Problem Doctors: Is There a System-Level Solution?

TO THE EDITOR:

Although we agree with Leape and Fromson's (1) call for action about the need to address physician performance failures, we do not believe that relying on the hospital credentialing process will adequately address this vexing problem for several reasons. First, many physicians do not have admitting privileges to any hospital. Second, among those who do have these privileges, most admit very few patients (2). Third, with the advent of hospitalists and the shift of more health services to the ambulatory setting, hospital credentialing committees now only oversee a fraction of the practicing physicians' delivery of service. Fourth, as the authors summarize, the state medical boards run many of the remedial programs in cooperation with other groups, such as the state medical society. In Rhode Island, our Board of Medical Licensure and Discipline works closely with the state medical society's Physician's Health Committee to provide treatment and rehabilitation for impaired physicians and assessment services for physicians with behavioral health problems (including sexual boundary violation, gambling, sexual and Internet addictions, and disruptive behaviors). In addition, our Board is involved with the Practitioner Remediation and Enhancement Pilot Project with the Citizen Advocacy Center through a U.S. Health Resources and Services Administration grant (3). Therefore, rather than relying on numerous hospital credentialing committees, we suggest that the state medical boards be empowered and supported to improve its oversight in these vital areas.