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Importance: False medical information disseminated dangerously during the COVID-19 pandemic, with certain physicians playing a surprisingly prominent role. Medical boards engendered widespread criticism for not imposing forceful sanctions, but considerable uncertainty remains about how the professional licensure system regulates physician-spread misinformation., Objective: To compare the level of professional discipline of physicians for spreading medical misinformation relative to discipline for other offenses., Design, Setting, and Participants: This cross-sectional study analyzed and coded publicly reported medical board disciplinary actions in the 5 most populous US states. The analysis included data from January 1, 2020, through May 30, 2023, for California, Florida, New York, and Pennsylvania and from January 1, 2020, through March 30, 2022, for Texas., Main Outcomes and Measures: Medical board disciplinary proceedings that resulted in some form of sanction were analyzed. Codes were assigned for the different types of offenses relied on by medical boards for imposing physician discipline., Results: Among 3128 medical board disciplinary proceedings in the 5 most populous states, spreading misinformation to the community was the least common reason for medical board discipline of physicians (6 [0.1%] of all identified offenses). Two reasons tied for third least common: patient-directed misinformation (21 [0.3%]) and inappropriate advertising or patient solicitation (21 [0.3%]). The frequency of misinformation conduct was exponentially lower than more common reasons for discipline, such as physician negligence (1911 [28.7%]), problematic record-keeping (990 [14.9%]), and inappropriate prescribing (901 [13.5%]). Patient-directed misinformation provided a basis for discipline 3 times as often as spreading misinformation to the community. The frequency of disciplinary actions for any reasons related to COVID-19 care, even if not about misinformation, was also quite low (10 [0.2%]). Sanctions in misinformation actions tended to be relatively light., Conclusions and Relevance: The frequency of discipline for physician-spread misinformation observed in this cross-sectional study was quite low despite increased salience and medical board warnings since the start of the COVID-19 pandemic about the dangers of physicians spreading falsehoods. These findings suggest that there is a serious disconnect between regulatory guidance and enforcement and that medical boards relied on spreading misinformation to patients as a reason for discipline 3 times more frequently than disseminating falsehoods to the public. These results shed light on important policy concerns about professional licensure, including why, under current patient-centered frameworks, this form of regulation may be particularly ill-suited to address medical misinformation.

Background: We sought to determine whether US Medical Licensing Examination (USMLE) Step 1 score, American Board of Surgery (ABS) In-Training Examination (ABSITE) score, and other variables are associated with failing the ABS qualifying and certifying examinations. Identifying such factors may assist in the early implementation of an academic intervention for at-risk residents., Design: Retrospective review., Setting: Seventeen general surgery training programs in the western United States., Participants: Six hundred seven residents who graduated in 2000-2007., Main Outcome Measures: First-time pass rates on the qualifying and certifying examinations, US vs non-US medical school graduation, USMLE Steps 1 and 2 scores, ABSITE scores, operative case volume, fellowship training, residency program type, and mandatory research., Results: The first-time qualifying and certifying examination pass rates for the 607 graduating residents were 78% and 74%, respectively. On multivariable analysis, scoring below the 35th percentile on the ABSITE at any time during residency was associated with an increased risk of failing both examinations (odds ratio, 0.23 [95% confidence interval, 0.08-0.68] for the qualifying examination and 0.35 [0.20-0.61] for the certifying examination), as was scoring less than 200 on the USMLE Step 1 (0.36 [0.21-0.62] for the qualifying examination and 0.62 [0.42-0.93] for the certifying examination). A mandatory research year was associated with an increased likelihood of passing the certifying examination (odds ratio, 3.3 [95% confidence interval, 1.6-6.8])., Conclusions: Residents who are more likely to fail the ABS qualifying and certifying examinations can be identified by a low USMLE Step 1 score and by poor performance on the ABSITE at any time during residency. These findings support the use of the USMLE Step 1 score in the surgical residency selection process and a formal academic intervention for residents who perform poorly on the ABSITE.

Objective: To summarize and characterize the questions on initial applications for medical licensure (nonosteopathic) as they relate to applicants' mental health and substance abuse., Design: Collection and analysis of applications for initial medical licensure (nonosteopathic) from 50 states and the District of Columbia., Participants: Nonosteopathic medical licensure applications of 47 states and the District of Columbia (N = 48)., Intervention: None., Main Outcome Measures: Number of questions per application relating to mental health problems and substance abuse, in addition to time qualifiers (e.g., current difficulty, specified number of years in the past, ever) and impairment qualifiers (e.g., functional impairment, treatment, hospitalization) per question or set of questions for each area., Results: Of 48 applications analyzed, 41 (85%) inquired about mental health problems and 43 (90%) inquired about substance abuse. Most explored periods between the past 10 years and the present; functional impairment was the most common inquiry., Conclusions: Applications for nonosteopathic medical licensure most often inquire about physicians' recent history of mental health and substance abuse problems as well as related functional impairment. Variation of items across state applications may have important implications for some physician applicants.

Formal audits of the continuing medical education activities of physicians licensed in Michigan were undertaken to assess compliance with a law mandating participation in 150 hours of continuing medical education each 3 years. A random sample of all physicians renewing their licenses in 1987 and 1988 were asked to provide documentation of their continuing medical education activities. The average physician participated in 175 hours of category I approved activities; 53.1% of the hours were obtained in a different state, and only 27.6% were obtained in the home community. A total of 13.7% (132/967) of the physicians were initially unable to document 150 hours of credit. Documentation deficiencies and addition errors were found on 72.5% of forms. If formal audits of compliance with legislation are to be undertaken, early notification of the participants and specific instructions for compliance are needed. Because of problems with documentation, only category I approved activities, with exclusions for trainees, should be used to assess compliance.