Ensuring Physicians’ Competence — Is Maintenance of Certification the Answer?

 “Pressed by their leaders, external stakeholders, and a public troubled by lapses in the quality of care and unsustainable cost increases, physicians are facing stiffer challenges in initiatives designed to link more closely the goals of learning with the delivery of better care and measures of greater accountability… ”

So begins Ensuring Physicians’ Competence — Is Maintenance of Certification the Answer? in this week’s issue of NEJM .

While the essay focuses on US system of reaccreditation, the opening remarks could apply to any (Western) healthcare system which desires its doctors to deliver best possible healthcare to citizens with greater accountability for the medical profession.

I want to know how my leaders allowed the demise of self-regulation to occur after several hundred years of autonomy.

Why does the author of the article believe there is no chance the medical profession can return to less fettered self-regulation?

Is it really in the public’s interest for politicians and healthcare payers to control medical profession ever more tightly? Is the cost for such regulation really affordable?

It is my opinion, that the majority of doctors are self-directed learners who perform better under less scrutiny rather than more. Healthcare innovation may well be stifled by the drive to tighten regulations for physician practice.

This is apparently a global phenomenon at least in the rich countries with managed healthcare systems. National medical bodies may need to work together to fight this threat to the effective care of our patients.

The increasing threats to independent practice and the profession of medicine are contrary to the human values in healthcare that is at the heart of what we do.

Small Business: U.S. doctors going broke – Jan. 5, 2012

Small Business: Doctors going broke – Jan. 5, 2012.

A sad story from the USA about the financial pressured on Private Practice in a managed healthcare economy with fee-for-service consultations.

It is interesting to observe from across the pond here in UK the tough times doctors face in USA when (a) they can buy expensive drugs in bulk, then charge the patient/insurer a premium, and (b)US government has blocked plans to reduce Medicare reimbursements many times over last decade while economy has been contracting.

Here in UK, the first scenario cannot happen, at least directly.  The nearest thing to the profit from buying drugs in bulk  and getting a profit from dispensing is by dispensing (rural) general practices.

The second issue of contracting doctors pay has not met any practical resistance in UK.  GP practice did increase a lot in 2004 with the new contract for General Medical Services; since then GP Partners’ profits have fallen in real terms, particularly with National agreement to cap increases to no more than 1.5%, while recommending staff get at least 3% pay rise which is paid for from Practice income!

There is nothing comforting from the article about the dire financial position of many U.S. doctors.  Medical professionals are among the most valuable members of a community.  Their presence ensures timely treatment of illness (well not aesthetic surgeons!).  Regulations designed to protect patients (and insurers’ profits) are squeezing the life out of many practices which will result in consolidation.  Rural folks will be most at risk from this.

It is timely to be reminded of the dangers of private medicine.  The medical industrial complex should not be allowed to hijack the public NHS otherwise in a few decades from now, I fear, British doctors will be the subject of a similar story.