State Medical Boards' Difficult Balance: Patient Safety vs. Provider Safeguards

  • Journal of Medical Regulation
  • August 2026,
  • 112
  • (2)
  • 36-50;
  • DOI: https://doi.org/10.30770/2572-1852-112.2.36

ABSTRACT:

Background State Medical Boards are public entities authorized to issue licenses to qualified physicians to practice. They are also authorized to investigate complaints, to press charges and to sanction licensees. Applications for licensing, privileging, or credentialing (at the state/facility/insurance level) often include questions about complaints and investigations, purportedly to assess moral character and fitness to practice.

Materials and Methods Primary license applications for MD/DO candidates from 50 US states, two US territories, and the District of Columbia from 2021/22 and 2023 were reviewed for questions relating to complaints, investigations, and discipline. States and territories were categorized into three tiers of professional and moral character questions based on number and quality of such questions. Nine representative state databases (three states from each tier) were then queried for their total number of complaints, investigations, and final adverse disciplinary actions/sanctions. Two years of data were queried for each of these nine states. The number of sanctions was then compared to the number of physician complaints and investigations. The three groups of states were then compared to each other to assess if harm reduction was proportional to number and depth of moral character questions.

Results Ten state medical boards inquired about any complaint ever lodged against the physician, while 27 state medical boards asked about current investigations. One medical board inquired about complaints or investigations over the past five years, 31 medical boards inquired about any investigation during clinical practice, and 26 medical boards queried investigations during training (school/residency/fellowship).

Sixteen medical boards asked about charges stemming from investigations; 42 medical boards asked about discipline/sanctions and two medical boards refused to consider a physician application if they are under investigation in another state. Three medical boards asked no questions about charges, or investigations.

Across all states and territories, 4% of complaints resulted in discipline/sanctions, impacting 0.28% of the physician population, regardless of the depth of moral character (number/type) application questions.

Conclusions This data confirms that questions about complaints and investigations are unlikely to identify physicians with moral or quality issues and may cause professional and personal harm to applicants and licensees. Such a low rate of final disciplinary actions raises concerns about the justification of medical board inquiries about unadjudicated allegations, complaints, and investigations, per se, instead of limiting queries to actual sanctions/discipline applied. While final disciplines/sanctions should continue to be disclosed, consistent with the Federation of State Medical Boards and National Practitioner Data Bank guidelines, questions regarding complaints and investigations should undergo critical review and be removed from these applications (primary and renewal), as there was no correlation with patient safety and may be illegal. Additionally, universal codification of terms should be applied to maintain fair and legal disclosures.

Keywords:

Introduction

Professional licensing bodies in medicine, law, dentistry, and other regulated professions are obligated to protect the public from professionals who are impaired, 1 defined as: "the inability to practice with reasonable skill and safety because of physical or mental illness..." 2

Licensing laws were developed with the purpose of protecting public health and safety by "creating barriers to employment—through testing, training, and fees—in professions determined to be sufficiently dangerous." 3 According to the 2025 US Bureau of Labor Statistics, licensing is required for 25% of the US workforce, with approximately 71.3% of jobs in healthcare, and more than 62.2% of jobs in the legal profession. 4 To this end, "a professional who has obtained a license has presumptively met the requisite level of competency and qualification, and once the state has granted a professional license, the licensee has a due process protected property interest" in their license. 5

State medical boards (SMBs) are agencies of the state, and state and federal hospitals, and regional medical facilities are licensed and funded (in part) by the government. Physicians (via their licenses) are authorized to practice by these entities and are protected both by the 1974 US Privacy Act and Constitutional due process. 6,7

Preliminary complaints against a licensee can be lodged at no cost, by patients, hospitals, employers, and colleagues. Sixty-three percent to 90% of complaints stem from patients. While complaints may have a legitimate basis, many lack medical accuracy, can be emotionally motivated, or are lodged as a preliminary evaluation to a medical malpractice lawsuit. 8,9 Complaints can also originate from within organizations or by competing providers as medicine becomes more administrative and corporatized. Over 80% of complaints and investigations are dismissed after initial review. 10

Over the years, many SMBs and privileging/credentialing facilities have begun to require physician applicants to answer more numerous and wider breadth of questions beyond that of settled malpractice suits, adverse disciplinary actions, or sanctions, conceivably to assess moral character and fitness to practice. Some states' application questions probe deeply into prior complaints, investigations, or charges, including dismissed and exonerated cases, requiring in-depth written disclosures often protected by peer review, from professional societies, or about the applicants' physical and mental health. Some states and the Interstate Medical Licensure Compact deny expedited and reciprocity licenses/privileges or simply refuse to review any application while an investigation is ongoing. Failing to report a complaint or investigation on an application can result in charges of falsification of documents, omission, and misrepresentation, which can fall under the auspice of unprofessional conduct, leading to further consequences. 11

Complaints which undergo 'preliminary' investigation are often misunderstood by physicians as unofficial and off the record, 12 but if such an investigation occurs concurrent with a change or lapse in employment, or a change in medical malpractice insurance, 13 the investigation must be reported to the National Practitioner Data Base. Many states publish or place on file unadjudicated SMB complaints/investigations even if charges are never filed or the complaint is dismissed. This publication becomes a de facto physician sanction affecting both reputation and job opportunities. 14,15

The Privacy Act of 1974 was intended to promote transparency and accountability in federal record-keeping, and to protect citizens from unwarranted government surveillance, reinforcing privacy rights. This law spawned the Health Insurance Portability and Accountability Act (HIPAA). All facilities and agencies that operate under federal executive branch contracts or grants, such as Medicare, must comply with this law, but SMBs are exempt under state jurisdiction, and many states make physician complaints and discipline records public. California, New York, Texas, and Iowa have enacted their own sets of privacy and public records laws whereas. Pennsylvania specifically has enacted non-disclosure around investigations. 16

In 2021, the Iowa State Supreme Court ruled that complaint and investigative information collected by their SMB must remain confidential until and unless a final written decision is issued, according to their state law. The Court required confidentiality because the release of unproven allegations could unjustly damage a professional's reputation and livelihood—establishing the Iowa state precedent that only final disciplinary action/sanctions can be reported and published. At the national level, both the Federation of State Medical Boards (FSMB) and National Practitioner Data Bank (NPDB) only publish final disciplinary action/sanctions and do not publish complaints or charges prior to disciplinary action or sanction. 26

This manuscript investigates the broad variability of state medical licensing applications, computes the likelihood of disciplinary action from such complaints, and details the outcomes of the moral character questions proportional to sanctions. Suggestions are offered for policy improvements.

Materials and Methods

MD/DO primary initial license applications were obtained from every US SMB, the District of Columbia (DC), and two US territories, as well as the FSMB Uniform Application for the year 2022. Mental health, moral character, and fitness attestation questions were recorded, codified and assigned point values for each query type. Data was further organized by questions about past "charges" and "discipline/findings" (present/absent), compliance with ADA and mental health/HIPPA protections (yes/no), refusal to grant licenses while an applicant is under active investigation (yes/no), and consistency with FSMB guidelines (yes/no; Table 1). Non-disciplinary/informal actions such as re-entry requirements are not included for review. Each state's assigned points were then summed for a total 'depth' of questioning score. States were then categorized into low, medium, and high 'depth of questioning' groups. Scoring explanations are detailed in Appendix A at the end of this article.

View this table:
Table 1.

State Medical Boards

View this table:
Table 2.

Selected States Review

View this table:
References for Table 2.

References for Table 2

FSMB national data was reviewed for the most recent available statistics on disciplinary actions against licensees for the most recent available year data, 2023. 17 The number of total registered physicians in each state was recorded from the American Association of Medical Colleges (AAMC) website or the relevant SMB website. 18

Three states were then identified from each of three tiers of questioning. Specific states were chosen based on their degree of difficulty in their licensing questions, availability of public information about applicants, and the states "Open Records Act," "Right to Know Act," or "Freedom of Information Act." The number of complaints registered, investigations performed, and adverse discipline/sanctions applied were reviewed from Florida, 19 Michigan, 20 and Pennsylvania 21 for the lower depth category. Data from New York, 22 Oregon, 23 and Washington 24 comprised the medium depth category, and data from California 25 , Nevada, 26 and Iowa, 27 comprised the high depth category (Table 2).

Data was abstracted from two separate years for each of these nine states based on publicly available reports for the fiscal year 2020/2021, or 2021/2022, and subsequently 2022/2023.

The Kruskal Wallis H test from scripy stats in Python was used to compare: 1) the number of complaints lodged and disciplinary actions against physicians, and 2) the number of investigations launched and disciplinary actions against physicians—between each group of states and between different years to determine if the number and depth of moral character complaint/investigation questions effectively yielded more sanctions (ie: identified the more dangerous (sanctioned) physicians). Significance was set at a p value of < 0.05 with a 95% CI.

Results

All but nine SMBs asked applicants about charges stemming from investigations or discipline/sanctions. Three SMBs (MI, NY, PA) asked no question about past or current complaints or investigations, while two SMBs refused to consider a licensee's application while under investigation (CA, CT). Twenty-seven SMBs asked whether applicants were under current investigation (Table 1). Of 35 SMBs asking about past investigations, 18 asked questions about current and past investigations exclusive of residency training, and seven SMBs asked about current and past investigations inclusive of residency training. On average, 2.71 (range 2-9) additional questions followed if an investigation or complaint was reported by the applicant. Nine SMBs (FL, MD, MI, MS, OH, PA, SC, WY, DC) proffered a low depth application from which MI, PA, and PA were chosen. Twenty-nine SMBs employed a moderate depth query, from which NY, OR, and WA were selected. Fifteen SMBs employed a high depth application (AL, AK, CA, CT, HI, IO, KA, MA, MO, NV, NJ, NM, NC, RI, Northern Mariana Islands) with IA, CA, and NV selected for detailed analysis.

Sixteen SMBs asked about charges stemming from investigations and 42 SMBs asked about discipline/sanctions. Three SMBs asked about concurrent physical/mental/emotional health and fitness (e.g.: "were you ever admitted to the hospital for any physical/mental/emotional diagnosis..."). Ten states make public any complaint against a provider and 37 states share complaint information with other SMBs. 28

In 2023, the FSMB recorded 6469 disciplinary actions against 3016 providers, 29 while the NPDB recorded 4833 physicians were disciplined in 2024. 30

Review of selected states and rates of complaints and sanctions

On average, 4% of physicians had a complaint lodged against them, and 27% of complaints resulted in an investigation being opened. An average of 4.6% (range 2%-11%) of nearly 76,000 complaints led to a sanction. Comparing the three categories of low, medium, and high depth application questions from the nine representative states revealed no significant differences in rates of complaints and sanctions with the Kruskal-Wallis H-statistic of 0.8000 ( p -value: 0.6703, 95% CI: 0.0134, 0.0740), nor a significant difference in rates of investigations and sanctions between states with the Kruskal-Wallis H-statistic of 0.08889 ( p -value: 0.9565, 95% CI: 0.0540, 0.4450). In all nine states, an average of 0.28% (range 0.1% - 0.5%) of physicians were sanctioned.

This extremely low percentage of "disciplinary actions" taken by boards overall, showing no significant difference between low, medium, and high 'depth of questioning' state applications, means that queries about complaints and investigations does not provide the type of information needed for harm reduction. This lack of predictive value suggests that most allegations are either:

  • Unfounded or unsubstantiated: Many allegations are resolved without disciplinary action, meaning they do not reliably indicate actual misconduct.

  • Dismissed or minor: Including these can unfairly stigmatize applicants without reflecting on a real threat to public safety.

  • Show a lack of merit: Allegations, especially unproven or preliminary ones, do not necessarily indicate a risk to public safety or a practitioner's competency while disciplinary or corrective actions represent confirmed issues and are more relevant to assessing a candidate's suitability for practice.

Discussion

Inherent in the process of evaluating applicants for licensure are issues that balance patient safety with physicians' due process, privacy rights, experience of stigma, implications on mental health, financial toxicity, and burden on SMBs. The process and these issues are discussed as follows:

Process of Medical Board Reviews

The process for review of complaints moves from a filed complaint to a "preliminary" investigation. The licensee may not be necessarily informed of the specific concerns of the investigation or what material is reviewed. Investigations vary by state as to who performs the investigation, who determines whether to proceed, and who consults on the medical issues and adjudicates the charge(s). 31

The investigation is conducted by a non-legal member of the board or contracted out to a third-party reviewer. The reviewer is supposed to obtain testimony from the parties involved and obtain the medical records and any hospital proceedings. The American Medical Association, 32 the American College of Surgeons 33 and many SMBs 34 require that the reviewer have similar certification, training, and practice setting as the licensee under investigation, but this requirement is not always followed. The licensee is then invited to respond in written format.

If investigation of a complaint shows probable cause, state SMBs can press charges under the Medical Practice Act, via a Notice of Proposed Disciplinary Action/Complaint and Notice, naming the proposed violation(s) and considered sanctions, comparable to pressing criminal charges against a citizen. Unlike citizens charged with a crime, licensees are not usually provided with the SMB's investigative files until after formal charges are pressed. Public disclosure of charges in most states commonly occurs before disciplinary action is assigned or accepted. 35

For example, in Washington, all complaints and investigations are entered into licensee's permanent public record. 36 Thus, even if a complaint is closed for lack of merit, the complaint remains discoverable. 25 Pennsylvania on the other hand, has redacted complaints and investigations since 2023 as there is often confidential information unable to be disclosed when a licensee is asked to 'divulge' information about a complaint or investigation they have been a part of. 37

The licensee can then agree to the initially recommended SMB sanctions or request a formal adjudicatory disciplinary hearing where evidentiary standard of proof is required: either a "preponderance of evidence" or "clear and convincing" proof—varying by state. 38,39,40 41,42,43 Legal representation is required to prepare and receive a hearing and may cost hundreds of thousands of dollars.

Per the FSMB, disciplinary actions can include required medical education courses or sanctions such as fines, limitations, restrictions, psychotherapy, conditions imposed, license denied, restricted, revoked, surrendered, suspended, placed on probation, or letter of reprimand. 1 Any adverse disciplinary actions/sanctions must be reported to the NPDB. Such final discipline must also be reported to each state in which a physician is licensed and to all facilities at which they are privileged. SMB sanctions can be "harsh and stigmatizing consequences of license discipline [and cause] humiliation, disgrace, loss of reputation and client bases." 23.

Due Process

Due process of law means that the government must act fairly and follow established rules when acting against someone's life, liberty, or property. It ensures that legal procedures are followed properly and that everyone is treated fairly by the legal system. Due process includes procedural justice, the rights to notice, to confront the evidence, to confront the accuser, to receive a hearing, and to be represented by an attorney. 44 The US Supreme Court recognizes that the right to pursue a chosen profession is within the liberty and property concepts of due process law. 45 The "right to choose one's calling is an essential part of that liberty which is the object of government to protect; and a calling, when chosen, is a man's [sic] property and right." 46 Licensed professionals thus have a property interest in their licenses; and the government may not revoke or curtail that license unless procedural due process protections are afforded and followed. 47 SMBs are often unable to evaluate the originating complaint for context of possible social, political, economic or professional motivations. SMB detailed investigatory findings, the named accuser, fair process, and bases for discipline are not often reviewed with licensees or their counsel prior to charging. While physicians who have a complaint filed and/or investigation initiated are advised to retain legal counsel immediately, 48 their counsel may not have sufficient experience with the SMB processes and guidelines, the ability to quickly assess medical facts, or the experience to recognize procedural errors.

In an effort to provide basic due process, this research suggests that all SMBs should publish their guidelines for investigation, establishment of findings, bases for decisions, rationales for various disciplinary actions, and make available the complaint, named accuser, and all findings at initiation of an investigation (preliminary or other) through the process of charging and hearing, so that physicians and their lawyers can effectively defend a medical practice and license.

The Privacy Act

The public trusts that information released by a SMB has been vetted and endorsed. SMB publication of allegations/complaints and investigations without a formal hearing and decision can confer the presumption of guilt and become a de facto sanction as the public tends to trust government first. This precludes due process, and often exacts a professional, personal, and social toll on the physician. It has been stated by some SMBs that by officially releasing or distributing pre-discipline information, "the public ... can make independent...informed decisions about their own care..." 15 However, the public is not often trained or qualified to interpret the published information. When 96% of complaints and investigations do not lead to a sanction, publication of complaints and investigations can be a violation of due process, precluding the ability of a physician to protect their license, property, and reputation.

This research found that states have differing rules surrounding the confidentiality and release of information. For those states which mandate public disclosure of allegations/complaints and investigations, it can be seen as a breach of procedural due process in the health care licensing system and harmful for those for which the 96% of complaints which do not lead to charges, and the 99% of physicians who will not be sanctioned. Publication of only the final disciplinary sanction in a public forum aligns with FSMB and NPDB standards, and due process rights. 49 50

The Privacy Act of 1974 is a federal protection requiring "no disclosure without consent" necessitating "each jurisdiction adopt a rule respecting confidentiality of records and sources that seeks to balance the need to protect the applicant, the sources, and the public." 51 This rule overrides any state Open Records Acts and provides confidentiality of records outside of cooperation with another examining authority." Twelve exemptions to the Open Records Act exist, and when challenged, have resulted in summary judgements for plaintiffs (ie: favoring defendant privacy). 52 In contrast to the privacy that an accused provider is entitled to, SMBs typically redact the complainant's name while exposing the physician and allegations against them—allowing potential bias.

Stigma and Mental Health

Physicians experience two types of fundamental stigma that arise from an allegation/complaint or investigation. Internal stigma refers to the shame and expectation of discrimination from the process of being investigated whether on moral conduct or standards of care. 53 When a complaint is filed or investigation initiated, the accused physician's mental health is challenged. Subsequent publication or disclosure of a complaint or investigation can further exacerbate any anxiety, depression, or shame.

External stigma and discrimination surround the "property interest" of a provider's license, regarding peer relations and perception in the community. This external sigma can cause loss of brand, reputation, promotion, administrative/committee positions, current and future job opportunities, new license applications, license renewals, privileging at facilities, credentialing with health insurers, and medical malpractice policy renewal. Social stigma increases stress and negatively impacts physicians' health and quality of life. 54

There is no current evidence to suggest that a physician's mental health diagnosis and treatment per se imply impairment or increased risk of harm to patients, nor higher rates of malpractice suits. 55,56 Yet, some SMB investigations delve into provider health diagnoses which may violate both HIPPA and ADA (mental and physical health) protections. 13 A 2014 settlement regarding the Louisiana Bar application found that applicant questions regarding disclosure of mental health issues did indeed violate the ADA, HIPPA, and the Privacy Act. 57 Additionally, mental health questions did not effectively predict future malpractice or misconduct nor justify restrictions to licensure in other professionals when evaluated by the same licensing means. 58 Given that no higher malpractice or discipline/sanction rates were identified between states whose applicants were and were not required to disclose mental health issues, such invasive questions were found to impose unnecessary burdens on applicants based on their diagnosis and treatment and in violation of the ADA. 59 In kind, this study identified no difference in sanction rates between states which require/delve into disclosure of complaints and investigations on applications.

Medical providers are already at elevated risk for suicide from burnout and from second victim status when adverse medical outcomes occur. 60 Provider suicides have been reported while under investigation when recovery from the stigma seemed impossible. An eight-year study from the UK reported 28 physician suicides while under investigation. Another study found that eight of 29 physician suicides between 2017 and 2020 in the UK were investigation related. 61,62 63

Financial Toxicity

There is significant financial toxicity associated with complaints, investigations, and charges, as legal representation for the provider is highly recommended when a complaint is filed. While most medical malpractice insurance covers some of the initial costs, out of pocket attorney fees are high (>$100,000 USD in 2003); 11 and some state boards (CA, OR, WA) are now mandating 'cost recovery' for the SMBs' own legal costs and encumbrances. 64,35

Superior courts judges are instructed that "longstanding administrative interpretations are entitled to some weight in statutory construction,' [but courts] remain responsible to determine if the administrative body is correct..." 65 Administrative judges have been found to give deference to hospital and SMBs, such that many decisions favoring physicians are barred until the appellate court level, exponentially increasing costs and time to recovery.

Burden on State Boards and Justice Departments

Work is created for SMBs and local/regional facilities to investigate complaints because the investigation occurs in both the primary state and in all other states in which a practitioner is currently or was previously licensed, usually adding 6-24 months, 11 exacerbating the shortage of physician supply. 66 A 2022 audit of the Nevada Medical Board highlighted these facts and found that the SMB "could improve the monitoring of its complaint resolution process which can take as long as several years to finalize." 67

Iowa Judicial Opinion Sets Precedent

In April 2021, the Iowa State Supreme Court decided that Iowa law prohibited the disclosure of complaints and investigative information prior to a regulatory board's final written decision. "In its unanimous decision, the court said the Iowa Board of Medicine should not have publicly disclosed information about a doctor under investigation, as was standard for the agency." 68 The justices wrote: "Read in its entirety, we do not believe the statute is ambiguous. Investigative information cannot be released to the public prior to a final decision in a disciplinary proceeding....In addition, a professional's livelihood can be damaged by putting unproved allegations in public view on an official government website." 69 The decision also found that the investigation questions were over-broad and ineffective in identifying unfit applicants.

The Iowa Court recognized that licenses are property protected by due process, 70 and thus pre-discipline publication of complaints and investigations in newsletters, on applications for licensure, and privileging prior to, or without sanctions, violated physicians' due process and confidentiality. Given the widely disparate question and disclosure practices between the SMBs revealed herein, development of more uniform guidelines in other states could balance transparency, confidentiality, and due process rights with patient protection.

This research confirms there is no public benefit, but rather has shown increased harm and cost, to disclosing complaint or investigation information. A distinction is consistently made between those who have had adverse disciplinary actions/sanctions imposed, who should be subject to public disclosure and have the action queried, and competent professionals with a prior/current complaint or investigation. The analysis herein reveals no population based public health benefit, paralleling research on mental health questions on licensing applications both for physicians and lawyers.

Limitations

Limitations to our research include the fact that many state applications have gone fully online and are now accessible only through internet registration compared to when this research was initially undertaken. We have the most current information from the SMB annual reports at the time of this research's acceptance for publication, which tend to be published at the end of their (varying) fiscal years, and may not be current to 2025/2026. Formal disciplinary actions were recorded, not informal. The number of sanctions may not be proportional to the number of physicians disciplined as oftentimes multiple sanctions are applied to one provider: as seen in the FSMB data with 6469 sanctions on 3016 physicians in the most recent data compiled from 2023. Some proponents of investigation questions may ask what other means do we have to track and trend potentially dangerous providers: the counterargument to this is that more is not always better, as shown here, and may actually be harmful-- correlating with a tried and true phrase in medicine "better is the enemy of good," which may be applicable here.

Recommendations

States can implement less invasive application practices while maintaining patient safety. Recommendations for improvement include instituting a standardized application for all SMBs and facilities, like the uniform application, to include removing questions regarding complaints and investigations. This would protect due process and privacy while continuing mandatory reporting on formal legal actions like the FSMB and NPDB guidelines. We also recommend strict codification of application terminology so they are understood by both applicants and licensing bodies, and these terms cannot be side-stepped to ask complaint/investigation questions in ulterior forms (ie: investigation ≠ review/report, etc.). By taking these steps, medical boards can better balance protecting public safety with ensuring a fair and transparent licensing process. Aligning with these standards avoids duplicative reporting and ensures the focus remains on verified reportable incidents. A framework for actionable steps for SMBs to align applications and adjudica-tion practices with FSMB and NPDB guidelines include the following:

  • Eliminate questions about unadjudicated complaints and investigations as these are not final legal actions and are not directly relevant to public safety or the applicant's competence as shown above.

  • Concentrate application questions to focus on issues that align with NPDB and FSMB reportable events, such as disciplinary actions and adverse findings, rather than complaints, preliminary investigation information, and allegations.

  • Board Members: Provide training on universal state applications, FSMB and NPDB guidelines to ensure that licensing decisions align with best practices.

  • Staff: Update staff on revised application processes and criteria for assessing applications.

  • Attorneys: Provide a certification course on public guidelines and policies for representing physicians before SMBs.

  • Applicants: Clearly communicate changes to applicants, explaining what information is required and why.

  • Define reportable events: Align policies with FSMB and NPDB definitions to ensure only relevant, reportable events are considered.

  • Focus on outcomes: Emphasize disciplinary actions or sanctions rather than investigations.

  • Simplify questions: Replace broad or ambiguous questions with precise queries that focus on legally reportable events using standardized terminology.

  • Provide Examples: Offer applicants clear examples of what constitutes reportable actions to reduce confusion.

  • Codify and standardize terms such as complaint, investigation, sanction, and discipline and not allow other terms to enter this legal realm (ie, "investigation" does not equal "report" or "review") across all SMBs.

  • Compliance Review: Ensure that changes comply with state laws, NPDB requirements, and FSMB guidelines, and due process rights of physicians/providers.

  • Collaborate: Work with other state boards to share best practices and ensure consistency across jurisdictions

  • Avoid Bias: Ensure that application processes do not penalize applicants for investigations that did not result in findings of wrongdoing—similar to the Pennsylvania changes.

  • Monitor the impact of application changes on licensing decisions and applicant feedback.

Conclusion

This review of questions asked on SMB medical board license applications regarding complaints and investigations found that the majority of states and US territories ask questions and publish information that is unlikely to meet the legal standards established in Iowa and would be judged in violation of the Federal Privacy Act and due process rights if tried in federal courts. The seminal Iowa Supreme Court decision is not binding precedent in jurisdictions other than Iowa, but the decision should ultimately and ethically oblige other medical licens-ing and privileging bodies (SMBs and facility boards) to conform and change their questions accordingly. Judicial and legal action to enforce compliance over the coming years will considerably benefit physician licensure applicants, practicing physicians, extend to other medical providers, and maintain careful protection of our patients.

Supplemental Material

Appendix A
Appendix A.

Appendix A

Footnotes

  • Open Access: © 2026 The Authors. Published by the Journal of Medical Regulation. This is an Open Access article under the terms of the Creative Commons Attribution-NonCommercial License (CC BY-NC, https://creativecommons.org/licenses/by-nc/4.0/ ), which permits use and distribution in any medium, provided the original work is properly cited, and the use is noncommercial.

  • Funding/support: N/A

  • About the Authors: Michelle F. Benoit, MD, MPH, is a Gynecologic Oncologist at Desert Regional Medical Center, Palm Springs, CA, and Laparoscopic Institute of Gynecologic Oncology, Portola Valley, CA

    Katherine A. O'Hanlan, MD, is a Gynecologic Oncologist at Laparoscopic Institute of Gynecologic Oncology, Portola Valley, CA

    Maxwell R. Mar is a Senior Research Analyst at Laparoscopic Institute of Gynecologic Oncology, Portola Valley, CA

  • Author contributions: MFB conceived of the topic. MFB designed and executed the study. MFB and MRM performed the data analysis, with review and iterative discussions with KAO. All authors reviewed the findings and identified key findings and discussion points. MFB and KAO and critically reviewed the work and edits by MFB, KAO, and MRM subsequent drafts. All authors reviewed and approved the final version.

  • Received December 19, 2023.
  • Revision received July 8, 2025.
  • Accepted August 21, 2025.

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In this Issue

Journal of Medical Regulation

Journal of Medical Regulation

Vol. 112, Issue 2

17 Aug 2026

Table of Contents Index by author

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Keywords

Licensure, investigations, due process, health policy, patient safety, provider safeguards, state medical boards, hospital privileging, credentialing, open records act, sanctions, charges, privacy act