Recidivism is a fundamental concept in the U.S. justice system — defined, simply, as the tendency for a person convicted of wrongdoing to re-offend.

Common sense tells us that by finding ways to reduce recidivism, we should also be able to reduce the incidence of misbehavior. But accomplishing that goal is no easy task: Just ask the generations of law enforcement officials, policy makers, judges and others, who for years have grappled with finding the balance between punishment and rehabilitation for those convicted of crimes in the United States.

State medical boards grapple with recidivism, too, and in the day-to-day work of medical regulators, it is a particularly challenging topic. Health care providers who get into trouble with state medical boards may be eligible for remedial coursework and other steps aimed at helping them overcome issues, but how effective are these actions in changing their behavior? And, if some providers are likely to be “repeat offenders,” how can we effectively identify them and prevent them from getting into more trouble in the future?

Data on recidivism and medical regulation is sparse, but the need for a better understanding of the topic is growing — especially in light of recent media attention on devastating issues such as sexual misconduct among physicians. We owe it to patients, whose safety we pledge to protect, to do everything we can to ensure there are no “repeat offenders” in such circumstances.

We need more dialogue about recidivism, and in this issue of JMR, we offer a special section with that goal in mind.

Our aim is to provide multiple perspectives, and in the pages that follow you will learn of the efforts of two state medical boards to better understand recidivism, as well as studies on the topic from two remedial education providers:

  • In an effort to understand levels of recidivism among physicians and physician assistants in the state of Washington, the Washington Medical Commission assessed 12 years of disciplinary information, discovering in the process that there are common timelines and complaint instances among recidivist providers in Washing-ton. The findings suggest that proactive interventions by medical boards, aimed at reducing the incidence of recidivism, may merit further study.

  • The North Carolina Medical Board undertook a comprehensive analysis of its disciplinary data in 2019, focusing on cases involving opioid prescribing. Its goals included gaining insight into the efficacy of its regulatory interventions, with an eye towards reducing recidivism. While the study enabled the Board to draw some general observations, one of its most important takeaways is that inconsistencies and insufficiencies in board data-collection processes are a significant barrier to making meaningful decisions regarding recidivism.

  • CPEP, the Center for Personalized Education for Professionals, conducted a retrospective study of more than 2,000 chart-reviews of individuals participating in its Practice Monitoring Program for physicians complying with board orders due to substandard care. It found that individuals who had completed a comprehensive competence assessment and education program before practice monitoring were significantly less likely to display continued substandard care than those who entered monitoring without engaging in a preliminary assessment and education program.

  • PBI Education conducted a study of a subset of licensees who attended its remedial courses in ethics, professionalism and/or boundary violations for a period of six to 11 years after course graduation. The study illuminates reasons why accurately quantifying recidivism after remediation can be difficult, concluding with suggestions aimed at helping the regulatory community achieve a more nuanced understanding of ways in which future studies of recidivism could be improved.

We hope these combined articles will broaden the discussion of recidivism, and we value the opinions of our readers on the topic. We encourage you to send your thoughts and suggestions to us at editor@fsmb.org.