As a patient, you put your trust in the medical professionals that oversee your care. Whether you’re working with primary care physicians, specialists, nurses, or any other care practitioner, you’re putting your health — and sometimes even your life — in their hands.
However, it’s important to remember that medical professionals are humans, and that means that from time to time, they may fall short of the expectations placed on them in their field. Sometimes, that happens in the form of poor treatment or improper procedures, the kinds of things that result in medical malpractice suits. But those shortfalls can also involve failures of conduct — including when drugs or alcohol prevent a medical professional from doing their work safely, or when practitioners behave inappropriately with their patients or colleagues.
To better understand this issue, we analyzed over 1 million adverse action reports filed from 2000 through 2022, looking specifically for records relating to drug and alcohol offenses or sexual misconduct. These records are part of the National Practitioner Data Bank, a database containing information about medical malpractice payments and other actions taken about medical practitioners across the United States and in Puerto Rico.
The data reflects that in the United States, claims of sexual misconduct against medical practitioners are on the rise, and that when drugs, alcohol or sex are involved, physicians face the stiffest consequences much less frequently than other types of medical professionals.
“Unable to practice safely”: Drugs and alcohol
Of the 1.07 million adverse action reports in the NPDB, 70,814 of them contain codes that mark them as related to drug or alcohol violations. The violations include failing a pre-employment drug screening, convictions related to controlled substances, impairment that prevents the safe practice of medicine, and “inappropriate acquisition or diversion of a controlled substance” – the practice of redirecting prescription medications intended for a patient to another party for illicit use.
More than half of the reported drug and alcohol violations — just under 40,000 in total — were by nurses, while 7,372 reports were made against physicians or physician residents (both MD and DO, or doctor of osteopathy, degrees). Those figures match up with data indicating that there are about 1 million practicing physicians in the U.S., compared to more than 5 million nurses (including both RNs and LPNs).
Inability to practice safely by reason of substance use was the most common substance-related violation across all license types, making up over 40% of adverse action reports linked to drugs or alcohol both for all medical fields and specifically for physicians.
Inappropriate acquisition or diversion of controlled substances, though, was much less common among doctors, representing less than 5% of the drug and alcohol reports against physicians — but nearly 20% of the violations when looking at other license fields.
And what happens when a medical practitioner is reported for drug or alcohol violations? The most common outcome is that the practitioner’s medical license is either suspended or put on probation by the state board — close to half of all drug and alcohol adverse action reports across all license types result in suspension or probation, with another 10% having their licenses revoked altogether. Nearly 700 prospective practitioners also had their initial applications for licenses denied due to drug or alcohol violations.
But physicians face the stiffest punishments much less frequently. They are about 25% less likely to face suspension or probation in drug or alcohol cases, and nearly 60% less likely to have their licenses revoked for a drug or alcohol violation than their colleagues are.
Sexual misconduct reports are on the rise.
From 2000 to 2022, there were also 7,333 adverse action reports based on claims of sexual misconduct by practitioners. 1,383 of those claims were made against physicians (across both MD and DO degrees, and including residents), the second most common license group to face reports of misconduct.
The most frequent offenders were practitioners in the rehabilitation, respiratory and restorative services group, topped by the individual license with the most reports of misconduct: massage therapists, with 1,276 adverse action filings. Another number that could be seen as cause for concern is 1,979: the combined number of sexual misconduct reports against licensed practitioners in the fields of behavioral health, social work and psychology.
Similar to the drug and alcohol reports, physicians face the harshest punishments much less frequently when it comes to adverse actions for sexual misconduct. The two most common outcomes for non-doctors after reports of misconduct are the state board revoking the practitioner’s license or the practitioner voluntarily surrendering their license. 1 in 4 non-physicians reported for misconduct have their licenses revoked, with another 20% choosing to voluntarily surrender.
But for physicians, probation and suspension are much more common, with about 10% facing revocation and another 10% choosing to give up their licenses. Doctors who are reported for misconduct are about 45% more likely to have their licenses put on probation than non-physicians and are more than twice as likely to be reprimanded or censured by state medical boards.
A troubling trend to keep an eye on: While adverse action reports related to drug and alcohol violations peaked around 2010 and have been steadily decreasing, the yearly number of reports of sexual misconduct by medical practitioners has nearly tripled, from an average of just over 150 per year between 2000 and 2005 to 425 a year from 2017 to 2022.
Which states experience the highest rates of drug/alcohol or sex-based misconduct by doctors?
The most common states for reports of drug and alcohol violations by physicians — as measured by total adverse action reports per 1,000 physicians in the state — are Southern and Midwestern states, including some that were particularly devastated by the country’s opioid epidemic, while the states with the highest rates of sexual misconduct violations by physicians are more spread out across the U.S.
Many of the states that rank low on the lists, like Pennsylvania, California, and New York, are high-population states that may have many adverse action reports filed, but have low rates due to large numbers of physicians licensed in the state.
Here are the total number of both drug/alcohol and sexual misconduct adverse action reports and the number of reports per 1,000 physicians from 2000 to 2022 for each of the 50 states and the District of Columbia:
|State||Drugs/alcohol: Total adverse actions||Drugs/alcohol: Adverse actions per 1,000 physicians||Sexual misconduct: Total adverse actions||Sexual misconduct: Adverse actions per 1,000 physicians|
|District of Columbia||49||2.0||24||0.6|
Methodology and data sources
All adverse action reports come from the National Practitioner Data Bank, a database maintained by the U.S. Department of Health and Human Services. We downloaded the most recent version of the dataset, updated in May 2023, and filtered on “basis for action” codes — the markers that describe the type of violation for which a practitioner was reported — that related to drugs, alcohol, or sexual misconduct.
License groups, basis for action codes and adverse action codes — which describe the action taken against a practitioner as a result of their conduct — can be found in the NPDB’s code list.
Comparisons of the relative likelihood of certain outcomes across different license groups (i.e. that physicians are nearly 60% less likely to have their licenses revoked after being reported for sexual misconduct than non-physicians) are based on calculating the percentage of all adverse action reports ending in revocations for physicians and for all other license fields, then comparing the two rates.
The rankings of states with the most drug/alcohol or sex reports per 1,000 physicians are based on the Kaiser Family Foundation’s count of physicians by state as of May 2023.