Wednesday, July 16, 2003

Haven't had time to post over the past few days. On call over the weekend, operating post-call on Monday until 7pm (oh to be a resident again!!). In the office all day yesterday and on call again today.
I sent this email to Neal Boortz last week concerning his position on licensure of physicians. He has not replied.
Mr. Boortz:
I wish to start off stating that I enjoy your show and visit boortz.com on
a daily basis. I am writing in response to the section of your program
notes from July 3, 2003 entitled "You Just have Yourself a Wonderful Fourth
of July"
and specifically this paragraph:

Inform your representatives that you want to be free to make your own
consumer choices, and that includes choices of which professional you want
to use for medical and legal services. Tell them that you are perfectly
willing to rely on your own judgment, or the judgment of private accrediting
agencies when it comes to selecting an attorney or a doctor. You might add
that you don't like the idea that you have to go to the government to ask
who may and who may not clip your fingernails.

I have also heard you mention on your program that you do not feel that
physicians should be licensed by the state. I am a licensed physician in
the state of Georgia and I must tell you that I disagree with you on this
Let us compare a medical license with the most common license issued by
the state, a driver's license. To obtain a driver's license one must pass a
test on the rules of the road and pass a driving test. This is done to
insure a basic level of competency before one is allowed to possibly
endanger one's self and others behind the wheel of a car. To obtain my
license to practice medicine I had to provide documentation of my education
and training. This was to insure that I had at least gone to medical school
and done additional training before I could possibly endanger some poor soul
who had become my patient. This is also to insure a basic level of
compentency. By requiring licensure, the state fulfills a duty to protect
the citizenry against potential harm.
In the paragraph above you advocate the use of private agencies to
monitor and provide accreditation of physicians. The danger in this is
that, as the cliché states "Who watches the watchers?". Physicians have the
choice to submit to further examination in their field of specialty and
become "board certified". Board certification is not required for licensure
or for admitting and treating patients in some hospitals. If private
agencies are responsible for accrediting physicians then a group of
physicians can get together and form a new board or "private agency" who
will then sign off on them, even if they cannot become certified by an
established specialty board. You can see the potential danger this brings
But what about the judgment of the individual? Medicine is very complex
and if a physician states he is "certified by the xyz board of specialists"
the patient may accept that as adequate. At the least a patient would have
to do some research to determine if that is a legitimate accrediting board,
or something thrown together by some physicians of dubious credentials.
By requiring licensure the state also provides accountability. A
physician must meet certain requirements to maintain a license. Patient's
may complain to the Board of Medicine and an investigation may be initiated.
The physician may have his license revoked or put on probation. A
"private agency" may be reluctant to discipline one of its' own (dues
paying) members, and if it did, what would stop the physician from starting
up his own "Board of abc specialists"? The civil litigation system would
not be a good policeman either, as the physician in question could simply
operate without insurance. This would remove the "deep pocket" of the
liability underwriter, making the financial benefit of a case minimal.
I agree that some of the professions that require licensure and their
boards are a method to limit competition (real estate agents and funeral
directors come to mind), but professions that require specialized expertise
(physicians, dentists, plumbers, and yes even lawyers) licensure is a method
to insure a basic level of education and compentency.
Bard Parker

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