Certifying Quality
As we continue to move further down the path of healthcare reform, finding ways to focus on and measure the quality of clinicians is generating more and more discussion. An article published this week in the Columbus Dispatch highlighted the value of board certification as a proxy for quality. The article even went so far as to reference the possibility of a higher rate of pay for physicians who maintain their certification. Opponents to board certification argue that performing well on a multiple choice exam does not truly represent good clinical quality, and that the cost to the physician as well as the time lost caring for patients in this era of physician shortage is not warranted.
In a related article from NPR, the dying art of physical examination of the patient was highlighted. In a 2002 study of family physicians, less than 40% could correctly identify 12 common heart sounds.
It would seem to me that these two studies cry out for the same solution – include hands on testing as a component of demonstrated competence for physicians. Now, before I cause a revolt at the ABMS, let’s think about this for a minute. Nurses are required to continually demonstrate hands on competencies in most hospitals to continue working in individual units such as the ICU. To be certified as an open water lifeguard you must demonstrate at least 4000 hours of open water experience to even be considered. If you want to fly a multiengine commercial jet you need at least 280 hours of experience, 10 of which are under the eye of an inflight instructor while demonstrating all the requisite skills needed to fly in a myriad of different circumstances. Why then would it seem so far fetched to require the same demonstration of skill for physicians? Combine a written course to assure mastery of knowledge with a live demonstration of clinical skills relevant to each physician specialty. Putting something of this nature into practice would of course be very challenging, but if we are truly going to demonstrate quality, this may be a good place to start the conversation.
Nice approach. If you could then provide some certification that was understandable to patients you could add value to the physician by raising thier profile in the community. Somehow you have to find a way to engage the patient in the quality debate.
You raise an excellent issue regarding competency and the practice of medicine. It seems as if the fundamental bedrock of how we train healthcare providers is just as much a redesign as the system the are expected to work in. Quality has suffered as certain misaligned payment models have promoted high volume with little to no quality controls. This has to change. Would reassessing competencies help solve this problem? I would say partially. The other side of the coin is better aligning our payment mechanisms to reward high quality, evidence based, effective treatment rather than how quickly you can have someone in and out. Outcomes are important, but ultimately, even with competencies and certification, it is an empirical question. @Miller7