First Do No Harm: The Consequences of a Physician Disciplinary Record

Colleen Carey | Cornell

Colleen Carey is an Associate Professor in the Department of Economics and the Brooks School of Public Policy at Cornell University. Carey’s research focuses on the economics of markets for health care and health insurance. She has held Federal service roles at Council of Economic Advisers (Staff Economist, 2011-12) and Centers for Medicare and Medicaid Services (Fellow, 2024-25). Previously, she was a Robert Wood Johnson Scholar in Health Policy Research at the University of Michigan and a visiting researcher at Princeton University’s Center for Health and Wellbeing.

Abstract

State medical boards enforce care quality standards by disciplining physicians via publicly disclosed administrative actions. We use a novel dataset of 70,000 state medical board actions in more than 40 states over the years 2008-2023 to report the first estimates of the effect of these disciplinary actions on physician careers. We find that 2.5\% of physicians ever receive a disciplinary action over this time period. We link these actions to administrative records on physician practice settings as well as large-scale medical claims to study how physician practices and labor supply change after discipline. We use a difference-in-differences research design leveraging variation in treatment timing among ever-disciplined physicians. We first report that many disciplined physicians continue to practice; this is true even for a substantial minority of those losing their license in a particular state. Disciplined physicians are twice as likely as not-yet-disciplined physicians to begin practicing in a new state. Disciplined physicians who continue to practice supply fewer claims, though are no less likely to have a hospital affiliation or be in solo practice; they are more likely to work in prison, tribal, or military clinics. By providing the first national evidence on the prevalence, correlates, and consequences of physician discipline, our study informs the optimal scope and design of state oversight.