title: Report on a flawed "report card": the public citizens ranking of medical licensing boards.
abstract: Any global ranking of states with respect to the health and safety of its citizens using specific, singular scales is fraught with difficulty and all such efforts should be interpreted with caution. It becomes even more problematic when one attempts to link physician discipline rates directly to either quality of care or injury and deaths of patients, as the Health Resource Group alleges. Any bona fide ranking of states with respect to health care or patient safety overall, whatever its source or its attempted correlations, would require a very complex, sophisticated equation with multiple, defined, distinct, quantifiable variables. The HRG report does not meet that high threshold. First, its report ranks states from best to worst using FSMB physician discipline action data despite the FSMB disclaimer that none of its numbers should be used to compare one state to another. Second, HRG sets up its own selective criteria for "seriousness" of discipline, and in so doing specifically excludes the category C disciplines, which Wisconsin uses often and responsibly in protecting the public and disciplining physicians. This arbitrary exclusion puts Wisconsin into an unwarranted "worst" state category. Third, HRG then links its worst states to practices that "injure or kill patients." However when one attempts to verify such allegations by comparing HRG rankings to specific quality-of-care rankings, using such measurements as Medicare data or Hospital HealthGrade data, such a sweeping allegation is unsupported. Finally, HRG's conclusion that "more is better" with respect to physician discipline rates needs to be examined and weighed very carefully. It may be, in fact, that in those states with lower rates of physician discipline ("worse" states by HRG standards) there are fewer complaints filed per capita in the first place, which would point toward a "better" level of practice in those states. Or it may be that a lower ("worse") record of disciplines is due to "better," more stringent screening of physicians in the initial licensing process, thus keeping out the problem physicians in the first place. Or those states with lower discipline rates may have more alternative programs and resources such as a voluntary impaired professional program, which has stringent monitoring but does not require formal discipline. HRG's ranking of Wisconsin as 49th in physician discipline rates is flawed in process and in fact. The accusation that such a low rating results in danger to patients or "not practicing medicine in the best manner" is an unsupported one. Comparison of the HRG ranking system with two other measures of quality of care--the Medicare Beneficiaries Quality of Care Study and the HealthGrades Hospital Quality in America Study--shows little consistency between those rankings and the HRG study. Overall, the Wisconsin Medical Examining Board continues to carry out its important mission of patient safety and physician licensing and discipline in a very responsible and accountable fashion, and a closer analysis of the Health Research Group report, which suggests otherwise, demonstrates it to be a flawed "report card".
authors.forename: Darold A
authors.initials: DA
authors.lastname: Treffert
authors.forename: Sidney E
authors.initials: SE
authors.lastname: Johnson
mesh_terms: D006801:Humans; D008007:Licensure, Medical; D010815:Physician Impairment; D028743:Professional Misconduct; D011639:Public Opinion; D011785:Quality Assurance, Health Care; D012926:Social Control, Formal; D014481:United States; D014922:Wisconsin