Overview of the Board of Registration in Medicine

This section describes the makeup and responsibilities of the Board of Registration in Medicine

Overview

The Board of Registration in Medicine (BORIM), established by Section 10 of Chapter 13 of the Massachusetts General Laws, is in charge of the licensing, regulation, and discipline of Massachusetts physicians and acupuncturists. BORIM, which was created in 1894, is charged with standardizing medical license practices to protect public health and safety. In 2018, there were approximately 40,000 physicians and 1,800 acupuncturists licensed in the Commonwealth.

According to BORIM’s 2018 annual report,

The Board of Registration in Medicine’s mission is to ensure that only qualified and competent physicians of good moral character are licensed to practice in the Commonwealth of Massachusetts and that those physicians and health care institutions in which they practice provide to their patients a high standard of care, and support an environment that maximizes the high quality of health care in Massachusetts.

Section 9(a) of Chapter 13 of the General Laws places BORIM within the Department of Public Health under the Executive Office of Health and Human Services. The BORIM board of directors consists of seven members who are appointed by the Governor (five physicians and two other members of the public) and serve for terms of three years. BORIM also has jurisdiction over the licensure and discipline of acupuncturists through its committee on acupuncture.

BORIM has five major divisions: the Licensing Division, the Enforcement Division, the Division of Law and Policy (DLP), the Quality and Patient Safety Division (QPSD), and the Operations Division.

The Licensing Division is responsible for processing physician licensing applications for new applicants and renewals for licensed applicants. The division validates physician credentials, including education, training, experience, and competency.

Under Section 5(f) of Chapter 112 of the General Laws, healthcare providers (e.g., physicians, medical office personnel, and hospitals) are required to file a report to BORIM on any provider they believe to be in violation of BORIM’s regulations, including those related to impairment. The Enforcement Division is responsible for investigating these statutory reports and other complaints, including those related to impairment involving physicians and acupuncturists, and for litigating adjudicatory matters. A complaint against a physician must allege that a licensee is practicing medicine in violation of law, regulation, or good and accepted medical practice as identified in Section 1.03(5)(a) of Title 243 of the Code of Massachusetts Regulations. Complaints are received from various sources, including patients and relatives of patients. Section 5(f) of Chapter 112 of the General Laws requires statutory reports of physician noncompliance to be filed by medical stakeholders, such as physicians who are self-reporting, healthcare facilities and providers, law enforcement agencies, and malpractice insurers.

DLP is responsible for researching legal issues, providing legal analysis, and advising BORIM about legal determinations regarding physicians’ licenses. DLP also works with other BORIM divisions on issues related to licensure, physician health, policy, statutory reports, and public information. Within DLP, the Data Repository Unit receives and evaluates statutory reports, oversees the accuracy of physician profiles, and reports BORIM’s actions on licensees to the National Practitioner Data Bank and other healthcare databanks. The Physician Health and Compliance Unit within DLP is responsible for monitoring licensees who are on probation because of board disciplinary actions and for determining whether they comply with their probation agreements (PAs).² PA requirements may include monitoring and the submission of compliance reports³ to BORIM. In 2018, there were 44 physicians monitored under PAs, 1 of whom successfully completed all the PA requirements. In 2017, there were 38 physicians monitored under PAs, 3 of whom successfully completed all the PA requirements. When a physician successfully meets all the requirements of a PA, s/he is eligible to have the probation period end.

QPSD oversees patient care in hospitals and offices to ensure that patients receive optimal care and to identify or prevent problems in practices. QPSD works with healthcare facilities to ensure the existence of a program of reviews and standards for quality care.

The Operations Division is responsible for BORIM’s budget operations, human resources, procurement, expenditure tracking, and facilities. The division includes a call center, a Document Imaging Unit, a mailroom, and a reception area. The call center is responsible for answering questions, helping callers obtain forms and other documents, providing copies of requested documents in physicians’ BORIM profiles, and handling licensing calls. In 2018, the call center received more than 19,000 calls. The Document Imaging Unit scans all agency documents into an electronic database for employee access.

Section 35M of Chapter 10 of the General Laws established the Board of Registration in Medicine Trust Fund, which BORIM can use, without prior appropriation, exclusively for its operations and administration expenses. The trust fund revenue consists of physician licensing and renewal fees. For fiscal year 2017, the board spent $8,851,893, of which $8,387,350 was from the trust fund. For fiscal year 2018, it spent $9,687,695, of which $9,223,149 was from the trust fund. In addition to the money in the trust fund, during our audit period BORIM received two state appropriations of $466,206 each, one in fiscal year 2017 and one in fiscal year 2018.

Physician Health Program

Most states identify a physician health program (PHP) through which physicians who have been reported as practicing medicine while impaired⁴ can obtain assistance to maintain or reestablish their licenses in good standing. This program is usually a nonprofit agency of the state’s medical society and functions as a resource for needed assistance. According to the Federation of State Physician Health Programs’⁵ website, 36 state PHPs have formal contractual relationships with their state medical boards. For the Commonwealth, physicians needing assistance are referred to Physician Health Services (PHS) as the provider of the Commonwealth’s PHP. The Massachusetts Medical Society identifies PHS to physicians as the Commonwealth’s PHP provider, and BORIM uses PHS for most impairment cases. PHS is a nonprofit corporation founded by the Massachusetts Medical Society to provide confidential consultation and support to physicians, residents, and medical students. Physicians who have been reported as practicing medicine while impaired can do the following:

• voluntarily self-report or receive assistance from PHS without BORIM involvement if no patient harm has been reported and the physician meets PHS requirements, such as receiving treatment, attending counseling meetings, and passing drug or alcohol tests
• obtain PHS services voluntarily because of a complaint before BORIM investigates
• be referred to PHS by BORIM for assessment and/or treatment as a condition of the BORIM board of directors’ disciplinary proceedings or PAs.

Physicians with BORIM PAs who receive PHS services related to substance use must also enter into a monitoring contract with PHS. PHS provides case management, including monitoring, and refers physicians to third-party vendors for assessment and treatment of substance use disorders, behavioral health concerns, occupational problems, or mental or physical illness, as needed. BORIM does not vet the third-party vendors that PHS selects to provide these treatment services. Help can also be obtained to address stress, burnout, issues with work-life balance, and a variety of physical and behavioral health concerns. Individuals with competency issues are referred by the BORIM board of directors either to PHS for assessment of other potential impairments or to a third-party vendor approved by the BORIM board of directors for assessment and services that the board of directors requires in order for the person to maintain licensure.

A physician’s PA with BORIM requires the physician to comply with all terms of the PHS monitoring contract, PHS to submit quarterly compliance reports to BORIM, and PHS to notify BORIM immediately of any noncompliance with the agreement. All fees and costs for compliance with the agreements, including costs for assessment and treatment, are the physician’s responsibility.

2.     PAs detail BORIM’s requirements for physicians to return to good standing and are signed by the physicians and BORIM’s chair. PAs involving substance abuse are typically five-year agreements requiring monitoring by Physician Health Services. If a physician does not comply with the agreement, a new PA is signed and the five-year probation period restarts.

3.     Compliance monitoring reports include quarterly Physician Health Services reports and other compliance reports submitted by the personal physician of the physician on the PA, worksite monitors, or chaperones. They are submitted either quarterly or monthly, depending on the terms of the PA.

4.     “Impaired physician” is defined in Section 1.03(5)(a)(4) of Title 243 of the Code of Massachusetts Regulations as a physician “practicing medicine while the ability to practice is impaired by alcohol, drugs, physical disability or mental instability.” This audit only includes alcohol and drug impairments.

5.     The Federation of State Physician Health Programs is an independent organization that focuses on the rehabilitation and monitoring of physicians experiencing substance use disorders.

Date published:	April 7, 2020