Thursday, February 17, 2005

Are Specialty Boards Monopolistic????
The answer would be "yes" according to a physician quoted in this New York Times article:Vascular Surgeons Bang on the Specialists' Door
He would seem an unlikely radical, but Dr. Frank J. Veith is waging an aggressive and unusually public fight in the clubby world of the medical profession.

A 73-year-old vascular surgeon who is the vice chairman of surgery at Montefiore Medical Center, in the Bronx, Dr. Veith is on a crusade aimed at the way the medical establishment divides its turf among different specialists. He and his supporters want to have vascular surgeons, doctors who operate on blood vessels, officially recognized as board-certified specialists.

Surgeons like Dr. Veith argue that this designation would improve patient care by ensuring that doctors who repair aortic aneurysms or perform other vascular surgeries are trained in that specialty. But those who oppose creation of the independent medical board that would oversee and certify that specialty say Dr. Veith and his backers are engaged in a power grab that would only fragment the field of surgery.

Dr Veith takes the view of that the recent proposal to streamline vascular training with a primary certificate as a first step since this plan does not call for the establishment of a separate board.
A separate board already exists but they want the recognition of the American Board of Medical Specialties.
The article quotes many for and against the concept of a separate vascular surgery board. Some highlights:
Some doctors say a new vascular board is unnecessary because vascular surgeons are already awarded a subspecialty certificate through the American Board of Surgery. "We're not particularly interested in giving that up," said Dr. Lewis, whose group includes other specialists like pediatric surgeons.

Those subspecialty certificates do not prevent general surgeons from performing vascular surgery, and he acknowledged that doctors who do higher volumes of a procedure tend to have better results.

And hospitals can already require doctors who perform vascular surgery to have subspecialty certification, Dr. Lewis said. "An independent board is not going to change that one iota."......
...But the vascular surgeons strenuously disagree, arguing that some of the training in vascular surgery that is now part of the general surgical education is being wasted on generalists who they say are either unlikely to ever again perform such operations or who may fool themselves into thinking they can handle complicated cases.

But what caught my eye was this quote from Dr. David Meltzer from the university of Chicago:
"Physicians are a bunch of monopolists who control entry into their profession in all sorts of ways," said Dr. David O. Meltzer, a physician and economist at the University of Chicago.

While medical specialization frequently leads to better care, he said, doctors are also eager to try to keep others from treating their patients for the same ailments.
If this is true, is it a bad thing? Should we let any Tom, Dick, or Harriet perform any procedures they wish? The public already is critical of our ability to police ourselves and at the same time when we try to improve the quality of our product we are attacked as "monopolists". Does Dr. Meltzer disagree with state licensure? Granted, board certification is a rather blunt tool for determining how a particular physician's patients will fare, but it is often the only one that we have. Volume of individual and institution are much better indicators of outcome. And there's not some big mystery about becoming board certified. You graduate from a accredited medical school, attend an accredited residency, submit data about your training (such as the number and type of cases performed) and sit for a test (or two). You don't have to know the secret knock or handshake and you don't have to wait for someone to retire or die before you can get in.
And despite the portrayal of Dr. Veith as a David against the ABMS Goliath, Dr. Veith is a monopolist himself, a vice-chair who won't write letters for his own residents in support of them obtaining vascular privileges. I personally have no problem with the creation of such a board, but as I have written before the results will take years to mainifest:
(T)here is no national body which determines what procedures a surgeon may or may not perform. Each individual hospital sets their own standards for privileges. Some hospitals require fellowship training and/or certification, while others may not (the same may be said for managed care organizations). Smaller or rural hospitals may not initiate a requirement for board certification.
Secondly, any changes, after they were initiated, would take several years to show the effects desired. That is because the "grandfathering" that would occur. Even the most vocal proponents of the creation of a new board agree that would have to occur...

Dr. Veith will find out the results in about a month.
Weblog Commenting and Trackback by HaloScan.com

This page is powered by Blogger. Isn't yours?