Should Medical Licensure Depend on Board Certification?

Don’t forget to vote!

I read an interesting article about my favorite hobby-horse in the July 9, 2012 issue of American Medical News, see link Don’t make licensure dependent on board certification, AMA says – The story was covered by Carolyne Krup, AMNews Staff writer. The heart of the matter is whether or not the insistence on being board certified and not only that, but requiring busy work Performance in Practice (PIP) modules should be a part of Maintenance of Licensure (MOL) as well. What this could do is exacerbate the growing shortage of physicians. In fact, a recent article by blogger Dr. Steven Roy Daviss, MD at Shrink Rap News highlighted the chronic shortage of psychiatrists which adversely influences compliance of insurance plans with the Mental Health Parity and Addiction Equity Act. Go to link Insurance Networks and Mental Health Parity : Clinical Psychiatry News for Dr. Daviss’ blog post.

Even though the American Medical News article mentions that an “estimated 200,000 U.S. physicians are not board certified” and the tone of it suggests that MOC and MOL may cause some practicing physicians to retire early, (which I have considered), I’m board certified and I still believe in the principle of continuous self-improvement. I just happen to believe that components of the MOC as currently designed don’t ensure that. The easiest example is the Performance in Practice (PIP) patient feedback unit, which requires psychiatrists themselves to solicit feedback from patients. I think feedback from patients and colleagues is important. However, I don’t believe psychiatrists themselves should be soliciting the feedback because of what I believe is a natural tendency for all of us to cherry-pick. I will not solicit feedback from a patient whose safety I had to ensure by involuntary hospitalization under court order. Most patients are angry about that, at least initially, and some continue to resent the intervention. I know that I would get a lousy evaluation from such a patient. And I suspect many clinicians would probably feel the same way about it.

An alternative might be to have a third party randomly distribute patient feedback forms. That would reduce cherry-picking. However, the American Board of Psychiatry and Neurology (ABPN) has made it clear that they don’t expect psychiatrists to change their practice on the basis of any patient feedback if it is perceived as being from a delirious, psychotic, pick-your-own-adjective, patient. In fact, the ABPN doesn’t want the actual feedback forms; they just want psychiatrists to notify them that the data is being collected (see post at link ABPN Webinar on the MOC Program for Psychiatrists and Neurologists, Part III « The Practical Psychosomaticist: James Amos, M.D.). In my opinion, that’s why patient feedback forms ultimately will not work to reinforce continuous self-improvement in psychiatrists.

Now add to that the MOL, which many physicians believe might be duplicative in adding yet another documentation burden. I can see why this might worsen the physician shortage. It could discourage young people from ever considering medical school in the first place, in addition to encouraging physicians to consider early retirement.

It’ll never be too late for the ABPN and the American Board of Medical Specialties (ABMS) to repent of the ill-conceived components of the MOC. Forgive and forget…and find a better way.

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