06/07/2009 05:12 am ET Updated Nov 17, 2011

Medical Boards: What They Do and Why They Matter

Every state has one, and all physicians pay them, yet many know little of what medical boards do and why they matter.

In the United States, physicians are given licenses to practice medicine by state medical boards, and what they bestow they can also take away. All 50 states, as well as Guam and Puerto Rico, have medical boards that license their doctors. When doctors go bad, the boards discipline their physicians by revoking their licenses altogether, placing restrictions on their practice, ordering re-education, or other measures to ensure that the quality of physician care is maintained to, at least, a minimum standard.

You can have good health insurance, live in a community with state-of-the-art facilities, and yet none of that matters if you can't find a doctor, or the doctor treating you is incompetent, negligent, or dishonest. That's why medical boards matter.

The public often gets its impression of the Medical Board of California through the popular media. A search of articles since the beginning of the year yields almost 500, and the stories reported are often shocking. A small sampling of the headlines illustrates the type of impression the public receives:

* Police Raid The Office Of Anna Nicole's Former Physician
* Doctor faces investigation after births of octuplets
* Doctor from Livermore charged with 64 felonies
* Doctor admits drug use, agrees to license probation
* East Bay surgeon accused of molesting unconscious patients
* Plastic surgeon gives up medical license; The action is unrelated to his operation on the mother of Kanye West
* Bonds' surgeon accused of assaulting another physician inside a Redwood City hospital

These stories, while true, paint only a part of the story. California is the largest of all the states' boards, licensing over 125,000 physicians and surgeons. Becoming a physician in California is worthy of notice. Our physicians have been put through their paces by meeting strenuous, specific educational standards and examinations, as well as a review of their behavioral history. Board certification in specialties, usually over three to seven years of postdoctoral study and work in low-paying residencies, is essentially a requirement for obtaining a permanent post or obtaining insurance reimbursement. Physicians practicing in California, while privileged in many ways, also must usually cope with thousands of dollars of educational debt, a high cost of living, and shrinking reimbursement rates. All are highly educated, and the vast majority are very competent, compassionate, honest, and work hard to serve their patients' best interests. That is the story that never makes headlines.

The California experience is typical in many ways to other state boards', and atypical in others. California is the land of celebrity, and when things go wrong, what would in most cases go unnoticed, become a cause célèbre. Some of the more notorious cases have given rise to legislation and greater regulation, while others simply become a sad tale of bad medicine.

The Board's size often makes it a leader and innovator. Another reason our Board is innovative is the amount of involvement in its activities by interest groups and individuals. California requires all boards to conduct business in public, allowing anyone to provide comment on decisions. Physician organizations, consumer advocates, and individual patients commonly attend Board meetings. Due to the amount of public input, issues surrounding alternative and complementary medicine, medical marijuana, outpatient surgery, cosmetic procedures, information disclosure, managed care, telemedicine, among many, many others, have been addressed in policy, legislation, and regulation.

As a result of the many discussions held on subjects compelled by interest groups or individuals, the Board has made significant changes. It eliminated the confidential program for alcoholic or drug addicted doctors, made significantly more information about disciplinary actions available to the public, created an aggressive educational outreach program, studied and promoted telemedicine, created a loan repayment program for physicians willing to work in underserved populations, promulgated regulations for liposuction, and lobbied for numerous legislative changes to address outpatient surgery and other patient safety initiatives. Although conducting business in public can be challenging, it compels our organization to move forward.

The flip side of such transparency is that we are a board that must serve many masters. While our Board is legislatively mandated to first serve the public interest, we do not work in an environment absent of political influence. Most decisions will be challenged by powerful lobbies, such as physician organizations, unions, trial attorneys, among others with substantial political sway. In the best of circumstances, all can come together to form a consensus for the greater good, in the worst of circumstances, good ideas may die in a legislative committee.

Despite many challenges, the Board works within its constraints to do its best to obtain the best outcome for public safety. As we all learned in our high school civics classes, the constitution requires due process for the government to take life, liberty and property -- and a medical license, legally speaking, is property. In all arenas, the legal system is slower than anyone would prefer, and the administrative process to revoke or limit a license is no different. In this way, California's experience is typical. In short, all medical boards have a rewarding but challenging job, and, while imperfect, their work matters. They are made better by honest involvement of the public and other constituencies, as well as stronger legislative tools and adequate funding. To better serve the public, boards need patients to be aware of their services, to contact them when they when they have questions or experience problems, and to lend their voices to support initiatives that provide greater public protection.