(1) Field Survey Results and

Observations

A field survey of State professional associations was conducted in Maryland, New York, and Virginia. Time and scope limitations prevented an analysis of all State associations in a selected State. However, the survey was directed to accomplish the following objectives:

• The associations' interaction with the State regulatory boards and enforcement agencies, particularly disciplinary procedures affecting member-practitioners

• The associations' operational activities in areas such as the conduct of self-regulatory programs, the efficacy of peer review procedures, continuing education, and the overall effort made to monitor and improve the health professionals' ability to practice a given profession.

Based on interviews with the health professionals in the three selected States, the following observations were made:

• Ethical Practices

In many areas such as Virginia, where the State Medical Society has 49 local components, to maintain State membership, the medical practitioners also must retain membership at the local level. This provides monitoring by medical professionals residing in the same community. Typically, the local medical professional is better qualified to screen and review the ethical practices of each practitioner

Lack Of Statutory Support

Typical of most professional associations, the society has no statutory basis or legal authority. As a result, it only can reprimand errant members or, as a last resort, revoke membership. Approximately 5,000 members out of an estimated 6,000 physicians licensed to practice in Virginia are members of the State medical soceity. Because of the relatively smaller number of licensed practitioners in Virginia (6,000) compared to New York (57,784), stronger group pressure can be applied in Virginia to influence membership activities

Self-Policing Provided

The interviewee from the State Medical Society of Virginia indicated that the society has performed internal policing by monitoring activities of its members, without utilizing the State board. The types of disciplinary actions in which the society has taken active roles are: Ethical Violations

These violations include problems involving medical advertising, professional signs, and announcements

Grievances from Patients

These grievances generally involve fees, failure to make house calls, failure to complete insurance forms, etc. For the most part,

The State medical societies maintain a commit-
tee on continuing medical education to improve
the quality of medical care. The program of
continuing education is not related to relicen-
sure and/or retention of society membership.
In Virginia, the society opposes mandatory con-
tinuing education because "fear of recertifica-
tion exists among practitioners." Drug abuse
education is seen only as a by-product of con-
tinuing education. Over a 3-year period, 150
points of continuing education activity (1 point
= 1 hour) are required.

The following subsections reflect findings from the nationwide questionnaire and provide insight into the areas of concern. Following each finding is a table for comparative analysis and a legend of abbreviations used in the table.

Of particular interest, the pharmacists viewed drug theft and forged prescription orders with concern and labelled them serious problems. Direct handling of controlled substances and increased exposure to the problem could be the reason for this heavily weighted finding. The pharmacists were only moderately concerned about the multiple prescription order problem. Once again, pharmacists' opinions were stronger than those of other professions. Illegal sales by registrants was assessed to be a minor problem. Pharmacy theft was felt to be the most likely source for the abuse of controlled substances. Increased enforcement activity was suggested by an overwhelming majority as the most effective method modifying drug problems. Sources of Controlled Substances for Diversion Data indicate that the most likely source of con

trolled substances diversion was by multiple prescription order (49 percent, or 120 of the responses). Pharmacy theft (45 percent or 109) was the next most likely source of diversion. Seventy-two percent (38) of the pharmacists felt that pharmacy theft the most likely source of diversion. Twenty-eight percent (11) of pharmacists and 28 percent (13), of veterinarians showed a substantial number of diversion sources other than those listed. When responses were assessed by relative State size, the priorities of abuse were the same as listed earlier. The likely sources of abused controlled substances are shown in Table 7.

Approaches to Diversion (Leakage) Control Because it was anticipated that the study would indicate that drug abuse and diversion were viewed as significant problems, respondents were asked which methods were most effective in modifying the problems. The most effective method of modifying the drug problem was found to be increased enforcement, 54 percent (133). The responses indicated that the next most favored means for problem modification was continuing education, with 41 percent (101) of the responses. Only 2 percent (6) of the respondents indicated that other associationsponsored activities would be effective in modi

fying drug problems. When drug problem modification was assessed with regard to state size ranking, the findings were corroborated. (See Table 8.) However, association-sponsored peer review was held to be a more important method for drug abuse problem control by the larger state size groupings: 44 percent (119) for the five largest States, and 38 percent for the second five largest States (6-10) compared with 21 percent (42) for all other States (11-51).

(3) Self-Regulation*

To find means to improve disciplinary and regulatory processes, association representatives' attitudes on self-regulation and peer review were addressed. It was recognized that these are not

utilized to the same extent in each profession, but that the need exists for ensuring comparability among the professions.

Respondents expressed mixed feelings about self-regulation. Twenty-five percent (62) said it has been positively considered, while 21 percent (51) said it had not. But when asked whether peer review had been considered specifically, a slightly larger number of respondents-67, or 27 percent said it had been positively considered. The relatively large number indicating positive consideration of self-regulation or planning and implementation of association efforts shows a trend toward self-regulation.

*EDITOR'S NOTE: Some statistics referred to in this subsection are found in tables not included in this document.