Originally created 10/24/98

Report suggests competence reviews for health care professionals



WASHINGTON -- Doctors and other health care providers should be periodically reviewed to make sure they are still competent, an expert commission says in a report contending that the interests of professionals too often outweigh consumer protection.

Most states require continuing education, but health care professionals should have their competence evaluated periodically after they are initially licensed to practice, the Pew Health Professions Commission recommends.

The commission also recommends more public representation on the boards that discipline doctors and other providers and a better way of resolving conflicts among providers about who is qualified to perform what service.

Groups representing doctors were cool to the recommendations, saying the current system works pretty well. Periodically testing doctor competence may sound good, but it would be expensive and complicated to do in a meaningful way, they said.

Overall, the report concludes, consumer protection often conflicts with the economic interests of health care professionals, including doctors, nurses, pharmacists, dentists and other providers.

The nation has only minimal standards governing health care workers, said former Sen. George Mitchell, chairman of the commission.

"Quite frankly, these minimal standards have served only to make certain that the most egregiously incompetent health professionals are prohibited from practicing," he said. "This is not enough."

The report recommends that professional boards charged with disciplining health professionals should have at least one-third of their members from the public, to make sure boards are not just protecting their own.

But the problem is not just in removing the worst people; it's making sure everyone else meets at least minimal standards.

Once a doctor, nurse or other provider is licensed to practice, he or she rarely faces another test of competence. States may require ongoing education, but there is no guarantee that anything was actually learned or that the appropriate courses were taken.

At the same time, medicine is constantly producing information about new techniques, drugs and practices, and it is hard for patients to know which doctors are up to date.

The report comes as lawmakers and consumers are looking more carefully at the quality of care.

Congress debated a "patients' bill of rights" this year that sought to ensure that health maintenance organizations were delivering quality care, and there are stepped-up efforts in the private sector to get more information about the quality of doctors, hospitals and health plans.

The commission hopes that this new focus gives doctors and other providers an interest in proving they are good at what they do, said its executive director, Edward H. O'Neil, director of the San Francisco-based Center for the Health Professions.

"Now there's really something in it for the doctor, for the nurse, to be able to say on a regular basis, 'I have demonstrated competence. I remain up to date on things,"' he said. "It should make them feel more secure in their own jobs."

Some specialty boards require competency reviews when doctors get recertified, and all of them have pledged to add reviews for newly certified doctors, said Dr. Stephen Miller, executive vice president of the American Board of Medical Specialties.

Board certification is a step above simple licensing. Doctors may practice medicine legally without being certified, but they must be licensed.

Requiring testing or other reviews when doctors renew their licenses would be cumbersome and largely irrelevant because it would be too difficult to test what a doctor actually does in his or her practice, Miller said.

The licensing tests given to doctors at the start of their careers cover a broad range of material, but by the time doctors have been practicing for years, they have specialized, he said.

Still, he acknowledged a public clamoring for assurance that doctors are good at what they do.

"Physicians, just like any other groups, listen to what the public is saying, and I think the public is asking about it, no question about it," he said.