Disciplining Physicians: Factors that Influence Severity of Punishment by a State Board: An Investigation fo the Texas State Board of Medical Examiners, 1989-1998

Physician conduct and competence is increasingly debated in today’s health care environment, an environment that is influenced by managed care, medical malpractice, and a more informed consumer population demanding a higher quality of medical care. Revocation of physician licenses has increased, and it has been noted that physicians older than 40 years received more disciplinary actions that their younger counterparts. Studies of disciplined physicians have been done in California, Rhode Island, Ohio, and New York. Additional studies have also been done investigating inappropriate prescribing practices and sex-related offenses committed by physicians. None of these studies identified risk factors that influenced the severity of punishment given by a state board. Additionally, data concerning osteopathic physicians was scant and not included. An important issue regarding physician conduct and competence is the comparability between osteopathic (DO) and allopathic (MD) physicians. Moreover, it is also important to know which, if any, factors influence the decision for a severe punishment (such as revocation or suspension of a license). In Texas, both DOs and MDs are licensed to practice medicine and, when warranted, disciplined by the Texas State Board of Medical Examiners (TSBME). The TSBME is the agency authorized to license and discipline physicians and other health care professionals as mandated by the Medical Practice Act. The current TSBME is composed of 9 MDs, 3 Dos, and 3 public representatives and all members are appointed by the governor for 6-year terms. Data obtained from the TSBME shows for each year from 1989 to 1998, Dos were more likely to be disciplined than MDs (figure 1). Whether or not this represents a truly great risk for Dos to be disciplined by the TSBME is unknown. Therefore, it is important to know whether the same standard of care is applied to Dos and MDs and given a compromise of that standard, whether Dos and MDs are treated equally and fairly. The purpose of this study is to determine which factors, including the type of degree a physician holds, influenced the severity of punishment given to physicians by the TSBME from 1989-1998.