Monday, October 7, 2013

What's the point of medical licensing?

A surgeon emailed me the following (in italics).

OK, I know this is radical but consider my argument...

Medical licensing protects no-one and costs physicians hundreds to thousands of dollars each year. If a physician is negligent, can the injured party sue the state that licensed him? I'm guessing not.

When I moved to my current location, I had to send lots of documentation to the state medical board so they could verify that I was a true and competent surgeon. I provided my employer with the same info so they could also verify my credentials. Now my employer can and will get sued if I commit a negligent act and absolutely should verify my credentials prior to handing me a scalpel. But the state? It's license is useless.

Most people choose a surgeon based on recommendations and word of mouth reputation and these are by far better indicators of quality than any credentialing board. Nobody asks to see my license, and, even if they did, it would not protect them any more than their trust in the health system in which I work.

If I was in private practice and had my license displayed on my wall it may give some reassurance to my patients, but it does not say anything about the quality of my work. Most doctors who really screw up due to negligence are licensed by the state.

I contend again, that word of mouth and reputation are the best indicators of a surgeons ability, anything beyond that is useless.

Caveat emptor, "let the buyer beware" remains the mantra of the informed consumer.

Thanks for letting me vent.

Of course this is a bit of exaggeration to make a point. We obviously need some sort of medical licensing or the public would not know if we were the same as the "butt enhancement" people who operate out of motel rooms.

But it's true that we—doctors and the public—don't get much bang for our buck. As I mentioned in my post about the Texas neurosurgeon who ran amok before that state's medical board took action, licensing fees are generally used by most states as a type of tax.

For example in the state of Texas, only$11 million of the $40 million in licensing fees collected per year goes to the medical board for policing the profession. The rest is left in the state's general fund.

My state also uses medical licensing fees as a tax rather than as a means to run a more effective medical board. I wonder how many other states do the same thing?

It's interesting that the surgeon who sent me this email has the same recommendation found by a researcher who recently looked at the relationship between hospital quality and patient satisfaction. Like many others, he found that there is no such relationship.

As the article about that paper states, "He [the researcher] suggested choosing a hospital the old-fashioned way: find a doctor you trust and ask for a recommendation."

PS: I'm surprised that lawyers haven't thought of suing states for allowing bad doctors to keep licenses.


artiger said...

It's kind of like a driver's license, isn't it? Lots of people have them, but it certainly doesn't say much as to the licensee's ability behind the wheel (at least not from what I have observed). I know it's not quite the same thing, but there are a lot of parallels one can draw.

Keeping in that vein, if lawyers started suing medical boards for the transgressions of their licensees, it's only a matter of time before states get sued after car wrecks for issuing driver's licenses to incompetent drivers. Oh what fun that would be.

Skeptical Scalpel said...

Yes, a license means that one has satisfied some process requirements. It doesn't say how good you are. BTW, board certification can be viewed similarly.

Anonymous said...

I took the National Boards. Why shouldn't I have a National License?

Skeptical Scalpel said...

Anon, excellent question. But then how would each state make money off the docs?

artiger said...

I like this type of conversation, and it has to start somewhere, so why not here?

Licensure, tort policy, whatever...I'd like to see a more uniform policy for all of us. Is a lap chole in Arkansas that much different from one in Connecticut? In some ways, maybe a bit, but in most other ways, no.

Still, I can't see the nation being united on much of anything. If perhaps we could be divided into two or more nations, with a loose, overseeing central government to keep us together overall (see a book from the 1980's called "The Nine Nations of North America"), I think the licensure issue could get some relief.

Skeptical Scalpel said...

I doubt we will ever see that happen in the US.

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