught with conflict since the law is frequently open to interpretation. Grey zones abound, but the Board’s mission as prescribed by law remains clear—We stand for the benefit and protection of the people of North Carolina.
As our environment evolves, we must evolve as well — electronic medical records, telemedicine, distance learning, hospitalists, urgent care centers and concierge medicine all present unique challenges and questions. The Board is actively pondering some of these issues now. It is natural, when you are part of an institution such as the North Carolina Medical Board, to defend the status quo. I pledge to do my best not to fall into that trap. And with that pledge, I offer a challenge to you: To be an active part of your Medical Board. Send us your suggestions and together we will find solutions to our knottiest issues.
Facts about your new Board president
City: Greenville, NC
Appointed: Nov. 1, 2008 | Term ends: Oct. 31, 2014
Specialty: Otorhinolaryngology (ENT surgery)
Certification: American Board of Otolaryngology; American
Academy of Facial Plastic and Reconstructive Surgery
Personal: Married to Jill Camnitz, Dr Camnitz has two adult children, a daughter and a son.