By Alieta Eck, MD and President of AAPS
The American Board of Internal Medicine is on a mission to curtail unnecessary medical testing, suggesting that physicians order too much and thus drive up the cost of care.
Dr. Christine K. Cassel, president and CEO of the ABIM claims to be looking at the big picture. "The campaign is not about rationing or withholding proper care. On the contrary; if waste is not reduced, there will be less money for the care that is necessary," she said. "If we don't as a community collectively address this cost issue, then there's a whole lot of people that aren't going to get the care that they need."
From my viewpoint as a practicing physician, central planners seem to consider any test that comes back normal to be unnecessary. On the flip side, any abnormal test that was not ordered one week earlier is a cause for a lawsuit. It appears that physicians are caught in a vice that cannot be not easily remedied. The real solution lies in patients having to bear the cost of most tests and in the physicians having to explain why they are needed.
But speaking of unnecessary testing, the ABIM is one of the leaders in demanding unnecessary testing for physicians to maintain certification in their chosen specialty. And ABIM would like to see the Maintenance of Certification (MOC) become Maintenance of Licensure. (MOL).
Over the past 20 years huge demands have been piled onto practicing physicians, pulling them out of their practices, expecting them to take costly review courses and having them spend thousands of dollars to re-certify in their specialties. While this MOC might sound reasonable, less than 5% of doctors feel that this makes them better able to care for patients. Specialists find that the tests are outdated, not surprising since it takes time to develop questions, and prepare and administer exams. Who needs this?
The fact that this re-certification is only imposed on younger doctors, and that the older physicians do not seem to be harming their patients, is lost or ignored by those who reap huge profits in the certifying industry.
The report from the MOL Implementation Group has 30 pages of wise-sounding but unsubstantiated rhetoric. They claim that they want to improve patient care and “facilitate the engagement of physicians in a culture of continuous improvement through a verifiable and reproducible system.” Read balderdash.
For “practical reasons,” they want to phase this in over 10 years. This will stave off the outcry of physicians currently running successful practices. By “grandfathering” current physicians, just as was done with MOC, MOL advocates would silence those who can see the bigger picture. The handcuffs on new young physicians can be tightened later.
As if physicians have nothing better to do, "state board members should require licensees to use comparative data and, when available, evolving performance expectations to assess the quality of care they provide and then apply best evidence or consensus recommendations to improve and subsequently reassess their care," say MOL advocates.
Medical students are very bright, motivated scholars who devote much time, personal expense, and energy to get accepted to medical school, pass their courses and take the standardized tests required to become licensed physicians. So when do they turn into lazy, incompetent, unmotivated, and greedy shopkeepers who need to be prodded and goaded to keep up with their chosen profession?
The people who are proposing all this are academicians who see a way of enriching themselves without having to actually care for patients. Christine Cassel herself earns more than $800,000 in salary and benefits. Regular doctors do the best they can to get good outcomes, even with patients who are often obstinate, non-compliant, and demanding. But dealing with irrational bureaucrats is another story.