At least 49 doctors whose licenses have been revoked, suspended or restricted are working for the Veterans Administration, according to an American Medical Association screening of the medical licenses held by 17,000 full- and part-time VA doctors.
The AMA review, which began last month, has so far examined least than one-fifth of the records of all doctors affiliated with the VA. The credentials of another 77,000 doctors who do work with the VA have yet to be checked, and it is expected that many more doctors with revoked or suspended licenses will be found among them.
The VA is the nation's largest health-care system, employing about 94,000 doctors. The VA review, when finished, will have covered approximately one-fifth of the nation's 527,900 active doctors.
All but a few of the 49 doctors to be singled out so far have licenses that have been suspended or revoked. The doctors are still practicing medicine while an audit team in the VA inspector general's office checks the findings.
Dr. Paul Schafer, executive director of the National Association of Veterans Administration Physicians, said, "If the 49 all check out to have problems, I have no doubt what's going to happen to them. They'll be fired for falsely representing a clean record on their employment document."
The VA does not report the names of doctors disciplined by the VA or disciplined outside the VA to state boards of health or the AMA. But it is reviewing that policy.
The information has not been shared previously because "we've had legal concerns under our internal privacy act whether we could do this," said Dr. Arthur Lewis, acting deputy director of the VA Office of Operations.
"We are now aware there are some problems" with some doctors' credentials, said Lewis, who is heading a newly formed credentials committee that will determine the fate of the VA doctors.
The screening is an example of the attention being focused on medical discipline because of recent publicity regarding the sale of medical degrees and doctors with impairments who are not caught by the disciplinary system.
The VA is the latest federal agency to request that its doctors' names be checked against disciplinary files kept by the AMA and the Federation of State Medical Boards. The medical groups are completing similar reviews for the Air Force, Army and Navy.
Dr. Arthur Osteen, director of the AMA's Department of Physician Credentials and Qualifications, reported that the AMA's May tally of 29 military doctors was in error, as it actually found 30 active-duty officers with revoked or suspended licenses. "There are 15 from the Navy, seven from the Air Force and eight from the Army," Osteen said.
An AMA spokeswoman added that the screening found 32 Navy Reserve doctors with similar problems. The Army and Air Force did not supply the names of reserve doctors.
None of the services would release details regarding the suspect doctors.
The only information offered was from Air Force officials, who checked the records of five doctors identified by the AMA and said two had left the Air Force in recent months, one is practicing with full privileges, another has limited privileges and its Office of Special Investigation is conducting an inquiry on a doctor whose privileges have been suspended.
Several other federal agencies, including the Public Health Service, are discussing similar credentials checks for their doctors with the AMA and the federation, according to spokesmen for both organizations.
In an effort to stop one newly discovered fraud, the AMA recently compiled a list of deceased doctors so state boards can check if any of its license-holders have assumed the name and background of a former physician.
"It's happened several times," the AMA's Osteen said of the imposters. "Someone who knows a doctor has died gets his hands on the credentials and moves to another locality."
In addition to screening the regular, salaried doctors at the Veterans Administration, the medical groups are checking 23,000 doctors who work sporadically in VA hospitals and clinics, 43,000 private doctors who submit vouchers to the VA for care given to veterans and 11,000 doctors in residency training.
Osteen said the review found 42 of the VA's approximately 6,000 full-time doctors and seven of the 11,000 part-time doctors employed in 1983 and 1984 have license problems.
The screening is needed, Lewis said, because a number of VA doctors were found earlier this year who have improper credentials or who failed to reveal they were disciplined by state boards.
"We're starting to do better background checks," Lewis said. "Before we just asked for references. Now we're going to track with each hospital where they worked."
VA failure to report the names of disciplined doctors has long been considered a weak link in the disciplinary chain, according to Dr. Bryant Galusha, director of the Federation of State Medical Boards. "The bad doctors leave the government and just set up shop in the states," he said during a recent meeting of the boards. "We've been trying to get the VA to report for years."
The federation, which shares its discipline information with the AMA, has records on 13,000 doctors with licensing problems. But both groups agree the records are far from complete. Some states do not report and others have a history of agreeing not to report a problem doctor to others if he will surrender his license and leave the state.