Doctors may be driven out of practice by tests

Your doctor, after a decade of rigorous training and 20 years of experience, may be driven out of practice by a $300 million industry that sells tests.

There is no evidence that having to take still another test every few years makes doctors any better. It does, however, force them to take off weeks to study whatever the testing gurus think they should, and to spend thousands of dollars to take the test.

A self-certified, self-accredited monopoly has grown up, including the Federation of State Medical Boards (FSMB) and the American Board of Medical Specialties (ABMS), to certify and re-certify physicians. Many physicians voluntarily seek board certification, an honor that is conferred after arduous additional training and examinations. In the past, board certification was for life. Younger physicians can get only a time-limited certificate.

Recertification is now often required to renew hospital privileges or to be listed on insurance panels. But if the education cartel gets its way, recertification could be required to renew the doctor's medical license. This is called Maintenance of Certification and Maintenance of Licensure (MOC/MOL).

The requirements for MOC/MOL may be far more intrusive than taking a test. Physicians may have to collect data about how they treat patients, and implement a plan to "improve" certain selected measures—that is to treat patients with a focus on one goal chosen by the authorities, without regard to adverse effects on individual patients.

The ABMS's mandated Practice Performance Assessment and Improvement Requirements (PPAIR) are untested, unproven, and poorly conceived," writes Paul Kempen, M.D., in the spring 2012 issue of the Journal of American Physicians and Surgeons. http://www.jpands.org/vol17no1/kempen.pdf Recent studies demonstrated that anesthesia practices that had almost become the "standard of care," such as tight blood-sugar control, resulted in more harm than good under real-world conditions.

"Forcing physicians to implement 'things to improve' is an open prescription to tinker with patients' lives or experiment on them without informed consent, merely to meet a licensure requirement," Kempen states.

With a physician shortage at the time that aging Baby Boomers will need more care, MOC/MOL will limit access to care where it is needed most, Kempen predicts. Americans will be forced to rely more on "physician extenders" who have far less education—an ironic consequence of a mandate that is supposed to increase quality.