THE FUTURE OF MEDICAL

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.
 Organization of Agency

Physician Physician Physician Physician Physician Public Public

Board Board Board Board Board Board Board
Member Member Member Member Member Member Member

Consumer Executive
DPH
Affairs Director

Enforcement Division of Patient Safety Licensing Physician

Division Law & Policy Programs Division Profiles Unit

Consumer Protection General Counsel Patient Care Initial Licenses Public Information
Assessment
Investigation Physician Health Renewals Web Site
Clinical Skills
Litigation Data Repository Verifications Call Center
Analysis
Clinical Care Affiliation Agreements
Liability Reform
 PUBLIC INFORMATION
Virtually anything a consumer or a physician might
want to know is available on the Boards website:
WWW.MASSMEDBOARD.ORG
Board Actions
Licensing information
Physician Change of Address Online
Complaint Forms & Instructions
Patient Care Assessment Alerts
New Licensees
Publications
FAQs
THE FUTURE OF MEDICAL
LICENSURE
 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
 MORE COMPREHENSIVE
EVALUATION

ACGME Core Competencies

 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
 EMPHASIS ON PATIENT SAFETY

Individual Responsibility
vs
Systems/Process Failure
 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
0 1 2 3 1,2 1,3 2,3 Full

Outs 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
MEDICAL MALPRACTICE DATA
 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 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 PAYMENTS
1994-2003

Amount Paid by Year

Inflation-Adjusted
Sum of Sum of Payments
Year Payments Avg Payments Count CPI (2003 $s)
1994 64,198,880 251,760 255 1.2416 79,707,111
1995 87,063,300 306,561 284 1.2073 105,115,795
1996 86,921,938 306,063 284 1.1727 101,935,224
1997 94,773,530 354,957 267 1.1464 108,650,028
1998 91,670,954 334,566 274 1.1288 103,481,322
1999 118,181,047 384,955 307 1.1044 130,524,086
2000 125,398,843 379,996 330 1.0685 133,991,795
2001 129,095,469 388,842 332 1.0390 134,125,163
2002 119,188,893 446,400 267 1.0228 121,905,260
2003 118,960,482 431,016 276 1.0000 118,960,482
 TOTAL MALPRACTICE PAYMENTS
1993-2004
Inflation-Adjusted Total Amount Paid by Year: 1994-2003

$150,000,000.00
Amount (in 2003 $s)

$100,000,000.00

$50,000,000.00

$0.00
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Year
 TYPES OF OB/GYN PATIENT
COMPLAINTS
580 Patient Complaints on Record Communication Issues

72 Substandard Care

Office Staff/Policies
68

Billing

MISC.

281 Hospital Disc or

159 Complaint
Sexual/ Professional
Boundaries
Other Jurisdiction Disc.
NUMBER OF COMPLAINTS PER OB/GYN

65 1 Complaint
2 Complaints
3 Complaints
4 Complaints
5 Complaints
6 Complaints
7 Complaints
81 192 8 Complaints
10 Complaints
11 Complaints
 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
50 remain in active practice, of whom 9 have been
disciplined by the Board.
48 NO LONGER IN PRACTICE
8 Revoked 2 SOA issued, overturned
9 Disciplinary Resignation 1 Letter of Concern
2 Suspended
4 Formal Discipline
4 Deceased
5 Formal Retirement 13 Did Not Renew
(1 after Discipline)
 Recommendations

Better Communication of Performance/Quality Data

Clinical Skills Assessment & Enhancement

Comprehensive Training In Best Practices & New

Technologies

Targeted CME opportunities in Communication

 BOARD OF REGISTRATION IN MEDICINE
WEBSITE

HTTP://WWW.MASSMEDBOARD.ORG