the future of medical licensure martin crane, m.d., chair massachusetts board of registration in...
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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
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
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
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
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