Pulse
No Whiners?
What’s behind the drop in complaints against Minnesota physicians?
The number of complaints received by the Minnesota Board of Medical Practice (BMP) declined again in fiscal year 2006. In all, 770 complaints—nearly 700 of which were against physicians—came in, continuing a downward trend that began in the mid 1990s when the number of complaints received by the board peaked at about 1,500 per year. Why the decline? And is it a positive development? Nobody knows exactly.
The number of providers in the state is certainly not in decline. The board regulates nearly 18,000 physicians in Minnesota, up about 500 from a year earlier and 4,000 more than a decade ago. It also regulates several other categories of health practitioners, including physician assistants, acupuncturists, traditional midwives, athletic trainers, and respiratory care practitioners, most of which have seen increases in their ranks. Other reasons for the decrease in complaints are more plausible. They include advances in technology and the environment in which most Minnesota doctors practice.
One of the significant changes in medicine in recent years is the move toward evidenced-based practice and the access to information that most physicians now have. “Our knowledge base has been exploding—more so than in the preceding century,” says Steven Altchuler, Ph.D., M.D., chair of the Minnesota BMP. “When I went through medical school, the expectation placed upon students was that you never looked anything up,” he says. But things are different now. Not only are physicians expected to look things up, but the Internet makes finding the latest information about research and best practices only a mouse-click away. And the availability of such resources decreases the chance that a physician will make a mistake.
Altchuler says the fact that most physicians in the state now are part of group practices, where they receive constant feedback from peers through formal and informal interactions, also has played a role in the drop in complaints. “We don’t practice in isolation anymore—the percentage of single-doctor practices in Minnesota is small,” he says. Another factor might be the fact that health plans have their own systems of dealing with physicians who have crossed a boundary before the situation becomes one that warrants the attention of the board.
Anatomy of a Complaint
What happens when a patient’s beef against his doctor goes to the authorities?
When a complaint comes to the Minnesota Board of Medical Practice (BMP)—and is deemed to fall within its jurisdiction—a file is opened and a BMP investigator called a medical regulations analyst is assigned to the case. If possible criminal violations are involved, the complaint will also be turned over to the Minnesota Attorney General’s office.
In the meantime, the physician targeted by the complaint is contacted and asked to respond with all information relevant to the patient/complainant. Once that information has been collected, the case is assigned to one of the board’s medical coordinators—doctors employed by the board who review the complaint and physician response and determine what further information is needed. “For example, if the case involves a cardiologist, the coordinator might recommend we hire a consultant to help us determine whether the proper standard of care was met,”says Robert Leach, the board’s executive director. No matter what the merit of a grievance, all complaints are reviewed by a complaint review committee, which is composed of three members of the board—two doctors and one representative of the general public. These committees meet monthly and decide whether to dismiss a complaint or hold it over for further action, which may mean that the physician will be required to appear before the board.
If a complaint is found to have merit, one of three formal interventions will occur. The first, and least severe, is a Medical Coordinator Conference, invoked in cases in which a doctor has made an isolated mistake. “We like to refer to these as ‘woodshed meetings,’” Leach observes. If the conference goes well, the coordinator reports the outcome to the review board, which will likely dismiss the case.
If the conference proves insufficient, the next level is an Agreement for Corrective Action, calling for remediation in the form of retraining or further education in a particular area of practice. Once those are completed, the case is closed.
The third and most serious level of intervention is disciplinary action, which must be approved by the board. These actions range from reprimands to suspensions to license revocations.
Interestingly, despite the decrease in the number of complaints filed in 2006, there was a slight increase in corrective actions taken by the board compared with the previous year.—R.B.
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In the Public Eye
The public now has a way of finding out whether a physician has been subject to a more serious disciplinary action such as suspension or license revocation or been required by the BMP to undergo remediation in a specific area of practice. It’s one piece of information that Minnesotans can access from the Physician Profiles that the board began posting in September on its Web site (www.bmp.state.mn.us). Anyone can visit the Web site, type in a doctor’s name, and find a rich store of facts about his or her education, experience, specialty, certifications, and more.
Minnesota is the 17th state in the country to post such material online. So far, response to the profiles has been overwhelmingly positive. “It’s been very interesting,” Altchuler says. “I have not heard any complaints from practitioners about wanting to make sure that patients have appropriate information about doctors. In fact, quite the opposite.” On the other hand, because the site is so new, the board is still assessing what other information should be included in the profiles.
In 2001, the board convened a task force to make recommendations on the kinds of information that should be included in the profile. The task force recommended that malpractice information be collected for a period of three years and that the data be categorized by area of practice specialty. The data would then be studied and another task force established to determine its reliability and then decide on whether the information would benefit the public and, if so, in what form it should be made available.
“Malpractice settlements present a difficult issue for us because there are settlements that represent simple business decisions by a practitioner and other cases that represent real instances of bad care,” Altchuler says. “How do we convey information to patients so that those distinctions are clear?” Providing raw data on malpractice, he observes, isn’t necessarily a good way to communicate those distinctions, at least in the absence of information comparing how an individual physician compares with other practitioners in the same field; after all, in some specialties such as obstetrics malpractice settlements tend to be much more common than in specialties such as family medicine. “When it comes to malpractice, it can be like tallying up automobile accidents, where you have two parties involved. One driver has an accident when he is sitting at a traffic light and is hit from behind. Another driver may have an automobile accident as he runs a traffic light and hits someone,”Altchuler observes. “Both drivers have had accidents, but only one of them is ‘responsible’ for their accident.”In the end, though, the board will find some way to post malpractice information as part of the overall effort to provide as much information to the public as possible. “What most people want to know,” Altchuler says, “is how my doctor compares to other doctors. The physician profiles are going help patients make informed choices.”—Richard Broderick
Patient Decisions
Do price and quality matter when choosing a doctor?
Minnesotans are starting to pay more attention to price, quality, and other measures when making health care decisions, according to a recent statewide survey by Blue Cross and Blue Shield of Minnesota.
But are they using such information when choosing a physician or clinic?
Although 80 percent of survey respondents said they look at published quality and safety information about a doctor, clinic, or hospital, only one in 10 said they would strongly rely on such measures when selecting a primary care physician. Rather, 47 percent said they would ask friends and family for recommendations; 34 percent would seek the opinion of another doctor; and 19 percent would ask a co-worker.
Still, the top reason for selecting a primary care physician had nothing to do with fact or opinion: It was convenience. Six out of 10 respondents said clinic location was extremely important when selecting a provider.
The survey of 401 adults also found that:
72 percent did their own research on a medical condition or health issue;
51 percent questioned their doctor’s advice on a medical condition or situation;
35 percent asked about the cost of treatment before receiving it;
25 percent sought a less expensive alternative; and
15 percent tried to look up price information.
The survey of 401 adult Minnesotans was conducted for Blue Cross by SNG Research Corporation between June 20 and July 22, 2006.
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