Viewpoints: Readers comment on Medical Economics stories

August 20, 2010

Letters address flawed boards, EHRs, and midlevel providers.

A gracious thank you

The July 9 "The Way I See It" piece ("Physicians make lasting impressions" [by Kim B. Kruger, MD, FAAFP]) was, in a word, excellent!

Kudos to Dr. Kruger. She has arrived at a place that many doctors are unable to find: the intersection of grace and humility!

Boards are flawed

I don't understand why the American Board of Internal Medicine is taking legal action against the physicians involved ("139 doctors caught cheating on boards" [Update], July 9 issue). After all, weren't they just playing by the rules of the game? Indeed, for many physicians, the boards do not reflect the reality of medical practice. Thus, they see them as a game to be played.

Some physicians take expensive test-preparation courses in which they are taught strategies on how to limit the number of answers to the most likely ones and how to answer esoteric questions. These courses are making a lot of money off of physicians' fears.

Clearly, the boards exert an inordinate and dangerous power over physicians' lives. Doctors can be denied staff privileges by hospitals or have their reimbursements lowered by health insurers if they do not have their board certifications.

Originally, they were voluntary tests, intended only to demonstrate an above-average knowledge in a specialty. Why did physicians allow them to accumulate such great power over their lives?

Initial certification by a board has some value in acting as a final exam to compare how physicians performed nationally. But the value of recertification is questionable because its "one size fits all" approach does not reflect how physicians customize their practices over time. Physicians in practice for, say, 15 or 20 years or more have knowledge bases and skills that often are much different than those they had when they started practicing.

The biggest flaw of the boards is their pass/fail approach. Ideally, the boards should uncover areas of weakness and recommend remedial study. The pass/fail method is wrong. It does little or nothing to improve physicians' abilities in their individual practices.

Shouldn't a physician's competence or lack of it be ascertained during residency and not after it? Aren't three or more years of on-the-job observation enough to determine their abilities?

Most physicians endure and complain privately about the boards' methods but remain silent publicly. The time has come for the leaders of medicine to challenge the boards.

EDWARD J. VOLPINTESTA, MD
Bethel, Connecticut