New York state has more than 75,000 practicing doctors. But in 2021, the state medical board only checked a federal medical misconduct database about 1,200 times — just once for every five new licenses issued that same year — according to a Gothamist analysis of data supplied by the Health Resources and Services Administration.
New Jersey uses the resource even less often. The NJ State Board of Medical Examiners, which licenses physicians in the state, did not respond to a request for information on the number of new licensees in 2021. The Gothamist analysis shows that the board checked the database just twice for every 1,000 practicing physicians in the state.
Patient safety experts and advocates say the National Practitioner Data Bank, or NPDB, is the best tool to track a doctor’s record across multiple states, despite a number of loopholes that weaken its effectiveness. Without it, they warn, medical boards can miss troubling signs in a doctor’s career, like losing clinical privileges at a hospital or making numerous malpractice payments in another state. But New York and New Jersey check the resource less often than many other densely populated states.
New York and other states that rarely use the data bank say they have other ways of finding that information and argue that the checks can become costly over time. It costs $2.50 to check the database once or to subscribe for updates on each specific doctor for a year. But the choice not to use the data bank more regularly could be putting patients at risk, said Robert Oshel, who worked at the National Practitioner Data Bank for more than a decade, most recently as an associate director.
“It may be practical for [state medical boards], but it's shortsighted in the long run in terms of protecting the public from possible bad physicians,” he said.
In 2021, New York spent around $3,000 on data bank queries, according to the Gothamist analysis of data from the Health Resources and Services Administration. That figure puts it well below the average spend by states on checks to the data bank.
Congress created the National Practitioner Data Bank in the 1980s as a clearinghouse for records of discipline and other actions against doctors. It has been collecting data since 1990. Hospitals, insurance companies and state medical boards report information on doctors to the data bank; employers and boards, as well as physicians themselves, can query the data bank and get back a list of malpractice payments and disciplinary measures that a doctor has incurred over the course of their career.
Members of the public are not able to look up individual doctors in the data bank, although some advocates are calling for that rule to change.
Congress’s goal was to prevent dangerous doctors from hopping from state to state. Oshel and other experts said that the data bank can catch information that physicians may not disclose in their applications for a new medical license or license renewal. Oshel estimated that close to 1 in 10 queries of the data bank turn up information that medical boards didn’t find anywhere else.
Ideally, he said, state medical boards would use the data bank to keep tabs on every licensed physician. But on average, New York made 1,500 queries per year between 2018 and 2021. In 2021 alone, the state licensed more than 6,000 new doctors, according to data from the education department.
New Jersey’s state medical board made just 259 checks per year for nearly 28,000 practicing physicians.
Both states require doctors to renew their licenses every two years, according to their medical boards’ websites.
By contrast, Florida and Massachusetts made more queries than they had actively practicing doctors in 2021. Both states’ medical boards also opted to subscribe to the data bank rather than making one-off checks, meaning they are notified within a day whenever a new record is added for a given doctor.
Ann Scales, a spokesperson for the Massachusetts Department of Public Health, said that the Board of Registration in Medicine has a subscription to the data bank for every practicing doctor in the state. The board also checks doctors as they apply for medical licenses, she added.
Reports from databases like the NPDB “play an important role in achieving its mission of patient safety and ensuring that only qualified and competent physicians are licensed to practice in the Commonwealth,” Scales wrote in an email to Gothamist.
New York and New Jersey have instead opted for one-time checks over continuous monitoring.
The data shared with Gothamist by the federal government on the total number of queries isn’t comprehensive, federal officials said. For example, it doesn’t include checks to the data bank made by physicians themselves.
Helen Haskell, a patient safety advocate and president of Mothers Against Medical Error, said state medical boards that don’t use the federal data bank more regularly could be missing out on vital patient safety information.
“If people are doing repeated harm, it's not a good idea to have them practicing,” she said. “And certainly, if they have been judged by another state to not be someone who should be practicing, you don't want them practicing in your state either.”
Haskell and other patient safety advocates are calling on medical boards to pay closer attention to doctors’ records in other states. Earlier this year, Texas banned doctors from practicing in the state if they’d lost their license or been convicted of certain crimes elsewhere in the United States.
Keshia Clukey, a spokesperson for the New York education department, said that financial concerns are a factor in the state’s decision not to use the federal data bank more often. She added that doctors also have to answer a series of “moral character” questions as part of their application process for a medical license, which includes information on civil lawsuits and disciplinary actions by employers.
"There is a cost associated with all NPDB inquiries, and at this time, the department has determined that routine queries of the database do not yield information about unprofessional conduct that is not available from other reliable sources," Clukey said in an emailed statement. New York requires doctors to self-query the data bank if they’re applying to get their license back after losing it, she added.
She said New York instead relies on the Federation of State Medical Boards, or FSMB, a nonprofit that collects data on physicians across the country. Queries are free for state medical boards, said Joe Knickrehm, vice president of communications at the FSMB. Massachusetts uses both databases, health department spokesperson Scales said.
“They are different data sets with different purposes.”
The FSMB’s database includes detailed information about a doctor’s education, board certification and licensure history, including whether they’ve lost or been denied a license at some point in their career. But it’s missing other information that the National Practitioner Data Bank requires hospitals and other entities to report, such as incidents where a doctor’s permission to care for patients was taken away because of safety concerns.
The NPDB also includes malpractice payments, though those aren’t necessarily indicative of actual medical misconduct by a doctor.
Hospitals are also required to report to the federal data bank if a doctor resigns in the middle of an investigation into their conduct, or if a physician quits in order to avoid an investigation.
Karmen Blackwell, a spokesperson for the HRSA, said that while the data bank and the FSMB have some information in common, ultimately “they are different data sets with different purposes.” The federal data bank’s chief aim is to track disciplinary actions, while the FSMB charts each doctor’s licensure history. Knickrehm said that the FSMB also includes disciplinary actions taken by state medical boards.
Oshel said that, while he believes the National Practitioner Data Bank is a valuable resource, the reporting rules have some loopholes that bad actors can exploit. For example, he explained, hospitals may omit a doctor’s name from a malpractice settlement, obscuring their role in some medical misconduct cases.
He also said hospitals sometimes warn physicians to resign their positions prior to the start of an official investigation into their conduct, removing the requirement to file a report with the data bank.
Oshel expressed doubts about the $2.50 charge being a cost burden to New York’s medical board.
“That's got to be budget dust in their overall budget,” Oshel said. “It's just not a significant amount.”
Nationally, state medical boards made more than 225,000 queries to the NPDB in 2021.
The NJ State Board of Medical Examiners did not return Gothamist’s request for comment.
Oshel and Haskell said more investment is needed from state governments to give under-resourced medical boards the staffing they need to thoroughly check doctors’ professional histories.
“The real cost is having the people to look at the data once [medical boards] get it,” Oshel said. “It's almost a situation where they may feel they're better off burying their head in the sand and not knowing.”
