Saturday, January 07, 2012

It's Time to Look Critically at Board Certification

From Edwin Leap, MD:
Unfortunately, the rank and file is very unhappy. There is remarkable discontent, and considerable anger, among the lesser physicians. That is, the test takers, the physicians in practice subject to the new rules, the ones who have to add one more rule, one more activity, one more form, one more check to their already busy lives.

That discontent, that anger, that frustration on the part of practicing physicians is, in my opinion, very rational. It’s a tough time in medicine. Our regulatory burden grows by leaps and bounds every year. We are watched and harassed, by CMS, by JCAHO, by our state medical boards, by our insurers, by our hospital staff offices and now, most painfully, by our own specialties.

Of course, all of it comes in the context of falling reimbursements, a federal government licking its lips for any spurious allegation of fraud and a system in which EMTALA forces physicians of all specialties to see patients for free, even as government insurance programs pay less than the over-head to see their patients (and fulfill the regulatory guidelines required for the privilege of doing so).

In light of all of this, I have to ask ABEM and every other board certifying body, a simple question:

“What are you people thinking?”

Here’s the reality. Our certifying bodies should be our greatest, most passionate advocates. When the Institute of Medicine issued a report some years ago that said physicians were killing people on a scale consistent with the holocaust, ABEM should have looked at the data and refuted it. ABEM, and ABIM and all the others should have taken our fees, run out and found the best PR firm they could afford. “We stand by our physicians and we have serious questions with these research results and the way they are being interpreted.” That would have been a good use of my dues. That would have merited high salaries for everyone in every board that stepped up for its members.

Instead, at every step, ABEM seems to argue that “the public” wants us to be watched more closely and tested more frequently. Except, I’m not confident that’s true. The public never cares where you went to medical school. The public thinks most emergency physicians are interns hoping for a “real practice” someday. The public wants affordable, quality care. The public, in practical terms, doesn’t know the difference between a physician, a PA and a nurse practitioner, and often calls all of them “doctor.” The public, furthermore, tends to believe that mid-level providers are more attentive to their needs. (Despite their lack of board certification; shocking indeed!)
There's plenty more.

Go now. Read the whole thing.


From my archives on the same subject:

1) Posers
2) Alphabet Soup
3) BoxTop Board Certification
4) Board Certification - Pay to Play?
5) The Cost of Our Medical Licensure Complex


Tim Hulsey, MD said...

Why is it "our" organizations always evolve into self-perpetuating associations worried only about their own institutional survival? Just look at the mac-daddy of all betraying institutions, the AMA. lists "Physicians" as supporters of obamacare because the AMA was, even though they represent less than 20% of us! Most of our specialty societies swear allegiance to the AMA. Our state medical societies are all clones of the AMA. I was elected by our county medical society as our trustee just to piss off the KMA! And I did a bang-up job of it, if I do say so myself. After about a year, I resigned from the job to get away from the taint! Instead of using our dues, as Leap says, to stand up for us, they tuck their tails and act guilty.
I am proud to say that I have never belonged to the AMA. I have recently let my specialty society membership lapse. Like Leap, I'm getting tired of the b*#^@$&t while getting no real representation. I can't get rid of the government bureaucracy, but I can damn sure eschew placing further anchors around my neck at my own expense!

Pluripotent said...

On the topic of medical errors mentioned in the post: I attended a lecture on this during my internal medicine rotation during which we were quoted all of these stats about how physicians are killing their patients. I was listening up to the point where he used appendectomies as an example. The physician lecturer quoted some number of appendectomies that were done "in error." But I actually gave a lecture on this myself during surgery. The fact is that there is a concept of "number needed to treat" which applies to most medical procedures and regimens. If a surgeon is not removing a minimum 2% healthy appendices, with up to 8% still being within the NNT, that surgeon is actually removing TOO FEW appendices. But this physician was including these as surgeries done in error. After that, my confidence is his critical thinking abilities plummeted and I began wondering what agenda he was trying to push, and whether all of his stats on "physician errors" ignored the concept of NNT to inflate his numbers for shock value (they probably did).

Anonymous said...

It is too bad that KevinMD gets the attention for this post. KevinMD has long ago been placed on ignore for his hatred of specialists. He loathes specialists up until the point when the cardiologist takes an extra 10 minutes to return his phone call in the ER at 2am (and bail him out).
Also, why would he take any claim on this topic? Are ER docs/family practice certified in peds/ortho/GI etc, etc. This is a disease of the specialists. Echo, nuclear, EP, interventional, CHF boards....

Keith said...

Keep hammering away Wes. Maybe someone will listen.

What our societies should have done is say sure, we will all get recertified, but you pay for the loss of income, travel expenses and costs of the exam. See how many of the people pushing this concept would see this as a plausible option then if they had to actually pay for their unfunded mandate.

What other profession needs to take a test every 10 years? None that I know of.

PS Did I actually agree with you for a change?