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University of Iowa News Release

Nov. 29, 2004

UI Health Law Center Looks To Improve Physician Quality

A national effort to help state boards of medical examiners better discipline incompetent physicians is under way, led in part by the National Health Law and Policy Resource Center at the University of Iowa College of Law.

"We need a better understanding of the factors associated with the success or shortcomings of the medical board discipline process so that boards can play a stronger role in assuring the quality of health care," said Josephine Gittler, a UI law professor and director of the National Health Law and Policy Resource Center. She said the project is studying the operations of medical discipline boards in seven states, including Iowa, and will issue a report of best practices for other state boards to consider.

The study is funded by the U.S. Department of Health and Human Services, which hopes to reduce health care costs in part by limiting medical malpractice lawsuits. As part of its fact-finding, HHS is funding projects to assess alternatives to lawsuits in resolving problems associated with medical errors, among them a more aggressive policing of incompetent physicians most likely to make mistakes that lead to lawsuits. Recent studies have shown that between 44,000 and 98,000 people die each year in the United States as a result of medical errors.

Gittler expects the study will be completed next June.

Historically, doctors rarely have had their licenses revoked because they are bad doctors, said Randall Bovbjerg a senior advisor to the National Health Law and Policy Resource Center and a researcher at the Urban Institute in Washington, D.C. Most sanctions leveled against doctors are for reasons such as substance abuse or criminal conduct.

According to Bovbjerg, the research so far has shown a variety of factors working against disciplinary boards, primarily that they operate with small staffs and small budgets so that they struggle to cope with the tens of thousands of complaints most state boards receive each year. To revoke an incompetent doctor's license can take months or years and cost a great deal of money, Bovbjerg said, especially if the case goes to a full hearing before the board of examiners.

"The underlying model is that state boards should find the bad apples and get them out of the system," he said. "Theoretically, this is a deterrence to doctors, but little evidence demonstrates it deters anything."

In addition, Bovberg said the health care industry is all too often unwilling to cooperate with state boards, and hospitals that cooperate may find it difficult to recruit health care professionals.

All of this, Bovbjerg said, makes it difficult for health boards to effectively discipline doctors and protect the public from bad physicians.

"As it's set up, the process is trying to achieve the unachievable," Gittler said. Finding a new way to set up the process, she said, is the ultimate goal of the study.

Dr. Susan Johnson, a professor in the Carver College of Medicine at UI and a member of the Iowa Board of Medical Examiners, expects that state boards will look forward to the report.

"There's very little research in this area, so I think most boards will welcome the center's findings," Johnson said. "We share the same concerns about ensuring the quality of physicians and maintaining the highest levels of public safety and public confidence in our health care system."

STORY SOURCE: University of Iowa News Service, 300 Plaza Centre One, Suite 371, Iowa City, Iowa 52242-2500.

MEDIA CONTACT: Tom Snee, 319-384-0010,