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Performance Audit 19-14

Georgia Composite Medical Board – Physician Oversight

Controls needed to ensure sufficient investigations and appropriate discipline

November 2020

 

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KEY RECOMMENDATIONS

GCMB should:
  • Expand public outreach and communication efforts.

  • Improve complaint processes related to prioritization, investigative plans, timeliness standards, and monitoring.

  • Implement strategies, such as sanctioning guidelines and formal training for board members, to ensure appropriate disciplinary decisions.

  • Report disciplinary actions and other required information on the physician profiles.
The General Assembly should:
  • Consider directing all fee revenue to board operations.

  • Increase the number of public members on the board.

  • Expand violation reporting requirements.

 

BACKGROUND

  • GCMB’s mission is to protect the public by licensing healthcare professionals and enforcing requirements of the Medical Practice Act. GCMB regulates approximately 54,000 professionals, with physicians accounting for the majority of licensees (more than 38,000).
  • GCMB’s physician oversight responsibilities include reviewing license applications to determine whether the applicant meets requirements and is fit to practice. GCMB staff also investigate complaints related to standard of care, over-prescribing, impairment, sexual misconduct, and other issues. The board reviews each case and may decide to close the case, send a non-disciplinary letter of concern, or impose formal discipline ranging from a reprimand to license revocation.

 

KEY FINDINGS

The Georgia Composite Medical Board (GCMB) aligns with best practices and other states in many aspects related to board structure and administration, as well as its overall licensing and complaint investigation processes. However, improvements are needed to ensure that potential violations are reported, all complaints are sufficiently investigated, and the investigations result in appropriate and consistent disciplinary decisions.


Board structure and administration are largely consistent with recommended practices, but important items are not aligned.

  • GCMB aligns with best practices in areas related to appointing members, electing officers, utilizing committees, and publishing minutes.

  • GCMB does not control its licensing revenue, remitting approximately $7 million to the state but receiving less than $2.5 million in state appropriations.

  • GCMB has fewer public board members than the recommended 25%.

GCMB’s licensing requirements are largely consistent with other states, with two exceptions.

  • Compared to other states, Georgia requires fewer years of postgraduate training for graduates of approved international medical schools.

  • Applicants have not been required to pass criminal background checks, but GCMB is in the process of implementing these checks.

Licensure Decisions and Complaint Outcomes


Complaints are likely underreported, and GCMB lacks controls to ensure that reported complaints are sufficiently investigated.

  • State law does not require violation reporting from informed sources, such as hospitals and peer physicians.

  • Complaints from the general public may be underreported due to limited public outreach efforts.

  • GCMB has an investigative framework similar to other states but would benefit from a more consistent complaint prioritization method, detailed investigative plans or checklists, formal timeliness standards, and systematic monitoring.

GCMB rarely imposes disciplinary actions and has lower discipline rates than other states reviewed.

  • Only 2% of cases are closed with formal discipline. Private letters of concern are issued in 17% of cases, while 81% are simply closed.

  • GCMB’s disciplinary rate is lower than the six other states reviewed.

  • When discipline is imposed, the information is not always clearly reported on the physician’s profile.