5 Things You Need to Know About Physician Medical Board Issues

Updated October 16, 2023 by Jason Esparza and TJ Payne

Of the many challenges physicians face, medical board investigations are often among the most stressful.  This article aims to empower you with insights into three common causes of physician medical board investigations, as well as the two potential post-investigation actions. By understanding these triggers, you can better assist your clients in navigating the complexities they might face.

3 Common Causes of Physician Medical Board Investigations

State medical boards bear the responsibility of verifying the qualifications and competence of licensed physicians within their jurisdiction. In instances where a physician is under suspicion or is alleged to have violated regulations, it becomes the job of the medical board to take appropriate action. While the range of grounds for medical board interventions is extensive, they typically align with one or more of the ensuing three categories:

1. Personal Issues

Unlike most individuals, personal issues and mistakes for physicians can have ramifications on their professional standing. Physicians are obligated to notify the relevant medical board about a wide spectrum of personal challenges or lapses in judgment.

2. Record Keeping

Challenges in record-keeping usually emerge when physicians fail to meticulously document their medical records, leading to gaps in crucial information. Record-keeping issues may also include providing inaccurate data or making alterations to records after the fact.

3. Claim Activity

Frequent or severe claims activities involving a physician can prompt a medical board investigation. Whether there's a recurring issue or an exceptional case, elevated claims activity is likely to trigger scrutiny from the medical board.

The 2 Types of Physician Medical Board Actions

Depending on the outcome of the investigation the medical board will proceed with one of two courses of action:

1. No formal action is taken

In cases where no violation is identified by the medical board, the investigation's conclusion is recorded without initiating any formal action. However, it is not unusual for fines to be imposed on the physician to cover the costs associated with the investigation.

2. Formal or public action

If the medical board determines that a medical practitioner has breached established codes of conduct, they will initiate actions against the physician's medical license. Depending on the severity of the violation, formal action could encompass measures such as license suspension, restrictions on future practice activities, or even complete revocation of the license. The physician may also have the option to voluntarily surrender their license.

Medical boards recognize that errors can occur, and complete license revocation is generally reserved for particularly egregious violations. More commonly, actions involve license suspensions and limitations on the scope of practice. In certain cases, supervision by another qualified physician might be mandated. Regardless of the outcome, these physicians require specialized consideration when it comes to matters of employment, medical malpractice, and potentially, rehabilitation.

Navigating Physician Medical Board Investigations

As an agent representing physicians, you may wind up playing a crucial role in helping insureds navigate the intricate landscape of medical board investigations. Understanding the triggers that lead to investigations and the potential actions that follow is essential to providing informed guidance. By equipping yourself with insights into the common causes of physician medical board investigations and the ensuing actions, you enhance your ability to support and guide your physician clients through the challenges they may face. Your expertise and assistance can make a significant impact on their professional journey.