THE FUTURE OF THE FUTURE OF MEDICAL LICENSUREMEDICAL 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.

PhysicianBoard

Member

PhysicianBoard

Member

ExecutiveDirector

EnforcementDivision

Division ofLaw & Policy

ConsumerAffairs

PhysicianBoard

Member

PhysicianBoard

Member

PhysicianBoard

Member

Public Board

Member

Public Board

Member

LicensingDivision

PhysicianProfiles Unit

Organization of Agency

Patient Safety Programs

Consumer Protection

Investigation

Litigation

Clinical Care

General Counsel

Physician Health

Data Repository

Initial Licenses

Renewals

Verifications

Affiliation Agreements

Public Information

Web Site

Call Center

Patient Care Assessment

Clinical Skills Analysis

Liability Reform

DPH

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 Responsibilityvs

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 Expected Runs By Situation

Bases Occupied

Outs

  0 1 2 3 1,2 1,3 2,3 Full

0 .46 .81 1.19 1.39 1.47 1.94 1.96 2.22

1 .24 .50 .67 .98 .94 1.12 1.56 1.64

2 .10 .22 .30 .36 .40 .53 .69 .82

*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 PAYMENTSSIZE 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 TOTAL MALPRACTICE PAYMENTSPAYMENTS

1994-20031994-2003Amount Paid by Year

Inflation-Adjusted

YearSum of

Payments Avg Payments Count CPISum of Payments

(2003 $s)1994 64,198,880 251,760 255 1.2416 79,707,1111995 87,063,300 306,561 284 1.2073 105,115,7951996 86,921,938 306,063 284 1.1727 101,935,2241997 94,773,530 354,957 267 1.1464 108,650,0281998 91,670,954 334,566 274 1.1288 103,481,3221999 118,181,047 384,955 307 1.1044 130,524,0862000 125,398,843 379,996 330 1.0685 133,991,7952001 129,095,469 388,842 332 1.0390 134,125,1632002 119,188,893 446,400 267 1.0228 121,905,2602003 118,960,482 431,016 276 1.0000 118,960,482

Inflation-Adjusted Total Amount Paid by Year: 1994-2003

$0.00

$50,000,000.00

$100,000,000.00

$150,000,000.00

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Year

Am

ount

(in

2003

$s)

TOTAL MALPRACTICE PAYMENTS 1993-2004

580 Patient Complaints on Record Communication Issues

Substandard Care

Office Staff/Policies

Billing

MISC.

Hospital Disc orComplaint

Sexual/ Professional Boundaries

Other Jurisdiction Disc.

Criminal

TYPES OF OB/GYN PATIENT COMPLAINTS

281

159

68

72

NUMBER OF COMPLAINTS PER OB/GYN

1 Complaint

2 Complaints

3 Complaints

4 Complaints

5 Complaints

6 Complaints

7 Complaints

8 Complaints

10 Complaints

11 Complaints

19281

65

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

48 NO LONGER IN PRACTICE

50 remain in active practice, of whom 9 have been disciplined by the Board.

8 Revoked

2 Suspended

9 Disciplinary Resignation

5 Formal Retirement(1 after Discipline)

4 Deceased

2 SOA issued, overturned1 Letter of Concern

4 Formal 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