As a member of a professional organization embroiled in this
controversy it has give me a front row seat to the problems with physician
regulation and how things are never quite what they seem to be. From the outset there was scant evidence that
recertification exams were necessary and with the exams no evidence that I am aware
of that they have accomplished anything.
The American Board of Medical Specialties (ABMS) actually has a page on
their web site devoted to what evidence exists and I encourage anyone to go
there and find any scientific evidence that supports current MOC much less the
approaching freight train of Maintenance of Licensure or linking MOC to annual
relicensing by state medical boards.
Feel free to add that evidence to the comments section for this post.
Prior to this idea there were several specialty
organizations that had their own programs consisting of educational materials
that were self study courses that could be completed on specific topics
relevant to the specialist every year. A
formal proctored examination and all of the examination fees that involves was
not necessary. The course topics were
developed by consensus of the specialists in the field. A couple of years ago I watched a CME course
presentation by a member of the ABMS who pointed out that three specialty
boards (of a total of 24) wanted to continue to use this method for relicensing
and recertification. They were denied
that ability to do that because the ABMS has a rule that all of the Boards have
to use the same procedure that the majority vote on. The problem was that very few of the
physicians regulated by these Boards were aware of the options or even the fact
that there would be a move by the ABMS for a complicated recertification scheme
and that they would also eventually push for it to become part of relicensing
in many states.
If the ABMS is really interested in evidence based practice,
the options to me are very clear. They
currently have no proof that their recertification process is much more than a
public relations initiative. Here is my
proposal. Do an experiment where one half
of the specialists to be examined that year complete a self study course in the
relevant topics for that year. That can
be designated the experimental group.
The other half of the specialists receive no intervention other than
self study on their own for whatever they think might be relevant. Test them all on the topics selected for the
self study group and then compare their test scores. See who does better on the test. Secondary endpoints could be developed to
review the practices of each group and determine whether there are any
substantial differences on secondary measures that are thought to be relevant
in the tested areas.
Until this straightforward experiment is done, the current
plan and policies of the ABMS are all speculative and appear to be based upon
what has been called conventional wisdom.
Conventional wisdom appears to be right because all of the contrary
evidence is ignored. There is no
scientific basis for conventional wisdom and it falls apart under scrutiny. Physicians in America are currently the most
overregulated workers in the world. The
rationale for these regulations is frequently based on needing to weed out the
few who are incompetent, unethical, or physically or mentally unable to
practice medicine. Many regulatory authorities
grapple with that task and maintaining the public safety. In many cases it is a delicate balance. But we are far past the point that every
physician in the country should be overregulated and overtaxed based on conventional
wisdom because regulatory bodies are uncomfortable about their ability to
identify or discipline the few. If the ABMS or any
other medical authority wants evidence based safeguards for the public based on
examination performance – it is time to run the experiment and stop running a
public relations campaign to support the speculative ideas of a few.
George Dawson, MD, DFAPA
