The state board that licenses and disciplines physicians should distance itself from the medical establishment and open its records to the public, legislative analysts say.
The 15-member Board of Physician Quality Assurance, which by law has only three non-physicians, should also add two more consumer members, according to a review by the legislature's Department of Fiscal Services.
The recently released audit concludes that while the board's performance has improved in its three years of work, several major changes are still needed to ensure the competency of Maryland's doctors.
The audit focuses on the tight relationship between the licensing board and the Medical and Chirurgical Faculty of Maryland, the state medical society.
Under state law, Med-Chi members are required to review nearly all serious charges brought to the board against a doctor. That process of "peer review" often stretches out unnecessarily for months, undermining the disciplinary process. And the public perception persists that doctors are "far too protective" of their colleagues, the audit says.
The audit suggests that the board refer some charges to other experts, rather than Med-Chi, a suggestion that could result in the state's hiring medical experts. Med-Chi does not charge the state for its peer reviews.
The audit also recommends taking away Med-Chi's power to nominate 10 of the board's 15 members, saying that the process may give the society too much control over the board.
Dr. Israel H. Weiner, chairman of the board, said the audit raises some good suggestions. But he said doctors -- whether in Med-Chi or not -- are the only people qualified to pass judgment on their colleagues.
"I think there is this perceived distrust of doctors reviewing themselves," Weiner said. "But that's what you're stuck with. No one else can review them when it comes to [assessing] standards of care."
A Med-Chi representative also disputed the audit's suggestions.
"The mark of every profession is its ability and competence in policing its own," said Gerard E. Evans, Med-Chi's chief lobbyist in Annapolis. "Med-Chi's role is consistent with every other profession's role in Maryland."
Evans said the review board, which was created by merging two other boards in 1988, is "a relatively new system."
"Yes, it has some kinks to be worked out," Evans said.
The audit suggests that the board should open its operations to more public scrutiny. By law, only its final formal conclusions can be made public. Even some final disciplinary actions are not made public, and patients who file complaints are kept in the dark about their cases.
"Denying consumers and complainants access to information serves the profession at the expense of the public; it is not in the public interest," the audit reads.
Weiner agreed that the board should be allowed to make more information public and has proposed making all of the board's charges public.
The General Assembly may consider the audit's recommendations when it convenes in January.