Revealing Medical Licensure and Discipline Information on the Web

The headline at Public Citizen's Web site offers a degree of titillation that was once available only from postcards peddled in a parking lot. It proclaims in bold red letters, "20,125 Questionable Doctors." In smaller type, it qualifies this claim with a quick appeal to authority: "Disciplined by State and Federal Governments."

Another headline offers "National CD-Rom Now Available." Scrolling down, a visitor to the site finds the promise of forbidden fruit:

Information in the federal repository of disciplinary actions by state boards and federal agencies -- the National Practitioner Data Bank -- is kept secret from patients and almost all physicians. It is partially in response to this congressionally mandated secrecy that Health Research Group has established our own publicly-available data bank of doctors who have been disciplined."

Public Citizen's Web site is not the only one offering information about physicians today (Table). A broad range of data providers, from individual state licensing boards to private companies, will give -- or sell -- information about medical school, residency, specialty certification and years of practice.

Forty-one states now post some information on the Internet about disciplinary actions against physicians. In addition, the Federation of State Medical Boards (FSMB) offers a search service (DocInfo) through its Web site. Consumers can obtain disciplinary information from state records through the FSMB for a fee of $9.95, payable over the Internet by credit card.

Despite -- or perhaps because of -- a last-minute change in state law that barred the posting of disciplinary records, the Virginia Board of Medicine Practitioner Information Web site received 16,000 hits in its first 36 hours of operation, according to a health department official quoted in The Washington Post. Those records are available on request from the state board of medicine.

"We're projecting 3 million hits this year, which is unbelievable," said Claudette A. Houle, spokesperson for the Massachusetts Board of Registration in Medicine, which was the first state medical licensing agency to post disciplinary files on the Web. She told Psychiatric Times, "We're getting national and international interest."

HealthGrades, a private data service that provides ratings on nursing homes, hospitals and hospices, as well as basic information on physicians, dentists and other providers, gets about 100,000 visitors a month to its site, according to Sarah Loughran, senior vice president of HealthGrades Inc.

Paying customers (employers and online health information providers) can obtain information about physicians, including disciplinary actions by state regulators and Medicare, as well as a profile that includes medical school, specialty board certification and a ranking of the hospital with which a given doctor is affiliated, Loughran told PT. On its public site, HealthGrades provides free basic information about physicians, including driving maps and office hours for each location if the physician works in more than one.

Public Citizen provides no free information on its site. It draws its data on physicians from publicly available records from various state medical boards and uses the site to promote its $400 book (or $20 apiece for regional reports) containing summary information about the 20,125 "questionable" doctors. A CD-ROM version sells for $600. It is based on disciplinary actions taken between 1990 and 1999. According to a press release from Public Citizen on Aug. 8, 2000, "It is likely that [the physicians named in the book] are still practicing." However, Peter Lurie, M.D., M.P.H., co-author of the study Public Citizen conducted that surveyed doctor disciplinary information on state medical board Web sites, admitted in an interview with PT that the organization has not attempted to verify whether or not all of the doctors are still in practice.

"There is no question that among those 20,000 people there are some who are not in practice. We don't have the ability to go back and one-by-one go through all 20,000," commented Lurie, who is also deputy director of Public Citizen's health research group. Lurie also said the Public Citizen data do not include information on malpractice suits or settlements.

Consumer interest in quality of care issues has spurred greater demand for information about physicians, but leaders of the medical profession have voiced strong concerns about the type of information being provided.

"Even before the state board put up its Web site, we voiced concerns about the information that is being made available about physicians," Sandra Bressler, director of professional standards and quality of care for the California Medical Association (CMA), told PT. "Some years ago, we sued the medical board about the release of information on physicians when they proposed to release pre-accusation notices about investigations they were conducting." The case was eventually settled, with the California regulators agreeing not to publish the information, but Bressler said that new complaints have arisen with the advent of the Web site.

"The California Medical Board's Web site is peculiar. When they file an accusation and then negotiate a settlement, [in which] one condition is that they withdraw the accusation, they still post the word Enforcement on the Web site in a column called 'Secondary License Status Code.'"

"We have proof that it has jeopardized at least one physician's income," Bressler continued. "A member was accused of gross negligence with respect to an orthopedic procedure. The board said that if he took a competency examination and passed, they'd withdraw the accusation. But they left the word Enforcement on the Web site. The physician was in the job market at the time, and a friend told him confidentially that he was not going to be hired for one position because of that 'blot' on his record."

Bressler said the CMA is not opposed to releasing information about physicians but believes it needs to be done carefully. "We have always said that it was appropriate to inform the public if a physician was disciplined. While many physicians don't like it, we have agreed that the board can let the public know when they've filed a formal document, such as an accusation, as long as it is clear that the charges are not proven. But if physicians have an accusation on file, many health plans refuse to allow them to take on additional patients. So, it is very significant when all that's out there is an allegation and no proof," Bressler explained.

California's site provides basic information -- e.g., license number, address, medical school, years in practice -- about physicians. In addition, there are 98 "status codes" ranging from "Canceled" and "Deceased" to "Denied," "Probation," "Accusation" and "Accus w/drawn." No explanation is offered as to why the codes were applied; however, consumers can contact the medical board directly for this information.

Of greatest concern to most physicians is whether or not information about malpractice suits and settlements will be posted. Last year, the American Medical Association led the charge against proposals in the U.S. Congress that would have opened the National Practitioner Data Bank, maintained by the U.S. Department of Health and Human Services, to the public -- a move advocated by Public Citizen and some consumer groups and opposed by the health care industry.

The AMA testified before Congress that malpractice settlements often reflected business judgments rather than medical issues. They cited a study that showed that only one malpractice case in five involved questions of negligence, and they also argued that malpractice lawsuits are not a good indicator of quality. The legislation died and the sponsor is no longer in Congress.

Dale L. Austin, interim chief executive officer of the FSMB, told PT that his organization has no official position on opening the National Practitioner Data Bank to the public, but "we know some of the challenges of extracting the data. The way it was set up in the first place was to provide information on both public actions relative to quality of care, plus malpractice cases, plus hospital actions, and to share that information among hospitals and regulatory agencies. It would be difficult to retrofit that to make it available to the public."

But information about malpractice cases remains at the crux of many people's concerns about posting data on public Web sites. In Massachusetts, the legislature worked with the medical establishment to create a rule that would be fair to doctors while providing guidance for consumers.

"In 1996, toward the end of the legislative session, we were told that the legislature was going to pass a profiling bill," recalled Francis X. Rockett, M.D., president of the Massachusetts Medical Society, in an interview with PT. "So, we began to work with the people involved to introduce a bill that allowed this information to appear on the Web site, but it was very careful that it didn't record every time a physician was sued. It allows them to post information about suits, but only closed cases. There can be no statement as to how much money a suit was settled for, if there was a settlement. They can only say that the settlement was average, above average or below average."

In addition, a disclaimer accompanies the information noting the number and frequency of lawsuits against other physicians in this specialty.

"When this first was proposed, the rank and file members initially were very opposed to it," Rockett continued. "They called it an invasion of their privacy and complained that we were the only group of professionals having this done to them and that the state should do the same sort of thing for lawyers. I think the rancor and the fuming and fussing have subsided. We've found out that most people who use the site are looking for what insurance plans a physician [accepts]."

The Massachusetts Web site often is cited as a model for the rest of the country, but it offers some protections for physicians that are not always found in other sites. According to Board of Registration's Houle, information about a physician is removed from the Web site after 10 years. "It's still archived and available, if anyone wants it," she said.

The FSMB appointed a Special Committee on Physician Profiling before developing its Web site. Earlier this year, a special committee of the FSMB issued its report and guidelines for medical information sites (Journal of Medical Licensure and Discipline 2001;87[2]:53-68), which includes the following recommendations:

1. The number of medical malpractice court judgments and arbitration awards against the physician within the last 10 years. This is a numeric field showing the total number of such actions in the designated time period.

2. The number of malpractice settlements when that number is equal to or exceeds three in the past 10 years. This is a numeric field. The field will be blank or contain a number greater than two.

3. Dollar amounts of awards, judgments and settlements should not be included for malpractice suits.

In addition, the committee urged that a disclaimer be added to the information explaining that malpractice judgments and settlements do not reflect quality of care.

Providing information on public Web sites is not cheap. Rockett said Massachusetts is contemplating an increase in licensing fees. "We suggested if they just spent their time and effort and money on things the board should be doing, like tracking down some of the reports and weeding out some of the physicians who should not be in practice, the money would be better spent."