• Accreditation
• Adverse events, epidemiology and detection
• Ambulatory care

The discipline of physicians is an issue of public trust. In the majority of Western countries, physician misconduct is self-governed at a state-wide or provincial level by physician licensing and regulatory associations. In the USA, this responsibility falls under the jurisdiction of state medical licensing boards. These state boards review complaints against physicians and investigate whether standards of care and professionalism have been upheld; they also decide upon specific punishments for misconduct, including fines, extra training and education, and licence suspension and revocation. However, there is no overarching federal standard with which each state regulatory board must comply, nor is there a unifying body that compares individual states and their quality standards and policies for physician disciplinary proceedings.

In this issue, Harris and Byhoff1 investigate physician misconduct cases using a US database of medical board disciplinary actions from 2010 to 2014. The authors report up to a fourfold variation in the annual rate of physician disciplinary actions between state medical boards. They also suggest potential explanations for such variability, such as variations in patient factors, physician factors and significant differences in the processes related to disciplinary proceedings by the individual medical boards. Ultimately, the authors recommend policies to improve standardisation and provide more consistent regulation to physicians in the name of public safety. Their findings underscore the timely issue of using physician discipline and misconduct as an extreme marker of physician quality. Importantly, it is among the first to highlight such variability across jurisdictions.

Historically, investigations on physician misconduct have limited their focus to a state-wide or provincial level, or have centred on malpractice claims and lawsuits against physicians.2–9 Only a handful of studies have examined …