Society and Medical Board Tackle Tough Issues Amid New Spirit of Collaboration

In an extraordinary public meeting, MMS officers met with the state Board of Registration in Medicine (BRM) to inaugurate what both sides hope will be a new era of cooperation and collaboration on matters important to patients, physicians, and regulators.

Photo by Frank Fortin

Participants in the MMS/BRM meeting included (left to right) board member Guy Fish, M.D.; MMS President-Elect Mario Motta, M.D.; board member Peter Paige, M.D.; MMS President Bruce Auerbach, M.D.; Board Chair John Herman, M.D.; and board members Myechia Minter-Jordan, M.D., and ­Herbert Hodos, Esq.

The 90-minute session, held as the BRM was still settling into new headquarters in Wakefield, was friendly and completely without rancor - in contrast to the more contentious atmosphere in recent years when the MMS appeared before the board in opposition to proposed new regulations. Long-time observers of the board said such a collegial meeting has not occurred in many years.

"I'm very happy with this," declared Bruce S. Auerbach, M.D., MMS president, as he left the meeting. "We'll have continued dialogue, and it appears we're facilitating a better working relationship with the new board."

The board is "new" in that its chair, John Herman, M.D., a psychiatrist at Massachusetts General Hospital, was elected last spring after serving as a board member for six years (see Vital Signs, August 2008). Recent appointees Myechia Minter-Jordan, M.D., and Herbert H. Hodos, Esq., joined holdovers Peter G. Paige, M.D., Guy Fish, M.D., and Dr. Herman at the MMS meeting. Two seats on the panel remain to be filled.

After learning that MMS officers hoped to discuss several matters with the board, Dr. Herman extended the invitation that set up the mid-September session. "The theme is quality and safety, and the means to get there," Dr. Herman said. "We've asked [the MMS officers] to tell us what's up and especially where collaboration between the board and the Society can yield improvements."

MMS leaders outlined for the board their concerns on several issues, including physician due process when complaints or concerns are raised, the medical licensing process, and a clinical skills assessment program in the works at the Society.

Physician Due Process a Thorny Issue
Achieving physician due process in matters before the board remains an often-contentious issue. Dr. Auerbach told the board that there is a "perception among much of the medical community" that the board's procedures for handling complaints against physicians need improvement in both "process and quality." The current impression among physicians, he said, is that the process is "more confrontational and punitive and not necessarily as efficient as one would like."

To that end, the MMS joined with numerous attorneys who defend physicians before the board in signing what Dr. Auerbach described as an "extraordinary letter" to the board. The letter asks the board to consider "that physicians under investigation are routinely unable to respond to board inquiries because they are unaware of the nature and specifics of the charges to which they are required to respond." The letter maintains that the board's "official (but unwritten) position" is to provide such materials only after it votes on a "statement of allegations." The signatories question the legality of that procedure and further observe that physicians are often tried in the court of public opinion based on the statement of allegations, which is a public pronouncement of the charges. The board maintains that patient privacy laws prevent disclosing this information to doctors.

"We are very interested in working together with [the board] to ensure as positive and open a process as confidentiality permits, and to ensure that physicians get all the information they need to review the complaint against them so they can respond appropriately," Dr. Auerbach said.

"We are all extremely aware of how momentous it is when a physician comes before this board to answer questions," Dr. Herman added. "This is not a 'next case' kind of thing. We agonize over each case."

W. Scott Liebert, a former BRM attorney who now defends physicians before that body, said the board and its general counsel "take their jobs seriously and are not out to hurt doctors." However, he added, "They are getting their information from one side only. Doctors have a right to information they need to respond completely and fully to complaints and investigations." Liebert, who attended the meeting, signed the letter to the board concerning this matter.

Addressing the issue of disciplinary efficiency, Dr. Herman said that about a year ago the board had approximately 140 open cases to be resolved. Now, he said, that number is down to 40. "It took a lot of work to get there," he said.

Licensing Cooperation Pledged
In recent years, MMS leaders have heard from members about difficulties encountered by physicians seeking licenses in Massachusetts. "It has to be acknowledged that this can be an onerous process," Dr. Auerbach told the board. "We're interested in how we can partner and work together to ensure an adequate physician workforce for the citizens of our Commonwealth."

Mario E. Motta, M.D., MMS president-elect, brought full details of the licensing issues to the board's attention. He said that MMS concerns about the process extend to both full licenses for physicians looking to enter practice in the state as well as limited licenses for residents accepted to training programs.

"The MMS strongly supports high standards for the practice of medicine," Dr. Motta said. "We strongly believe that no one should practice medicine in Massachusetts without legitimate credentials that have been fully verified." But, Dr. Motta added, no hospital or practice should ever lose the services of a doctor for lack of a timely licensing decision.

"If there are legitimate reasons to deny a physician a license, that should be done, and done publicly as a reportable action," he said. "But a de facto denial by delay serves no one."

Noting that licensing is the board's primary responsibility, Dr. Motta suggested adding staff to the board's licensing division, simplifying the physician licensing process, and making online applications available for all applicants.

"This is another area that we have to look to the Massachusetts Medical Society for feedback," said Dr. Fish, who added that "denial by delay is something that should not happen." He expressed hope that the board and the MMS could work together to "streamline the process."

Clinical Skills Assessment Moves Forward
The board also warmly greeted news that the MMS was well on its way toward developing a new clinical skills assessment program for physicians. Kenneth R. Peelle, M.D., an MMS past president and chair of the Society's Clinical Skills Assessment Task Force, described how the voluntary, confidential program - based on ones now running in California and Colorado - might work.

The general perception of such programs is one obstacle, Dr. Peelle noted. "This is not about punishing bad apples," he said. "This is about assessing and enhancing skills."

Financing is another issue. "We need to start small because of finances," Dr. Peelle said. He appealed to the board for help with that, adding that any such program must eventually sustain itself.

Dr. Fish called the skills assessment plan a "great concept," and he volunteered to serve as the board's liaison to the MMS on the project.

"We will succeed only with cooperation between the board and the Society," Dr. Peelle concluded. He said he envisioned the board and the MMS sharing information on program development going forward and that the board would be a primary referral source for doctors who eventually take part in the program.

Nothing New on Board Regulations
Another lingering issue that has stirred controversy between the board and the MMS was barely discussed at the meeting. "There are these things called the regulations," Dr. Herman declared toward the end of the proceedings. He said board members have received all the MMS testimony on proposed changes to the board's regulations. "We are all trying to get up to speed," Dr. Herman said.

With that, the unusual meeting ended, amid handshakes and photographs.

Because the board has jurisdiction over licensing and discipline, "there will always be an adversarial nature to some of our relations with the board," Dr. Auerbach said afterward. "But today was a demonstration of a much more collaborative working relationship."

- Tom Walsh

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