Paying customers (employers and online health information providers) can obtain information about physicians, including disciplinary actions by state regulators and Medicare, as well as a profile that includes medical school, specialty board certification and a ranking of the hospital with which a given doctor is affiliated, Loughran told PT. On its public site, HealthGrades provides free basic information about physicians, including driving maps and office hours for each location if the physician works in more than one.
Public Citizen provides no free information on its site. It draws its data on physicians from publicly available records from various state medical boards and uses the site to promote its $400 book (or $20 apiece for regional reports) containing summary information about the 20,125 "questionable" doctors. A CD-ROM version sells for $600. It is based on disciplinary actions taken between 1990 and 1999. According to a press release from Public Citizen on Aug. 8, 2000, "It is likely that [the physicians named in the book] are still practicing." However, Peter Lurie, M.D., M.P.H., co-author of the study Public Citizen conducted that surveyed doctor disciplinary information on state medical board Web sites, admitted in an interview with PT that the organization has not attempted to verify whether or not all of the doctors are still in practice.
"There is no question that among those 20,000 people there are some who are not in practice. We don't have the ability to go back and one-by-one go through all 20,000," commented Lurie, who is also deputy director of Public Citizen's health research group. Lurie also said the Public Citizen data do not include information on malpractice suits or settlements.
Consumer interest in quality of care issues has spurred greater demand for information about physicians, but leaders of the medical profession have voiced strong concerns about the type of information being provided.
"Even before the state board put up its Web site, we voiced concerns about the information that is being made available about physicians," Sandra Bressler, director of professional standards and quality of care for the California Medical Association (CMA), told PT. "Some years ago, we sued the medical board about the release of information on physicians when they proposed to release pre-accusation notices about investigations they were conducting." The case was eventually settled, with the California regulators agreeing not to publish the information, but Bressler said that new complaints have arisen with the advent of the Web site.
"The California Medical Board's Web site is peculiar. When they file an accusation and then negotiate a settlement, [in which] one condition is that they withdraw the accusation, they still post the word Enforcement on the Web site in a column called 'Secondary License Status Code.'"
"We have proof that it has jeopardized at least one physician's income," Bressler continued. "A member was accused of gross negligence with respect to an orthopedic procedure. The board said that if he took a competency examination and passed, they'd withdraw the accusation. But they left the word Enforcement on the Web site. The physician was in the job market at the time, and a friend told him confidentially that he was not going to be hired for one position because of that 'blot' on his record."
Bressler said the CMA is not opposed to releasing information about physicians but believes it needs to be done carefully. "We have always said that it was appropriate to inform the public if a physician was disciplined. While many physicians don't like it, we have agreed that the board can let the public know when they've filed a formal document, such as an accusation, as long as it is clear that the charges are not proven. But if physicians have an accusation on file, many health plans refuse to allow them to take on additional patients. So, it is very significant when all that's out there is an allegation and no proof," Bressler explained.