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Our collective trust that healthcare professionals will be respectful, helpful, and committed to healing is often justified. However, when patients’ trust in these values is breached, especially due to sexual misconduct, harm to patients can be severe. The Federation of State Medical Boards (FSMB) released a policy paper in 2020 revamping how boards should respond to accusations of physician sexual misconduct (PSM), defined as “any behavior that exploits the physician-patient relationship in a sexual way” (FSMB, 2020). Amongst several recommendations, the FSMB implored states to be unprecedently transparent in publicizing their orders. Our study (Bruce & Acierno, 2022) examined if these goals for increased transparency are being met in 2022, two years after the FSMB policy paper. 

We examined the medical board websites of all 50 states and Washington, D.C. and developed a search procedure to try to maximize ecological validity and allow us to assess what barriers patients could face in searching this information. For each state, we searched the phrases “[state] medical board” and “[state] medical board disciplinary actions” using Google to find websites affiliated with government website servers. For each state website, we sought three features: a list of disciplined physicians with related orders, licensee profiles with access to orders, and case summaries that could quickly inform the public of PSM.
This search found only 24 states, including Washington D.C., offered a list of disciplined physicians. 17 additional states published meeting minutes or bulletins that named such physicians; 44 states offered a search function where a consumer could find a particular physician’s profile. However, about 39% of these websites had technical issues or outdated information. Twenty-one states provided case summaries of recent board decisions and orders, but only 9 of these used direct language when describing the case. The remaining 12 states used vague language, such as, “boundary violation,” or wrote of punishments that hinted at PSM, such as ordering a male physician to only see female patients with a chaperone present. Additional barriers included listing every order for every physician, making this search particularly tedious. Some states also created websites that would require individually searching every physician in the state to find orders in question, which also requires finding these names to begin such a search. Other states required formal Freedom of Information Act requests, which we posit could intimidate a consumer. In all, our team found = 245 orders set between July 2020-July 2022 across 24 states in about 12 hours. 

Taken together, it would seem less than half of state medical boards are publishing information regarding PSM in line with FSMB’s policy paper at this time. In our study, we offer several points of discussion and ideas for future research to ultimately provide recommendations that can better protect patients. First, we raise concerns about the indirect language found in many of the case summaries. Speaking indirectly about these events, which are often traumatic for patients, risks several consequences. Researchers need a certain level of detail of behaviors in question to properly study how to prevent these events. More generally, indirectly describing the events invites questions of dismissing the severity of what occurred and the impact the misconduct had on patient-survivors. Second, we consider mandated reporting procedures, which could help state medical boards carry out their duties but could take away a sense of control for those already experiencing trauma. It is our hope that this study can spark more attention to the issue of PSM and find ways to prevent these events and support patient-survivors.  

Target Article 

Bruce, M. J., & Acierno, R. (2022). Medical board transparency regarding physician sexual misconduct: Two years post–policy updatesJournal of Traumatic Stress.

Discussion Questions

  1. What barriers might state medical boards be facing that prevent them from releasing PSM-related information as requested? 
  2. What motivates patients to report PSM, and how do they go about reporting?  
  3. What does addressing issues of betrayed trust, as seen in PSM, look like in psychotherapy?

About the Authors

Madeline J. Bruce, MS is a PhD candidate in clinical psychology at Saint Louis University. She is completing her clinical internship in the Department of Psychiatry and Behavioral Sciences at McGovern Medical School at UTHealth Houston.

Ron Acierno, PhD is a professor and vice chair of Veterans Affairs in the Department of Psychiatry and Behavioral Sciences at McGovern Medical School at UTHealth Houston. He also serves as the Executive Director of the UTHealth Trauma and Resilience Center.

References Cited

Federation of State Medical Boards (2020). Physician Sexual Misconduct. https://www.fsmb.org/siteassets/advocacy/policies/report-of-workgroup-on-sexual-misconduct-adopted-version.pdf