In December, I had the pleasure of speaking to the Tennessee Recovery Coalition, a non-profit dedicated to educating the community about the disease of addiction, promoting evidence-based treatment models, focusing on primary prevention tactics, and advocating for patient-centered policies.

Against the backdrop of the opioid crisis and the myriad of challenges facing the health care industry, we discussed the purpose and practices of the Tennessee Board of Medical Examiners.

The Board of Medical Examiners was created in 1901 by the Tennessee State Legislature with the mandate to protect the health, safety and welfare of people in the State of Tennessee. On a day-to-day basis, the board awards provider licenses to qualified candidates. The board also interprets the laws, rules, and regulations to determine standards of practice. Finally, the medical board is responsible for disciplining licensees who are found in violation of the laws and regulations governing their practice.

Members of the Board of Medical Examiners are appointed by the governor of Tennessee to five-year terms. In order to interpret the rules regarding standards of practice, board members issue advisory private letter rulings, issue declaratory orders, and make determinations in contested case hearings.

The board is tasked by the state legislature with holding doctors accountable for their competency and behavior. As such, the board aims to strike a balance between punitive measures and enforcing accountability through educational training, chart monitoring, and demonstration of competency. Because the correlation between patient outcome and provider behavior can vary widely, the board makes its judgments about physicians based on the physician’s behavior, not on patient outcome, seeking to distinguish between normal human error and intentional reckless behavior. The board also makes judgments determining how actions outside of a physician’s professional life affect that individual’s ability to safely practice medicine.

If a physician is found to have committed misconduct or is in noncompliance, the board has a range of remedies to ensure it has provided the best chance for a correction in the licensee’s behavior and/or to avoid future noncompliance. The board may refer a physician to the Tennessee Medical Foundation for non-disciplinary counseling, recommend the physician undergo a psychological/behavioral health evaluation provided by the Vanderbilt Comprehensive Assessment Program for Professionals (VCAP), require the physician to complete education and training, demonstrate competency, or finally, the Board may impose disciplinary action.

Typically, punitive action is reserved for physicians who are under the influence of substances while practicing, have blatantly disregarded the standards of practice, are recklessly unsafe, have committed a criminal act, or have engaged in behavior considered unprofessional, dishonorable, or unethical.