DOD Health Care:

Additional Efforts Needed to Verify Physicians' Qualifications

HRD-88-39: Published: Jul 18, 1988. Publicly Released: Jul 18, 1988.

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In response to a congressional request, GAO reviewed the procedures and processes the Department of Defense (DOD) uses to ensure that its physicians are medically qualified, to determine the: (1) adequacy of the DOD approach; and (2) impact of new licensing requirements on DOD unlicensed physicians and the military health care system.

GAO found that: (1) although the military services have substantially tightened preemployment screening since 1984, they have not fully implemented DOD requirements which would ensure that only qualified physicians practice medicine in military hospitals; (2) 53 percent of the 426 physicians' records it reviewed did not contain authenticated medical diplomas, and most lacked complete or adequate documentation to support the award of clinical privileges; (3) many physicians did not meet the DOD requirement for a current state license, while about 1,200 had never been licensed; (4) DOD expressed concern about the possible effects on patient access to health care if a large number of unlicensed physicians were prevented from practicing medicine independently; (5) DOD waived licensing requirements for several foreign national physicians practicing in overseas DOD facilities and plans to continue doing so on a case-by-case basis; and (6) to improve its credentialing system's efficiency, the Army established a central database on individual physicians, including authenticated information on education, training, experience, certification, and licensing.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: DOD Directive 6025.6 was issued June 6, 1988. The services have completed verification and are collecting and reporting licensure data to DOD.

    Recommendation: The Secretary of Defense should direct the Secretaries of the Army, Navy, and Air Force to complete validations of the qualifications of all physicians practicing medicine in military facilities. These actions should include: (1) validating the qualifications of all DOD physicians for whom validations have not been completed against databases maintained by the American Medical Association, the Federation of State Medical Boards, and where appropriate, the Educational Commission for Foreign Medical Graduates; and (2) performing original source validation whenever possible of the education, training, and certification of all physicians for whom original source validation has not been performed.

    Agency Affected: Department of Defense

  2. Status: Closed - Implemented

    Comments: DOD Directive 6025.11 was issued May 20, 1988.

    Recommendation: The Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs, in conjunction with the service secretaries, to issue a directive that reemphasizes the importance of fully implementing the performance-based credentialing system at all military hospitals.

    Agency Affected: Department of Defense

  3. Status: Closed - Implemented

    Comments: The services have established databases and are collecting data on all adverse privileging actions.

    Recommendation: The Secretary of Defense should direct the Secretaries of the Navy and Air Force to establish central databases to support the credentialing system. Such systems should also be used to support requirements of the Health Care Quality Improvement Act of 1986, and should be interfaced with the centralized malpractice information system.

    Agency Affected: Department of Defense

  4. Status: Closed - Implemented

    Comments: DOD and the services issued directives establishing a 5-day time frame for reporting to the Federation.

    Recommendation: The Secretary of Defense should direct the Assistant Secretary of Defense-Health Affairs, in conjunction with the service secretaries, to issue a directive emphasizing the need for timely reporting of adverse privileging actions to the Federation of State Medical Boards within mandatory time frames. The directive should stress the need for the military services, especially the Air Force and Navy, to report to the federation all physicians who have had their credentials restricted but are still in military service.

    Agency Affected: Department of Defense

 

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