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May 15 2012

To all expert reviewers. . .We thank you!

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Image for To all expert reviewers. . .We thank you! Editor's note: NCMB's process for arranging independent expert medical reviewers has changed. The staff contact as of May 2022 is Pamela Smykal, NCMB’s Quality of Care Paralegal who manages the outside reviewer program. She can be reached at or at 919-326-1109 x282.

Last year the NC Medical Board called on more than 100 practicing physicians who provided independent expert reviews of quality-of-care cases under investigation by the Board. The list of physicians who have offered to provide reviews to the Board numbers more than 350. Expert reviews help to determine whether care met accepted standards in scores of cases under review, guiding the Board’s decision to proceed—or not—with prosecuting individual cases.

The Board wants to extend a public ‘Thank You’ to each and every one of the professionals who have offered their expertise as independent expert medical reviewers to the NCMB. Their dedication and time is greatly appreciated by the Medical Board and its staff.

In the brief interview below, NCMB Medical Director Scott G. Kirby, MD, spoke with Forum Editor Jean Fisher Brinkley about the important role external reviewers play in the Board’s disciplinary work.

What constitutes a meaningful review from the Board’s perspective?
The Board is looking for a concise review of the care provided with specific reference to the diagnosis, treatment, quality of the medical record and overall care provided. We need people to review the medical records and provide a summary of the care that was provided. We need the reviewer to make a statement as to what the accepted standard of care for the particular area under review is. Then they should describe in detail the deviations from the standard of care and, finally, provide a rationale for their conclusions about why it was below the standard.

How valuable are the services provided to the Board by independent expert medical reviewers?
Extremely. External reviews are an integral part of the Board’s determination to resolve a case in a certain way. The Legal Department cannot proceed in a standard of care case without an external review in most cases. Of course, there are some areas where it is self-evident. Wrong site surgery, retained foreign bodies and other things like that don’t necessarily need an external review. But for many other standard of care cases an external review is really needed to move forward. And even in some behavioral cases, such as in psychiatry where the standards of care regarding boundary can become blurred, a review is sometimes needed.

Are there any specialties or subspecialties that are in particular demand to conduct external reviews?
We have burned out our pain management docs, I’m afraid, because controlled substances prescribing is such a frequent problem. We need more physicians who are engaged in pain management—non-interventional pain management—to participate.

Are there specialties that are overrepresented?
A great many pediatricians have indicated their willingness to review, but we have very few pediatric quality of care cases to send out. That’s a good thing. Thank goodness we don’t have a lot!

Is there anything else you’d like to add?
Reviews are very time sensitive, and physicians have a lot of obligations. Some of the medical records we send out for review are very complex and take a tremendous amount of time. The problem is we need to get the reviews back in a very timely manner. We usually say within four to six weeks but we’d really like to get them back sooner. If physicians are not willing and able to have a fairly quick turnaround time, it would be better for them not to participate.

Interested in reviewing standard of care cases for the NCMB?
The NCMB frequently calls on independent expert reviewers to analyze patient medical records and report their opinions and conclusions to the Board for its consideration as part of the overall case review process.

On rare occasions, a reviewer may be asked to offer testimony at a formal disciplinary hearing. North Carolina law (NCGS §90 14 (f)) specifically protects individuals who provide expert medical opinions to the Board in good faith, without fraud or malice, from liability in civil proceedings.

Although the time required to complete a report varies, a typical review takes approximately one to three hours per patient. Compensation is provided at $175 per hour.

External reviewers should be ABMS or AOA Board certified, have no history of public discipline with the Board and have been engaged in active clinical practice in North Carolina for at least the past two years.

To indicate your interest in providing outside medical reviews, contact

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