In a world of 24/7 news coverage often highlighting high-verdict medical malpractice cases, few physicians know about thousands of complaints that undergo review by state medical boards each year. Most complaints are filed by patients and/or family members, malpractice payment reports by insurance companies, and actions by other state medical boards. In North Carolina, where I practice, nearly 3,000 complaints were filed in 2021, 1,835 of which were filed by patients or other members of the public. The number one reason for complaints from 2002-2012 was an alleged communication issue, followed by quality of care concern.
Medical board case review – who and how?
Many complaints are initially reviewed by staff members, but in North Carolina, about 150 cases per year are also referred to licensed physicians for review. Physicians with a license in good standing, no pending or past complaints, and training, qualifications, and expertise within a similar field of clinical practice as the physician named in the complaint can generally serve as expert reviewers. Case review comes with monetary compensation for the time needed to carefully and objectively review medical records pertinent to the case; North Carolina compensates at a rate of $175 per hour for review, and up to $300 per hour for deposition or trial testimony. Fewer than 5% of complaints proceed to court proceedings, and legal immunity is assured by state law.
Outcomes of medical board case reviews
Cases may be resolved with no action taken, private action taken, and/or public action taken. Transparency can help patients and their families feel more confident in medicine’s dedication to self-regulation through this process; medical licensure information is typically publicly available, accessible via web search. Most cases are resolved with no action taken. For example, in 2021 in North Carolina, only three complaints resulted in license revocation and only two in license denial.
An unexpected benefit of medical board case review is the opportunity to shine a bright light on physician health. In 2021, the North Carolina Medical Board “saw a more than threefold increase in public actions related to alcohol and substance use.” This suggests a dramatic effect of the COVID-19 pandemic on the health of physicians who personally bore a disproportionate burden caring for others during the height of the pandemic.
Physician, heal thyself
Medical board case review is a valuable opportunity to use critical thinking skills to learn from other cases and ultimately improve patient care. For physicians also looking to make additional income from home on a flexible schedule, this is an opportunity to get paid AND give back to the medical community. Many physicians considering expert witness work voice concerns over the ethics of testifying against another physician. The medical board case review process illustrates how vitally important objective case review is to the quality-control role of state medical boards, and no one knows standard of care like physicians working in the trenches, seeing patients firsthand and on the clinical frontlines.
I have been retained as an expert witness in nearly 200 medical malpractice cases and have found the work to be extremely intellectually rewarding. I love teaching other physicians how to put their skills to work reviewing cases, and also working with both plaintiff and defense attorneys to help them understand the clinical issues at hand in a variety of malpractice cases. I have also reviewed cases for the North Carolina Medical Board and have seen firsthand how the process serves physicians and patients. Case review has made me a better physician and helped me serve as a valuable resource to my medical colleagues and patients.
Public engagement in quality of care helps everyone. Physicians are uniquely suited to review medical board complaints, and it is appropriate to value the time spent providing this service with additional compensation. Our patients benefit from physicians willing to review cases, and so do our medical colleagues who can learn from reviews – whether supportive of their actions, or illustrative of areas needing improvement. Learning doesn’t stop after medical school and residency, and medical board case review is one way physicians can earn additional income that pays off in many ways for everyone.
Gretchen E. Green is a radiologist.