1. THE FUTURE OF MEDICAL LICENSURE
After your introduction, advance to next slide
Martin Crane, M.D. , Chair
Massachusetts Board of
Registration in Medicine

2. BOARD MISSION STATEMENT
To ensure that only qualified physicians are
licensed to practice in the Commonwealth, and
to support an environment that maximizes the
high quality of health care in Massachusetts.
It’s always nice to mention the mission statement, demonstrating what we think we’re about.
You can also mention that in Massachusetts currently there are 605 active DOs (2%), and 28,525 MDs (98%).

3. Organization of Agency
DPH
Patient Safety Programs
BRIEFLY describe the make-up of the Board (5 docs/2 public members, appointed by Gov to staggered 3-yr terms).
BRIEFLY describe divisions of the agency.
Consumer Protection
Investigation
Litigation
Clinical Care
General Counsel
Physician Health
Data Repository
Patient Care Assessment
Clinical Skills Analysis
Liability Reform
Initial Licenses
Renewals
Verifications
Affiliation Agreements
Public Information
Web Site
Call Center

4. PUBLIC INFORMATION WWW.MASSMEDBOARD.ORG
Virtually anything a consumer or a physician might want to know is available on the Board’s website:
Board Actions
Licensing information
Physician Change of Address Online
Complaint Forms & Instructions
Patient Care Assessment Alerts
New Licensees
Publications
FAQs
I think we always want to point out our website, and the kinds of information that can be found there. Ours is pretty good, so we should be proud of it.

5. THE FUTURE OF MEDICAL LICENSURE

6. CURRENT PATH OF LICENSURE
Medical School
Internship
Residency (Limited License)
COMLEX/USMLE
Full License
CME Credits
Biennial Renewal
Repeat Last 2 Steps as Necessary
The traditional path to licensure (although as late as 20 years ago, some jurisdictions still did not require residency).
COMLEX stands for Comprehensive Osteopathic Medical Licensing Examination

7. EVOLVING PATH OF LICENSURE
Stronger education requirements
More Comprehensive Evaluation
Focus on Clinical Skills
Emphasis on Patient Safety
Licensure is a career-long process, not a single event
Here’s the trend.
So what do we mean by this? The following slides elaborate on each of these points.

8. STRONGER EDUCATION REQUIREMENTS
Highlight Communication Skills
Emphasize Working Within a Team Structure
Teach Students to be Doctors, Not Just Scientists
Incorporate Professionalism into the Curriculum – and Evaluation
Research and experience suggest that communication and team work are absolutely critical to good health care and reducing medical errors.
Professionalism (defined in upcoming slide) is another element the literature – and training programs – are focusing on.

9. MORE COMPREHENSIVE EVALUATION
ACGME “Core Competencies”

10. CORE COMPETENCIES Patient Care Medical Knowledge
Practice-Based Learning & Improvement
Interpersonal Communication Skills
Professionalism
Systems-Based Practice

11. ACGME ELEMENTS of PROFESSIONALISM
Honesty/Integrity
Reliability/Responsibility
Respect for Others
Compassion/Empathy
Self-Improvement/Knowledge of Limits
Communication/Collaboration
Altruism/Advocacy

12. FOCUS ON CLINICAL SKILLS
Again – COMMUNICATION, First & Foremost
On-Going Evaluation of Competency
Staying Current with National Standards & Benchmarks

13. EMPHASIS ON PATIENT SAFETY
Individual Responsibility vs
Systems/Process Failure
It’s all about who or what bears responsibility. When an error occurs, was it because of the action of a physician(s) or other medical staff?
Or was it a systems failure, like poor prescription verification protocols that resulted in a patient being given the wrong drug.
Health care facilities have to be open, honest and transparent about investigating – and reporting – what happened, because that’s the only way to avoid similar mistakes in the future.

14. LICENSURE IS A CAREER-LONG PROCESS
On-Going Clinical Skills Evaluation
Evaluation Will Be the Standard for Everyone, Not Just Those with Deficits
Targeted CMEs
Clinical skills evaluation is the watch word(s) of the day. No longer will physicians obtain their licenses and be free to practice forever without some sort of post-licensure demonstration of continuing clinical competence.
Evaluations will be regular and routine, but they will also come in response to questions raised about a particular physician’s skill level.

15. “Baseball – of all things – was an example of how an unscientific culture responds, or fails to respond, to scientific methods.”
Moneyball – Michael Lewis

16. PREDICTABILITY Baseball Expected Runs By Situation Bases Occupied1 2 3
1,2
1,3
2,3
Full
.46
.81
1.19
1.39
1.47
1.94
1.96
2.22
.24
.50
.67
.98
.94
1.12
1.56
1.64
.10
.22
.30
.36
.40
.53
.69
.82
Outs
*The sacrifice bunt
*The stolen base
*The intentional walk
“The Numbers Game”
Alan Schwartz

17. PREDICTABILITY Medicine Consumer/Other Complaints Hospital Discipline
Professional Liability Payments
Discipline by Medical Board/Behavior in Medical School From: “Disciplinary Action by Medical Boards & Prior Behavior in Medical School” – M.A. Papadakis

18. MEDICAL MALPRACTICE DATA
So, other than it’s the right thinig

19. Massachusetts Medical Malpractice Data 1990-2003
5.40% of all physicians made a payment in
6.17% made a payment in
Agency has done 2 reports on medmal statistics – & – available on website!
NOT including OB-only specialty – there’s only 23 of them, and statistics are meaningless with so few.
This type of analysis (to benefit the profession) is one reason BORIM asks for so much info (# of suits, payments, specialty, etc.)

20. SIZE OF PAYMENTS
Over the 10-year period the average payment was $360,000
In 2001 the average payment in the U.S. was $300,000. In Massachusetts it was $388,841
The number of payments over $1,000,000 grew from 5.9% to 8.5% of all payments (a 50% increase)
Growth in $1M+ payments tracks national data perfectly
Drop in under-$100K payments possibly due to reluctance of contingency fee lawyers to pursue small awards
Payments between $500,000 - $1,000,000 rose 19%
Payments under $100,000 dropped 36.6%

21. TOTAL MALPRACTICE PAYMENTS
FOCUS ON FAR RIGHT COLUMN: Inflation-adjusted payments by year PEAKED in 2001 – we hope this is the start of a trend!
Analysis of 2004 data will be done in the fall. If trend continues, entirely possible medmal insurance premiums could start to level off or fall – takes a few years, as payments made today are for suits filed years ago.

22. TOTAL MALPRACTICE PAYMENTS 1993-2004
Just a graphic representation of the previous slide. Red line shows statistical trend. We hope that line will begin to swing downward soon.

23. TYPES OF OB/GYN PATIENT COMPLAINTS72 68
281
159

24. NUMBER OF COMPLAINTS PER OB/GYN65 81
192

25. OUTLIERS 98 physicians had more than two paid claims
4.2% of the 2,307 physicians who made a payment.
1/4 of one percent of all physicians.
These 98 physicians were responsible for
388 ( 13.5%) of all paid claims.
$133,988,105 (12.9%) of all dollars paid.

26. 98 OUTLIERS 48 NO LONGER IN PRACTICE
50 remain in active practice, of whom 9 have been disciplined by the Board.
48 NO LONGER IN PRACTICE
8 Revoked
2 SOA issued, overturned
9 Disciplinary Resignation
1 Letter of Concern
2 Suspended
4 Formal Discipline
4 Deceased
5 Formal Retirement
(1 after Discipline)
13 Did Not Renew

27. Recommendations Better Communication of Performance/Quality Data
Clinical Skills Assessment & Enhancement
Comprehensive Training In Best Practices & New Technologies
Targeted CME opportunities in Communication

28. BOARD OF REGISTRATION IN MEDICINE WEBSITE
Impress upon them that they can read the full medmal report, our annual report and others online.