Transcript WALKER-CPEMeeting

North Carolina Medical Board:
Addressing ‘practice drift’
William A. Walker, MD
Board President
North Carolina Medical Board
Presented October 2013
1203 Front Street | Raleigh, NC 27609
www.ncmedboard.org
| [email protected]
North Carolina
Medical Board
800.253.9653
www.ncmedboard.org | [email protected]
What is ‘practice drift’?
• All practice ‘drifts’ over time as medical practice
evolves to include new techniques and modalities
• Trained professionals expected to engage in
continuing education to keep skills sharp, learn
the new
• NCMB generally not concerned with this type of
drift, provided licensee is clinically competent
North Carolina Medical Board
www.ncmedboard.org | [email protected]
Drift that is concerning to the Board involves:
• Physicians who have moved into an area of
practice firmly outside their areas of specialty
training
o Example: Surgeons drifting into nonsurgical practice
such as urgent care or family medicine; Non-surgeons
drifting into procedures-based practice, including
cosmetic surgery
• Training that is cursory (hours or days)
North Carolina Medical Board
www.ncmedboard.org | [email protected]
• Physicians who qualify for licensure in NC are
granted a generalized, undifferentiated license
to practice medicine and surgery
o NOT licensed by specialty
o Licensees are on their honor to practice only in
areas where competent
o ‘Drifting’ into an area in which licensee has not
trained is not unlawful; it may be unethical and
unprofessional (grounds for NCMB action)
North Carolina Medical Board
www.ncmedboard.org | [email protected]
• NCMB believes the vast majority of licensees
practice within their specialty area of training
• Growing number of licensees are drifting into
areas for which they did not train. WHY?
Money – ‘drift’ into cash-based services including
cosmetic surgery
Burnout – leaving ER/OR-based practice for “easier”
primary care
Past history – Obstacles to practicing in area of training
North Carolina Medical Board
www.ncmedboard.org | [email protected]
• NCMB’s mission and mandate is to protect the
people of North Carolina by:
1. Ensuring that it licenses only those
professionals with the competence and
character to practice safely
2. Intervening when it determines that a
licensee is practicing in a manner that does
not meet accepted standards
North Carolina Medical Board
www.ncmedboard.org | [email protected]
• NCMB regulates ‘drift’ as it regulates any quality
of care case – does care meet at least minimum
accepted standards of care?
• If no, NCMB may take action
(conditions/limitations, license suspension)
• NCMB does NOT target or proactively search for
licensees who are ‘drifting’ – cases come to the
Board through regular channels
North Carolina Medical Board
www.ncmedboard.org | [email protected]
• NCMB adopted a Position Statement on Physician
Scope of Practice to make clear its position on
‘drift’ in 2011
• Position states that licensees who have ‘drifted’
will be held to the standard of care in that area of
practice, regardless of training (e.g. family
medicine doc doing cosmetic surgery held to
same SOC as ABMS-boarded plastic surgeon)
North Carolina Medical Board
www.ncmedboard.org | [email protected]
‘Drift’ case study
• ENT surgeon in major NC metropolitan area builds
plastic surgery practice
• Numerous patients report bad outcomes to NCMB
• Independent expert medical reviews find care in
these cases below standard
• Board investigation finds evidence that licensee has
medical/neurological problems and has engaged in
self-treatment and self-prescribing.
Board action: indefinite suspension of medical license
North Carolina Medical Board
www.ncmedboard.org | [email protected]
‘Drift’ case study
• Family medicine physician completes weekend
course in select cosmetic surgery procedures
• MD begins offering cosmetic procedures to patients.
• MD performed cosmetic surgeries on family
members and engaged in an intimate relationship
with a person who was previously a patient
• MD self-prescribed weight-loss medications
Board action: Four-month suspension, served
retrospectively; Must not practice cosmetic surgery
North Carolina Medical Board
www.ncmedboard.org | [email protected]
‘Drift’ case study
• ENT surgeon built cosmetic surgery practice
specializing in facial plastic surgery
• Multiple patients who underwent face lifts filed
complaints with the Board
• Independent expert medical reviews found care
below standard
• MD charged in spring 2013; pending hearing
North Carolina Medical Board
www.ncmedboard.org | [email protected]
• Historically, NCMB has sought to prohibit/end
substandard practice when it occurs in the
context of practice drift, not remediate the
licensee
• NCMB sees little role, if any, for assessment
centers, personalized physician education
organizations in addressing drift
North Carolina Medical Board
www.ncmedboard.org | [email protected]
• Questions?
North Carolina Medical Board
www.ncmedboard.org | [email protected]