Group medical practice has grown globally, necessitating evaluation methods to enhance patient care and physician well-being. The College of Physicians & Surgeons of Alberta (CPSA) launched a pilot project, the Group Practice Review (GPR), to assess family medicine and general practice (FM/GP) clinic performance, focusing on groups or clinics rather than at the individual level.
Eight volunteer clinics with a total of 65 FM/GPs in Alberta, Canada participated in the GPR pilot. Compliance with CPSA's Standards of Practice (SOP), chart scores, complaints, and risky prescribing were evaluated. SOP compliance was assessed through office observation and policy reviews. Prescription flags identified the number of patients on high doses of opioids and benzodiazepines.
None of the clinics met all CPSA SOP. On average, 91.7% of SOPs were met. Common deficiencies included patient recordkeeping and drug storage standards. Post-visit feedback suggested improvements in process definitions and access to SOP compliance reports before facilitation visits. The average cost per physician to conduct the GPR as a part of the pilot project was $300 Canadian dollars ($225 USD).
The GPR pilot demonstrated a feasible, cost-effective approach for evaluating FM/GPs in group settings, fostering proactive environments and promoting timely corrective actions.
The Australian Health Practitioner Regulation Agency (Ahpra) manages complaints made about registered health practitioners across Australia. The negative effects that complaint processes can have on the mental health of health practitioners are well documented.
To identify factors that help make the complaints process positive and worthwhile for people who made a complaint, practitioners who are the subject of a complaint, and staff who manage complaints processes.
Semi-structured interviews of 26 participants (eight complainants, ten practitioners who were the subject of a complaint, and eight complaints management staff) were conducted. Participants were selected using criterion-based purposive sampling and linked with positive responses from Ahpra's internal surveys. Key themes were identified via thematic analysis.
Frequent, clear, and empathetic communication was a key determinant of overall process satisfaction across all participant groups. Staff identified that early engagement to set expectations and regular, proactive provision of information or reassurance throughout the process were essential to improving practitioner experience and making the complaint management process worthwhile for complainants and practitioners alike. Regular updates, direct engagement with staff managing complaints, and having an informed understanding of Ahpra and its role also had positive impacts.
Improvements to the provision of process information and continued investment in staff communication training are recommended to enhance positive experiences.
While high-profile cases have drawn attention to egregious violations committed by healthcare providers, less is known about the broader patterns of misconduct across all healthcare professions.
This study examines misconduct trends across 27 healthcare professions in Michigan between 2011 and 2023, utilizing data from the Department of Licensing and Regulatory Affairs (LARA). The project converted publicly available LARA disciplinary reports into an analyzable digital database, facilitating a comprehensive understanding of healthcare provider misconduct.
Findings include an 83.2% increase in complaints between 2011 and 2023, contrasted with a 3.6% decline in total sanctions over the same period. Negligence was the most frequently observed misconduct across all healthcare boards, while certain professions exhibited disproportionately high rates of misconduct. Sanctions varied widely, with fines being the most common and permanent license revocations being exceedingly rare.
The study highlights systemic challenges in oversight, including inconsistent reporting mechanisms, finite regulatory resources, and gaps in accountability. By revealing these limitations, the data underscores the need for process and policy reforms to improve transparency, standardize reporting, enhance regulatory capacity, and prioritize preventive intervention. This study identifies professional misconduct trends amongst Michigan healthcare providers (2011–2023), including high rates of sexual misconduct and violations of continuing education requirements in some professions. Fragmented and inconsistent reporting hinders effective oversight, undermining patient safety and public trust in the healthcare system.
Increasingly, for-profit corporations are delivering a greater portion of healthcare services. While this may enhance operational efficiency and organizational effectiveness, it may raise questions about safeguarding of patients’ interests and supporting the autonomy and professional judgement of individual professionals who may work as employees. In such corporate healthcare settings, there may often be leaders who themselves are licensed professionals. These individuals may not personally provide care to patients but direct the work of other professionals or establish corporate policies, practices, and cultures that shape the practice of others. In such situations, the problem of "dual loyalties" may arise, in which licensed healthcare professionals must simultaneously reconcile a professional/ethical and fiduciary responsibility to act in the best interests of patients with a corporate responsibility to maximize shareholder value. While many different agencies—including governments, accreditation bodies, and industry agencies—participate in the regulation of corporatized healthcare, the specific responsibilities and opportunities for licensing bodies to ensure appropriate management of dual loyalties has not been widely discussed. The multi-faceted and highly interconnected nature of this wicked problem opens opportunities for discussion and reflection within licensing bodies regarding how best to use mechanisms such as Codes of Ethics, Standards of Practice, and complaints/investigation systems in the context of dual loyalties in corporatized practice settings.
]]>The Colorado Physician Health Program (CPHP) provides evaluation, diagnosis, treatment referral, and monitoring for physicians, physician assistants and anesthesiology assistants experiencing health or psycho-social problems. We examined trends in complexity of cases presenting to CPHP between fiscal years 2016-2017 and 2020-2021.
Case complexity was rated as mild, moderate, or high based on clinical and administrative complexity. Differences in complexity were examined by year and participant demographic, practice, and case characteristics, using chi-square and logistic regression analysis.
Mild complexity cases declined from 57% to 14% and moderate cases increased from 25% to 73% (P<.001). Cases with high complexity (15% of cases) remained relatively stable. Complexity was higher for older participants (P=.04), primary presenting problem of DUI/DWAI (P=.01), mandatory referrals (P<.001), and longer participation (P<.001), and lower for participants with work stress/burnout (P=.04).
Potential reasons for the changes in complexity observed include increased stress in work settings, proposed changes in the regulatory environment that could threaten confidentiality, and the emergence of in-house wellness programs. Physician health programs need to prepare for increases in case complexity and the accompanying need for more referrals for care, higher levels of monitoring, and greater skill in diagnosing and addressing health and behavioral issues.
The COVID-19 public health emergency increased demand for healthcare services, prompting emergency policy changes that expanded access via telehealth.
To identify determinants of state telehealth policies related to in-state licensure waivers and payment parity.
A retrospective, longitudinal analysis of monthly state telehealth policy changes between January 2020 and December 2022 was conducted. Multivariate logistic regression was used to estimate the relative importance of public health, state health policy and socio-economic factors for waiving in-state licensure requirements or implementing payment parity.
Waiver implementation and maintenance were more likely in ACA expansion states, states with higher COVID-19 elderly mortality rates, and increased new health center market entry but less likely in states with Democratic governors, Interstate Licensure Compact participation and Certificate of Need laws. Payment parity was more likely in states with Democratic governors, higher elderly vaccination rates, and CON laws, but was less likely in IMLC states.
The adoption and maintenance of telehealth policy changes was influenced primarily by public health shocks and health policy factors, as well as the political orientation of state governors. Comparatively, socioeconomic conditions were less influential.
Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist that has been approved for use as a clinical and veterinary anesthetic since 1970. Although esketamine, a specific molecular form of ketamine, is FDA-approved for the management of treatment-resistant depression, regular ketamine is often used off-label at subanesthetic doses to treat depression as well as other psychiatric disorders and pain. Despite the lower doses of ketamine used for analgesia and depression, ketamine can cause dissociative, psychomimetic, and hemodynamic symptoms that require careful monitoring during and after administration. Over the past several years, rising public interest in ketamine has led to a "wild west" of so-called ketamine clinics, which offer off-label ketamine treatment, sometimes through compounding pharmacies, for a variety of conditions. These clinics are largely unregulated, representing a possible ongoing threat to the safety of patients which may merit action among state medical regulators. Regulations may be helpful for all of the stakeholders in the off-label ketamine marketplace, including distributors, compounding pharmacies, clinics, and providers themselves. In this article, the pharmacology of ketamine and evidence supporting off-label use are reviewed, along with suggestions for regulating the burgeoning ketamine clinic landscape.
]]>The 2024 physician census conducted by the Federation of State Medical Boards (FSMB) documents a total of 1,082,187 actively licensed physicians across the United States and the District of Columbia, marking a 27% growth since 2010. These physicians represent graduates from 2,392 medical schools spanning 171 countries. US medical graduates (USMGs) comprise 77% of the workforce, while international medical graduates (IMGs) account for 23%, with a growing share of US citizens among IMGs. Women now account for 39% of all licensed physicians—a 65% increase since 2010—and the number of osteopathic physicians (DOs) has more than doubled during the same period. The mean age of physicians is 51.8 years, with nearly one-third aged 60 or older, highlighting potential future workforce attrition. Multi-state licensure is on the rise, with 24% of physicians holding more than one license, a trend accelerated by regulatory innovations such as the Interstate Medical Licensure Compact and the expansion of telehealth services. In 2024 alone, a record 146,000 licenses were issued by state medical boards. Despite these positive trends, the physician workforce faces persistent shortages, rising attrition rates, and growing demand for healthcare services. Against this backdrop, reliable and timely workforce data are indispensable for effective decision-making and for preserving access to safe, high-quality care.
]]>State medical boards (SMBs) are tasked with protecting the public but vary in rates of severe disciplinary actions taken against physicians who harm patients. Prior work yielded a SMB-informed list of 56 policy recommendations for protecting the public from egregious wrongdoing by physicians. However, these recommendations have not seen widespread adoption by boards.
The purpose of this study was to identify lessons learned from SMBs who recently successfully implemented innovative policies that protect the public.
We conducted in-depth semi-structured interviews with executive directors and board members from 7 SMBs across the United States and its territories.
A total of 13 themes were identified reflecting lessons learned that other boards could adopt when implementing new policies. Advice emerging from interviews included both people-focused and process-focused lessons, spanning domains such as proactively anticipating and acting on barriers to policy implementation, leveraging networks of different stakeholders, using data to inform policy change and case investigations, and attending carefully to board composition and capacity building.
The lessons identified provide valuable guidance and a helpful starting point for SMBs seeking to cultivate change in their board's policies and practices.
After more than 100 years of successful self-regulation of physician specialties in the United States, requirements for maintaining certification have changed from lifetime certification to required demonstration of competence at regular intervals. In addition, the integration of education and professional development into the certification process has become more prevalent and expected by certificants. Over the last decade, most American Board of Medical Specialties (ABMS) Member Boards have transitioned from a traditional point in time recertification examination requirement to a longitudinal assessment that blends summative assessment with formative learning tools to aid certificants in staying up to date.
Given the novelty of this assessment design, measurement experts convened to establish best practices and minimum standards for development of longitudinal assessments for ongoing certification requirements.
Consensus-based standards for longitudinal assessment program design, scoring and reporting, and assessment security are outlined in this article. They are relevant to regulatory bodies and non-medical professions who have or may consider implementing a longitudinal assessment. As the field of medicine evolves, medical regulation must also adapt to the changing landscape and expectations of the public and the profession.
The State Medical Board of Ohio oversees more than 100,000 licensees and receives approximately 7,000 complaints yearly. Under the supervision of the State Medical Board, the Quality Assurance Committee was created to review closed complaints to serve as an additional safeguard for the protection of the public. The popular belief is that quality assurance relates to the production of an acceptable grade of a product or a brand. Quality assurance is also important regarding complaints against licensees. We present our experience in developing the program, lessons learned, and results obtained. The program has added an additional layer of protection to the public while treating all licensees fairly.
]]>This commentary highlights the Licensed Physician Censuses published biennially by the Federation of State Medical Boards between 2010 to 2022 and provides an overview of the forthcoming census, which will be featured in the next issue of the Journal of Medical Regulation. These censuses identify all actively licensed physicians in the US and the District of Columbia, offering critical insights into demographic, educational, and licensure trends. By analyzing physician workforce patterns, these comprehensive snapshots help inform policymakers and healthcare professionals about workforce assessments and strategic planning efforts.
]]>Interstate licensure portability has become a significant issue for US healthcare providers. Healthcare compacts have emerged as a promising solution to facilitate interstate licensure portability for many healthcare specialties while maintaining individual state autonomy.
This study aimed to describe the landscape of interstate healthcare compacts in the US.
We systematically analyzed compact and legislative websites to determine state-level healthcare licensure compact participation over time.
More healthcare compact bills have been passed over time, as established compacts recruit new states and new compacts emerge. Of the 15 active healthcare compacts identified, all 15 compacts saw the first state/territory to pass compact-specific legislation in at least 1 state/territory in the year of or following the approval of the drafted model legislation. However, the time between when compacts are first discussed to the approval of the drafted model legislation varied considerably between compacts, ranging from 1 year to 20 years. Very few states/territories pass more than 1 or 2 healthcare compact-related bills in any year.
In the last decade, the landscape of interstate healthcare practice has changed dramatically, and state and territory participation in interstate healthcare licensure compacts has expanded over time.
To combine the perspectives of health and commercialization experts on the ethical and regulatory needs for non-fungible token (NFT) implementation in healthcare.
Perspective
For a multidisciplinary perspective by an interdisciplinary group, current event articles and research articles were interpreted and assessed.
Health data has become fragmented and disorganized, resulting in poor accessibility, increased administrative costs, and integrity vulnerability. Healthcare is uniquely suited to adopt blockchain and NFT technology as potential solutions. The incorporation of blockchain technology may offer multiple improvements in data-sharing through consensus, tokenization, and decentralization. However, the current regulatory infrastructure to support blockchain is poorly defined.
Healthcare NFTs would revolutionize patient control over their health data and promote more ethical transparency of data ownership while also reducing administrative security costs. However, blockchain poses unprecedented requirements of healthcare regulation within the unique realms of patient privacy and data ownership. Large-scale implementation of blockchain cannot be achieved without regulatory collaboration.