More articles by Lawrence B. Erlich, M.D.
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The best way to evaluate the work if a doctor is to measure the
outcome of his work, that it, how many patients die, how many live, how many get better.
In order to do that the evaluator must measure the severity of the doctor's cases. Doctors
in university centers have the highest death rates but they see the sickest patients,
often the ones that other doctors have found hopeless. Doctors in small community
hospitals may well see only uncomplicated cases. The processes of evaluating the severity
of a doctors' cases is called "severity weighting" and while it can be done, it
is very expensive and difficult and very few hospitals or programs can afford it.
The only alternative left is to measure "input measures,"
that is, measures of the doctor's training, experience, and the way he is viewed in the
profession. There is only one credential that is recognized by all aspects of the health
care delivery system as a measure of the ability of a physician to delivery quality
medical care. It is called "board certification."
The problem is, what is board certification? Even doctors don't seem
to know, and it is certain that lawyers, judges, and patients do not know. However, a
lawyer who is about to hire an expert or a lawyer who would like to cross examine that
same expert would do well to know.
All of the certifying boards are small corporations. I once wrote to
the American Board of Psychiatry and Neurology, Inc., the board the certifies
psychiatrists, and asked them for the criteria that a small corporation had to meet in
order to call itself a board. They answered that the criteria that they had to meet were
the standards that allowed them to be a small corporation. In other words, anyone can call
himself a board, and probably already has.
There are about 200 small corporations in the United States that
call themselves certifying boards. The movement started toward the beginning of the
century by the ophthalmologists who were concerned because the training of
ophthalmologists in this country was uneven. The wanted the public to have a way to be
able to identify an ophthalmologist who had good training so they developed a test that
was designed such that only a someone who knew how to take care of patients, could pass
it. Subsequently, most other specialties developed such tests and of the original boards
decided that they needed someone to certify them as competent to examine physicians for
competence. This organization is called the American Board of Medical Specialties. The
ABMS issues a directory of all certified specialists in the country and it has an 800
number that you can call to find out if a physician is certified by one of the original
boards. In addition to these boards, which are recognized nationally and internationally,
there are a number of other organizations that call themselves boards. They vary by every
measure. Some have been around for a long time, and some come and go quickly. One such
board only lasted two weeks. Some give searching tests and are well respected, and some
"grandfather" candidates, that is they give the candidate a certification if he
sends in a lot of money and some credentials.
There are two easy ways to determine the nature of a board: First,
call the Board of Medical Examiners in the State of Florida. In Florida, if a physician
claims certification by a board that is not a member of the ABMS, he can be fined
$2000.00. Second, call a local hospital. Most hospitals will not give a physicians full
privileges unless he is certified by a board the that is a member of the ABMS. If a
physician claims certification by a board that would be ignored by the local hospitals,
would that not go against his credibility? If the hospitals ignore the certification, will
a jury of reasonable persons choose pay attention to it, or would they dismiss it and the
physician with it?
Do you have a question about certification? I am a Fellow of the
American College of Medical Quality so I am supposed to know about such things. Email me
your question and I will try to give you an answer.
