The Role of Public Members on State Medical Boards

Growing Use of the Internet for Health Information

The increased public discourse about patient safety, and a growing interest in consumer-related information about medical practices, coincided with the growing use of the Internet to gather health information. In 1997, the U.S. Census Bureau began tracking Internet usage in American households, and found that year that 18 percent of U.S. households had Internet access. By 2000, the number had jumped to 41.5 percent, and by 2007 it had reached 62 percent.4

Many state medical boards began to see a growing consumer use of online information resources offered to the public. The Massachusetts Board of Registration in Medicine launched the nation's first “Physician Profiles” program in 1996, providing information about physicians, and it offered web-based access the following year. The Massachusetts board reported 529,250 web-based interactions with its profiles website in 1997. By 2008, the number had grown to more than 6.5 million profiles interactions.5

Increased Focus on Consumer-Driven Medicine

A second change in health care that has contributed to the need for, and interest in, public membership on medical boards has been the rise of consumer-driven health plans (CDHPs) and a move toward a greater consumer orientation in health care decision-making. A CDHP is defined as a “…. health plan—which is high-deductible health insurance with a personal account to pay for health expenses.”6 A Kaiser Foundation report offers a practical definition: “This term applies to a broad range of health plan designs such as Health Savings Accounts (HSAs) or Health Reimbursement Accounts (HRAs), but is most commonly used to describe the combination of a high-deductible health insurance plan with a tax-deferred savings account used to pay for routine health care expenses.”7 These plans have increased in availability and use since the passage of the 2003 Medicare Prescription Drug, Improvement, and Modernization Act.8

There are demonstrable changes in behavior among patients in such plans,9 and among those who bring a consumer-oriented mindset to their medical decision-making.

It is important to note that consumer-driven health plans are only one part of the overall consumer health care market, but the upward trend in high-deductible health plan options and increased consumer decision-making in health care settings is well documented.10 The important point to be made is that the consumer voice is becoming more prominent in health care overall, and that public members can help bring these perspectives to medical boards. As the move toward consumer empowerment in health care continues, public members will have increased potential to provide a critical link between the changing attitudes and behaviors of consumers and the medical profession.

Continuing Societal Trend Towards Diverse Representation in Government and Broader Community Involvement

The third societal factor contributing to the importance of public membership on medical boards is our society's continuing demand for more diverse representation in government and involvement of a broader community in decision-making, which has been on the rise in the United States for decades.

My experience with the Virginia Board of Medicine has taught me that when people of diverse backgrounds are placed on public boards, multifaceted viewpoints result. And these invariably contribute to a more robust discussion of any issue.

Our society's movement toward greater diversity in public service should be fully reflected in the practices of the regulatory community. It is both in our boards' best interests and in the best interests of those we serve.

This is particularly important as the regulatory community seeks to inform the public more effectively about the role of state medical boards. Public members with diverse backgrounds and broad experience in community organizing can lead board efforts to inform underserved communities about the resources boards offer.

For example, a Latino public member may have the strong community resources needed to help propel an effort at building greater awareness of the work of medical boards to the Spanish-speaking community through cultural literacy and sensitivity initiatives. Such efforts to engage previously under-served and unreached communities can strengthen support for a board and help it achieve its mission.

Legislators who represent such communities are more likely to support public agencies that provide appropriate services and support for their constituents. Doing the board's work well, on behalf of all constituents, is a board's greatest asset. Public members can, and should, be leaders in these efforts.

The Task at Hand

The FSMB Foundation's public member initiative aims at two fundamental needs: first, ensuring that guidelines are created to assist states in the recruitment of the best-qualified public members; and second, providing the training and orientation needed to ensure that public board members without medical backgrounds can quickly and effectively assume their responsibilities.

A look back at the environment for public board members over the last two decades sheds light on why this effort is important. In 1992, the American Association of Retired Persons (AARP) Consumer Affairs Section released a report on research it conducted regarding the needs of public members of state licensing boards. Although not specific to boards of medicine alone, the AARP study offered recommendations that would have strengthened the role of public members on state medical boards.

The AARP report cited a 1992 study from the Citizen Advocacy Center (CAC) that found that training or orientation sessions for public members, when offered, did not meet the needs identified by the public members themselves.11 While licensing board staff emphasized process and procedural requirements of the board, the public members identified “issues training” and “leadership training” as important, but usually unavailable. In fact, the CAC report lamented that leadership training was “virtually non-existent—only 7% [of public member survey respondents] said it was offered.”

A later report by the CAC identified specific qualities in potential candidates for appointments that appointing authorities should consider. Issues such as potential ties to the regulated profession, level of education, demonstrated commitment to participation in public service, and knowledge of the regulated industry or profession were all identified as vetting criteria upon which appointing authorities could rely. The study also addressed public members' perceptions about the appropriate percentage of public member representation on the boards. More than 28 percent of respondents reported that the ideal board composition would be 25 percent public members; an additional 22 percent of survey respondents indicated that at least one-third of board members should be public members.12

Despite the clearly established need for better recruitment, training and preparation of public members, nearly 20 years after these studies little progress has been made in creating best practices for public-member training or the establishment of criteria for selection. In a survey of state medical boards and public members conducted in 2010, the FSMB Foundation discovered that although public-member representation has increased over the last 20 years, the ideal board composition numbers suggested by respondents in the CAC survey are not reflected in current board compositions across the country.13 Clearly, the CAC's recommendations have not permeated into the ranks of state decision-makers as they fill their boards.

Additionally, the Foundation's 2010 survey showed that AARP and CAC training recommendations also have not been comprehensively adopted. The survey shows that significant numbers of currently serving public board members believe that the hours allotted to initial training and orientation for new members should be increased, for example. Moreover, while more than 80 percent of public board members want ongoing training about their roles and responsibilities, less than half of boards offer such training.13