Minnesota Worst at Protecting Patients from Bad Doctors?

The Wall Street Journal's Health Blog contained one of those factoids that's bound to get sent around, devoid of context and attributed to the Journal — as it was today by Politics in Minnesota's Morning Report.

Where doctors are most (and least) likely to get busted, WSJ Health Blog. MN at the bottom of the list.

But what does Minnesota being at the "bottom of the list" mean? That our state medical board is terrible at disciplining physicians and therefore not protecting public health? The Health Blog at least takes a stab at evenhandedness.

It’s hard to know what to make of the rankings. Sid Wolfe, who runs Public Citizen’s Health Research Group, argues that state boards that are better funded, better staffed and more effective tend to have more disciplinary actions. But an official at the FSMB tells American Medical News that “it could very well be that the best medical boards succeed in preventing serious problems and would have low numbers of disciplinary actions, and the citizens of those states would be better protected.”

That doesn't stop Public Citizen from including Minnesota on its Worst States list.

I'm inclined to go with the theory that fewer disciplinary actions reflects Minnesota's generally high level of health care outcomes in the state and the relatively low proportion of paid malpractice claims. (We rank 25th for total number of paid claims, and the states that rank better have smaller or similar populations. Other "worst" states like South Dakota, Wisconsin and Mississippi also had low claims.) I'd guess the state's fairly high penetration of managed care organizations also has something to do with enforcing standards and upholding quality of physician performance.

Finally, since a small percentage of doctors commit most of the negligence, medical errors and other infractions that prompt medical board action, disciplining a higher proportion of physicians could simply be evidence of a higher proportion of substandard practitioners in the state.

In other words, Edina may have fewer arrests per capita than Minneapolis, but that's not because its police do a worse job.