Amid the growing public clamor over patient safety, quality of care, and malpractice, state medical boards find themselves on the hot seat. The pressure is especially intense when the evidence suggests they haven't done their disciplinary jobs.

Last year, for example, critics slammed the South Carolina Board of Medical Examiners for botching its attempt to suspend the license of FP James M. Shortt—a self-described "longevity physician" who's under investigation by state authorities for giving intravenous hydrogen peroxide to two patients who subsequently died. (In April, the board temporarily suspended Shortt's license after he was accused of inappropriately prescribing steroid testosterone to four unidentified male patients.)

This year, a series on medical boards in The Washington Post singled out the District of Columbia Board of Medicine for a variety of lapses, including its alleged foot-dragging in the case of Jewel A. Quinn, an orthopedic surgeon who reportedly practiced under appallingly filthy conditions and couldn't produce patient records upon request.

Still, people on all sides of the issue want medical boards to do a better job of disciplining unprofessional or incompetent doctors, and to play fair with the vast majority who practice as they should. "Whatever state you're in, no one benefits from having a weak medical board," says Rolf P. Sletten, head of the North Dakota Board of Medical Examiners, one of the most active in the country. "Not the profession, not the public."

The issue of better doctor policing has also entered the malpractice debate. Last year, as part of its strategy to cut claims, the Bush administration commissioned the Urban Institute and the University of Iowa to study how medical boards can operate more effectively, weeding out bad apples before they put patients at risk. The report is scheduled to come out this summer.

How will boards respond to this new push to get them to intervene more aggressively in the area of quality? Which boards are doing the best disciplinary job—and why? What standards should boards be aiming at? We took a look at these important issues.

Best practices every board should adopt

What are the ingredients of a successful medical board? The FSMB provides the answer in a document called A Guide to the Essentials of a Modern Medical Practice Act. First published in 1956 and now revised every three years, the guide serves as a template for state statutes governing medical boards. The document also serves as a kind of marketing tool, selling state lawmakers and boards on what the FSMB sees as the best way to do things.

On the all-important issue of structure, the guide recommends "a separate state medical board," with the broad autonomy to generate sufficient revenues through licensing fees and other physician charges; to adopt and manage its own budget; to "hire, discipline, and terminate staff"; and to "institute actions in its own name," drawing upon "adequate" legal and investigative staff.

Boards should also have broad subpoena power, be capable of sharing data with a variety of entities that also monitor information pertinent to physician performance (Medicare, Medicaid, hospitals, health plans, malpractice insurers, and so forth), and be capable of taking disciplinary action based on "a preponderance of the evidence" rather than the stricter "clear and convincing evidence."

How do boards stack up to these benchmarks?