Is there an agency (either state or federal) that tracks physicians, and evaluates them on a regular basis for the quality of their work? I would assume this would be done by each state if it is done at all…
And if so, can doctors lose their license to practice if they are deemed incompetent?
I am pretty sure (and please correct me if I am wrong) that doctors periodically have to be re-certified, however I have no idea what this entails. Is it an exam of some sort, or is it just a required filing/licensing fee that the state gathers whenever the re-certification date rolls around?
Also, if these exist, do they operate only when a complaint is filed with their office by a patient, or do they monitor doctors regularly, with or without patient complaints?
Physician licensing is done at the state level in the U.S.–every state has a board of healing arts or equivalent.
In my state (Kansas), M.D. licenses have to be renewed every year, but it’s mostly administrative: pay the fee, provide proof of continuing education, provide proof of professional liability insurance, and you’re good to go.
If a complaint is filed (by a patient or by another doctor/nurse/insurer/etc.), the board will open an investigation, and yes, that could lead to the doctor losing their license.
I think what the OP was talking about is whether e.g. government busybodies come around once in a while and review charts, criticize decisions, and otherwise proactively try to find flaws in a doctor’s practice. E.g.:
Government inspector: “What’s this?”
Doctor: “That is Mrs. Smith’s record. She was last here for treatment, ahh, let me see, April 12.”
Government inspector: “You prescribed HyperDrug for her Transcranial Hematosis?”
Doctor: “Yes, that is my standard treatment. It has worked for most of my patients, including Mrs. Smith.”
Government inspector: “There’s been some new research. According to Johnson (2014), HyperDrug is associated with an elevated risk of cancer of the spleen in people of Irish descent. Here’s Mrs. Smith’s background check that I picked up yesterday at The Background Check Office. Irish! You’re a quack! By the power vested in me by the Medical Board, I deem you incompetent! Turn over your license!”
What there is instead is checking if your doctor is Board Certified. Board Certification in your specialty needs to be maintained and that process requires (in my specialty at least) evidence of a certain amount of approved continued medical education of both facts and of quality improvement activities, and passing a test of knowledge and judgement every so many years.
Yes many of us think that the maintenance of certification process is a bit of a racket but at least it provides for some baseline.
State Medical Licensing Boards can also revoke or suspend a license for cause but not with any sort of regular evaluation for quality. These suspensions and revocations will be for things like sexual misconduct, drug abuse, criminal activity, fraud, and so on.
Thank you. This is what I imagined, but now I know.
As far as continuing education goes, what is required? Is there a list of approved and/or reqired classes, or do you have a large amount of flexibility?
As for filing a complaint, who would a patient file a complaint with? If I had a problem with a doctor’s performance (let’s say he/she did something completely negligent/incompetent… and it could be anything from a bad surgery to say a GP prescribing conflicting drugs which could cause a permanent problem… ). Does each state have a place for patients to go to file a grievance?
I am a bit disappointed to hear that the yearly certification is little more than a filing fee and some standard paperwork, especially considering how fast the medical world moves… However, I am not so sure how easy it might be to create a method to evaluate competency for each discipline, either.
Well, both actually. I didn’t think what you described actually existed, however, because I can’t even begin to imagine the nightmare of bureaucracy this would create. It simply would not be practical (or possible) to look at each doctor in this way. Beyond the logistics, I would think that the only people who could accurately evaluate any doctor’s decisions would be another doctor (or former doctor). That would be a tough job to fill, I would think.
That is why I was hoping there was some sort of a re-certification process by which a doctor would have to re-establish his/her expertise in the field by passing a competency exam of some kind.
It does sound like a racket, but that hardly surprises me. As you said, it does provide a minimum baseline, which is something… What IS surprising is that the licensing procedure isn’t more rigorous.
When you say passing a test of “knowledge and judgement”, what does that entail exactly? Is it all based on the latest medical information, or is it more general? And do you get the material ypu will be tested on prior to your exam?
Do doctors, as a group, want more difficult testing, to weed out less talented people, or are they content with the system as it stands?
Yes there are approved continuing education activities that earn countable credits. They come on category 1 and 2 (details of which you likely don’t care about). The number of credit hours varies per state; Illinois for example requires 150 hours in a 3 year cycle.
The test is specific to the specialty and is general with many clinical scenarios presented. There are lists somewhere of the areas that will be tested on but they are not exactly like lists to memorize.
No as a group we do not want “more difficult testing”. Honestly the best good the testing and recertification process engenders is that it helps motivate and structure those continuing education activities. But as a tool to discriminate between a competent and an incompetent doctor? These sorts of tests do not capture that at all. The real world answer is often not included as an option. What do I do when presented with a circumstance that I am not sure about in the real world? Order a b or c test or intervention? Label it as likely z? No. I either do some research or make a call to the person I know who knows the best course and/or refer. These tests cannot evaluate how well we each know when we need to ask for help versus what is in our wheelhouse; how we manage the universe of knowledge that is not in our heads but that is still available to us; how well we function as part of a team to deliver care. Nor do they evaluate how well we take a history and listen to our patients. How well we explain things and how effectively we motivate our patients to make needed changes. The problem solving in a test environment is not the problem solving of real world patients in front of you and the “less talented” may test well.
My local hospital/medical center/trauma center has lots of doctors that are not board certified. The quality of healthcare is very high/excellent according to ratings.
Would I prefer a board certified doctor? Yes. Am I concerned being treated by a non board certified doctor from my local hospital? No. FWIW, I grew up in a university town where one neighbor was one of the best internists around, another was chief of anesthesiology at the university, another a heart surgeon, etc. So I’ve been around the very best. But I also due my due diligence when selecting a doctor; board certification is just one thing to look at, too.
I don’t disagree with you much Duckster. The op asks if there is are doctor evaluations for quality other than patient rating scores (and probably word of mouth). Board certification and its maintenance is really the best we’ve got for that for individual physicians, providing some evidence of having a basic fund of knowledge and judgement in the specialty. Again, the knowledge and judgement proven there does not necessarily correlate with the knowledge and judgement needed to perform well clinically in the real world. And how a hospital or other delivery system works is less dependent on the individuals having large funds of knowledge as how the team functions cohesively.
Curious though … you say you do your due diligence when selecting a doctor. How do you, in that process, judge whether or not a doctor has an adequate knowledge base and the quality of their clinical judgement?
As a physician I am very much aware that patients really have no way to judge that. I get chosen and recommended to others (beyond insurance considerations) based on whether or not my office works smoothly, that we return phone calls promptly, that we both listen and explain adequately and that it sounds good to them. Docs who promote pseudoscience woo sound good to many patients too. How should or can my patients do due diligence to determine that I am not telling them out of date or just plain wrong crap and making less than superb clinical judgements?
The only example I know of regular testing of physician competency by a government agency is the mandated annual proficiency exam for anyone who screens and diagnoses gynecologic cytology (Pap) tests. Both pathologists and cytotechnologists are evaluated. This began on a national basis back in 2005. The original impetus was a Wall St. Journal article in 1987 exposing sleazy practices at some commercial labs (Pap smear “mills”) where high volumes of tests were screened in a sloppy manner and harm resulted.
There are 10 slides that have to be read in the annual test and the passing grade is 90%. Fail and you get a couple chances to be retested; after that you cannot screen/sign out Pap tests anymore until “remedial” training is completed and retesting is successful.
Whether this is a good real-world means of evaluating competency in cytopathology is debatable. The exam consumes 2 hours of work time per year (not counting the labor of staff who have to prepare for the test). Now imagine testing on all conceivable facets of diagnostic skill for all physicians - such as physical examination skills, knowledge of test ordering and interpretation, accuracy of diagnosis, what drugs and other interventions to prescribe/recommend, when to refer a patient to a specialist, etc. etc.
No one would ever get actual patient care done; they’d be totally swamped with testing on top of all the paperwork/computer record documentation/quality assurance that takes hours out of every day already.
There are a lot of gates and gatekeepers a doctor in the US has to pass before they even get to practice. It’s a rigorous gauntlet. I think it’s reasonable assumption that if you have your MD you have a reasonable handle on the field and reasonable level of required continuing ed updates should suffice for most doctors.
Having said this there are some doctors that have behavioral and/or mental or job performance issues. A test you prepare for, sit down and take is very unlikely to catch most of these issues. Doctors even crappy ones are likely to be pretty damn good at taking sit down tests it’s a skill they needed to get to be doctors in the first place.