State boards that license doctors face major problems in acting against incompetent physicians and evaluating foreign medical school graduates' training, the government reported yesterday.
The inspector general's office of the Department of Health and Human Services reported that, although the state boards have tightened licensing requirements and increased disciplinary actions against doctors, they need greater financial and legislative support to ensure that medical practitioners are competent and ethical.
"They were understaffed, they had huge backlogs, they simply weren't able to handle in timely fashion the cases they had," said Don Nicholson, HHS assistant inspector general.
The report also found that consumers and law enforcement agencies are the source of most complaints leading to discipline of incompetent physicians. "We'd like to sensitize the medical profession . . . to make referrals to the state licensing boards" when doctors are unfit to practice, he said.
Disciplinary actions by state medical boards increased 45 percent, from 953 to 1,381, between 1982 and 1984. However, most such actions were reprimands, censures or voluntary agreements between board and doctor, rather than more serious penalties such as license revocation, the report said.
Inappropriate writing of prescriptions was by far the most common violation, representing 50 percent of all disciplinary actions, Nicholson said. Such offenses included overprescribing to patients and unlawful distribution of drugs to addicts.
Drug or alcohol abuse by doctors was the second most common, representing 25 percent, he said. Most abuse cases involved drugs, possibly reflecting the role of drug enforcement agencies as a source of complaints, he said.
Boards took "strikingly few" disciplinary actions against incompetent doctors, the report found, despite an increase in public concern and malpractice suits. Reasons cited include the legal complexity and cost of such cases and the difficulty of proving incompetence, especially given varying standards of practice among doctors.
States are preoccupied with evaluating graduates of foreign medical schools, which has become "the major policy concern of most boards," the report found. All states have adopted the same new licensing examination for these individuals, and most have increased training requirements and improved efforts to verify credentials.
However, the report found that states cannot assess the education provided by foreign schools and that many U.S. hospitals fail to screen foreign-educated applicants adequately for residencies. As many as 19,000 U.S. citizens are studying medicine outside the country, and the majority of foreign-educated doctors training in U.S. hospitals were born in the United States.
The report recommended that HHS establish an accreditation system for foreign schools and limit government aid to foreign graduates.
It said that states should require a "training license" for medical residency and that hospitals and Peer Review Organizations should be required to inform state boards of poor performance.
Dr. Bryant Galusha, executive vice president of the Federation of State Medical Boards, said that 24 states have laws requiring doctors to report colleagues' incompetence, that 37 require hospitals to do so and that the federation has a central data bank on doctors disciplined by state boards.