PrimeTime: Researching Your Doctor

Nov. 16 -- How much do you know about the doctor you choose from your health plan?

A six-month PrimeTime Thursday investigation found that between Cigna and Aetna, more than 150 doctors on their 1999 provider lists for the New York City, Washington, D.C. and Los Angeles areas had been disciplined by state medical authorities in the last 10 years for a wide range of offenses. More than 70 had been disciplined for medical negligence or incompetence, including two surgeons who had operated on the wrong knee. Others were cited for substance abuse, sexual misconduct, fraud, poor record-keeping and over-prescribing drugs.

“There’s no question that doctors who have repeatedly been found to practice poor medicine are put on these lists, and it’s just a matter of which patient it’s going to be that’s going to be the next victim,” says Dr. Sidney Wolfe of Public Citizen’s Health Research Group, which publishes a yearly book called Questionable Doctors.

But Susan Pisano of the American Association of Health Plans, a trade group representing managed care, says, “Health plans go through a very rigorous credentialing process with physicians.” Health care companies, she says, check the National Practitioner Data Bank, which is not open to consumers, for any disciplinary action against a doctor and monitor performance and sanctions on an ongoing basis.

Unless a doctor’s license has been suspended or patients are at risk of imminent harm, she says, then a peer-review board evaluates doctors on a case-by-case basis, taking into account, for example, the passage of time or a doctor’s possible rehabilitation.

Patients, she adds, are better off choosing a doctor from a health plan’s list because picking a doctor out of the Yellow Pages is not nearly as secure as choosing one that has been pre-screened by a managed care company.

Still, she says, “we would agree that more information needs to be made available” because it’s a good idea for patients to do their own research before choosing a doctor.

So how can you find out if your doctor has been sued for malpractice or disciplined by a state medical board or federal agency?