Archives for August 22, 2006

Medscape Editorial on Reforming Physician Licensure

Here’s a nice, brief editorial by Dr. Michael M.E. Johns, CEO of the Woodruff Health Sciences Center at Emory  University.  He’s got a point about the current state of CME and relicensure being somewhat anachronistic.

Here’s where he and I can completely agree:Link to Editorial on MedScape Emergency Medicine

CME credits are now the measures by which most states certify physician competence, and the vast majority of CME offerings have little impact on how physicians practice medicine.[1] Knowing that this is a flawed system, organized medicine continues to endorse it.

So here are 3 proposals to modernize:

3. CME should not be used for certification or relicensure. The American Board of Medical Specialties’ stepped process of certification[2] should be applied to relicensing. Submit a step every 2 years and earn relicensure.

Well, details, details.  My specialty society is doing yearly exams, which qualify me to take only one test at the end of ten years, instead of two.  I don’t know about the 2 year steps he’s talking about, and hope a reader can educate me.  But, we agree on the basics, that CME isn’t useful in practice, and that we already have systems in place to certify and recertify docs and their abilities.

As a practicing doc I’m required by the states I’m licensed in to have 25 hours of CME a year (minimum, one of which has to be in the “Ethics” category, and there’s a series of rants in that one idiotic hour requirement).  So, I go to conferences in nice places, listen to CME that usually covers things I already know, or that add a tidbit or two.  Is that a waste of time?  Probably.  A waste of money?  Decidedly.  Does it ‘change my practice’?  Not yet.  (It has spawned an entire industry of medical CME, though).

I think our CME requirement could be waived if our Board Certifying Societies attest that we pass a meaningful test every year, as we’re doing in EM now.  (To clarify: we take a test but still have to have the hours of CME as it stands).  We could have our test result sent directly to the state medical boards in lieu of CME.  I see a role for CME for those who aren’t board certified / certifiable, but that’s another detail.

Enough with the agreement. 

Whenever the answer to a complex problem is “Federalize it”, I’m not going to be a proponent.  Joke about the DMV all you want (and I will), but there’s a local / state answer to my problem.  Try that with the IRS, which I’ve been doing for about two years now.  Federalizing medical licensure won’t make the system any better or safer, but it will add a level of government (read:bureaucracy) that won’t be simple or straightforward.  For example, I give you every interaction (outside the Passport system, which I’ve found to work very well) you’ve had with the Feds.  I’m not some anti-government nut, but I don’t think an abject State failure has been laid out here.  Do individual states screw up individual licensure decisions?  Yes.  The answer is better information clearinghouses, not the IRS for Doctors federalizing the licensure of Physicians.

MedBlogs Grand Rounds 2:48, or, 100th Edition!


Grand Rounds 100th Edition

Grand Rounds Turns 100! Originally conceived by Dr. Nicholas Genes, the weekly linkfest celebrating the highlights of the medical blogosphere has reached its 100th edition. Intended to introduce the wider world to the growing medical blogosphere (doctors, nurses, students, administrators, EMTs, techs, and patients who blog), Grand Rounds has blossomed into a phenomenon noticed by The LA Times, Web MD, and Instapundit to name a few. For this the 100th edition I’d like to throw down a cool 57 links, an inclusive orgy of medical goodness, only tolerable in such gluttonous proportions once in a lifetime. Behold today’s display of medblogging largesse, hereby called Grand Rounds #100, hot off the press.

100!  We’ve gotten to 100 editions of MedBlogs Grand Rounds!  I’m in it, and am proud to be a part of it.  And, many happy returns.


Oh, here’s our humble beginnings.