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All six study Boards were in the middle half of budgetary resources nationally in 2003, but the highest state studied still had almost double the funding of the lowest. Pre-hearing processes resolve almost 20 of cases, either dropping them after further consideration by staff and prosecuting attorneys or settling them by agreement with the respondent. Only about 1.5 of complaints reach formal hearing.

First, we thank John Hoff, former Deputy Assistant Secretary, Office of Disability, Aging and Long-Term Care Policy, who saw the need for and took the lead in setting the goals of this study, as well as project officer Linda Bergofsky, who contributed throughout the project, including participation in one site visit and two annual meetings of the Federation of State. Available documentation on Boards was obtained; and open-ended sessions were conducted with physician and non-physician Board members, executive directors and other managers, staff, and outside observers or participants in Board activities. Information on Board structure and operations came from detailed case study interactions in six states during 2004-05. Descriptive analysis of cross-state structural and performance data was possible based on case study results and national data on Boards for 2003, the most recent available, from the Federation of State Medical Boards, and current licensure requirements came from the compilation of the.

Intake resolves about 14 of cases before investigation, largely because they are minor or complain about unregulated behavior, such as physicians charges. Investigation closes almost two-thirds of cases, typically because there is too little evidence to support formal charges but sometimes with an informal notice of concern or similar communication with the respondent physician.

Second, we thank the knowledgeable and helpful members of the projects Technical Advisory Group (TAG) (Appendix A). Before case studies began, they helped shape the issues addressed and overall approach taken, as shown in the concept paper (Bovbjerg and Stockdale 2004).

The volume of complaints per thousand physicians varies considerably by state, in part because of differing standards of what constitutes a complaint. Complaint resolution proceeds through four main stages: intake, investigation, pre-hearing preparations, and hearing.