Term Limits – they’re not just for politicians

meter  My professional activities bring me into regular contact with current and former members of state medical boards throughout the United States. One of the conversational threads that often arises involves reappointment to the board. Often, I’ve heard phrases like, “I’ve termed out but the governor hasn’t appointed anyone yet to take my place” or “We have a Republican governor now and I was appointed by a Democrat so I’ll have to wait and see if I’m reappointed.”

I know some of you are reading statements like these and perhaps entertaining a few thoughts of your own. “Governors appoint members to state medical boards?”  “How is political affiliation relevant to medicine? “How long do these people serve?”

State medical boards have always been mildly quasi-political creatures. From the time of their creation in the 19th century, most states have authorized their governor to make these appointments—often with input (e.g., suggested nominees) from that state’s medical association. Most of the “political” aspect has been less about party affiliation than gubernatorial largesse as a political appointment.

Prior to the 1960s, medical boards were the exclusive province of physicians. Today, nearly every medical board has public members; many have other allied professionals serving on the board as well.

But this is all background…my focus is on term limits. Today, most state medical boards restrict the amount of time someone can serve on a medical board through the use of term limits. According to the 2018 U.S. Medical Regulatory Trends and Actions all but about a dozen states impose such limits. I would argue that this is a positive—a practice consistent with accountability and good governance; and that failure to impose term limits for service on these critical boards is inconsistent with the public interest.

Granted, the comparison I’m about to make is a little bit of the apples to oranges variety but I’ll share it anyway.

Looking back at over the long span of medical regulation it’s clear that term limits were not always common. My prior reading and researching allows me to list many individuals with unusually long tenures on their state medical board.

Take, for example, Herbert Platter, MD. He first joined the newly established Ohio Medical Board in 1896. He continued serving on that board until the mid-1960s. The man was in his mid-90s and still serving on the board. platter

This may have been an extreme outlier but not by that much. Robert Derbyshire, MD, served on the New Mexico Medical Board from 1952 to 1984. Henry Fitzhugh served 25 years on the Maryland board. Impressive but still less than the 30 years or more service by Roy Harrison (Louisiana), Arthur McCormack (Kentucky), David Strickler (Colorado), George Williamson (North Dakota), Thomas Crowe (Texas), William Scott Nay (Vermont), Charles Pinkham (California) and Beverly Drake Harrison (Michigan)…or 40 years of service by Adam Leighton (Maine).

All of these examples are from the first half of the twentieth century. This was a long time ago and one might be excused for thinking, “So what? How is this relevant today?” I would argue this earlier experience is not only relevant but instructive as there were two recognizable problems that arose from the lack of term limits during this period.

Longevity fosters an unhealthy deference

All of us have been in situations where we were the ‘new kid.’ Whether as a new faculty member, a new staff hire or the latest appointee to the medical board, we have all experienced something analogous. We walk in all too aware of our knowledge gaps and inexperience and with all the predictability of a muscle reflex we look (consciously or not) to ‘veteran’ peers to give us guidance. Insider knowledge offered as a helping hand to the newcomer usually includes not only the practical, helpful tips we seek for navigating a new landscape but also that veteran’s subjective views and biases acquired through their tenure in the position. Imagine the deference new board members or even new staff give to the long serving veteran on a state medical board.

This same dynamic worked through several generations of medical boards when lengths of service such as those I mentioned stretched into decades. The deference extended to the views of board members could extend beyond their actual authority. The contemporary writing about this phenomenon asserted that the “professional prestige” acquired through decades of service allowed these board veterans’ pronouncement to carry a de facto “force of law” beyond their statutory authority. And in an era characterized by strong deference to physicians, this combination of a physician credential and longevity on a medical board made it possible for individual board members to carve out a ‘small kingdoms’ within which they enjoyed relatively high degrees of latitude and discretion.

Closing off new ideas/new blood

The absence of term limits and often extreme longevity of service by earlier members of state medical boards likely fostered complacency and reluctance to deviate from the status quo. Change is not something that most of us eagerly embrace. Put us in any position or role, regardless of what it is, and we’ll ultimately develop or establish a routine or pattern for ourselves. It’s one of the most predictable human characteristics—something allowing us to function through daily life.

For all the talents of a Herbert Platter or David Strickler (and there were many!), how many other individuals were denied an opportunity to serve when a single individual commanded a spot on the board for six decades or even three? One trade off with longevity is the lack of a regular, periodic infusion of new blood…and with it new ideas and fresh perspectives on old problems. Or even the naïve but beneficial “Why?” posed by newcomers. This simple but powerful question forces each of us to step back and articulate how we have arrived at the status quo…and by extension, whether where we have landed is still where we want or need to be.

derbyEven one who enjoyed such extreme longevity on his medical board (Robert Derbyshire) acknowledged the trade off this entailed. Yes, the veteran of 20 years on the medical boards may have become expert in disciplinary hearings but, Derby wondered, at what cost in terms of other/new ideas?

I’m not arguing that every state medical board lacking term limits for its members is unhealthy in its deference to veteran board members’ views or that they are lacking in new ideas. What I am arguing is that the lack of term limits inherently fosters an environment potentially (and unnecessarily) vulnerable to these pitfalls.

The views expressed are those of the author and do not reflect those of the Federation of State Medical Boards.