How Qualified Is Your Doctor On Neuropathy?

Today's post from online.wsj.com (see link below) is an important one for both patients and doctors alike in that it highlights the need for doctors to keep up to date with the latest developments in their field but it should be said that our doctor must still be our best friend in the fight against neuropathy. You need him or her to help you through the minefield that is neuropathy treatment and questioning his or her competence may not be the best way to a constructive working relationship. That said, many people living with long-term neuropathy have an idea that they are building up more knowledge and experience than their doctors and this may come from the fact that unless a doctor is a fully-qualified neurologist, he or she has to deal with hundreds of diseases and conditions in his practice - they can't be expected to be experts on everything. For the patient it's very useful to know what the medical authorities actually do to encourage doctors to keep on top of new information and developments. This article is a sort of guide to the current requirements in the USA and gives us some reassurance that there is a 'quality control' structure in place. It may be interesting to discover what sort of system exists in your own territory. Having confidence in the doctor treating you is vitally important to your long term recovery.

The Informed Patient How Qualified Is Your Doctor?
 By Laura Landro Jan. 20, 2014
 
Doctors face new requirements to keep up-to-date to stay certified

Doctors are facing new requirements to keep up-to-date in their knowledge and care for patients in order to stay certified by medical boards.

'Taking a single test at a single point in time [to get board certified] doesn't mean you are forever ready to practice in the current era of medicine,' says Erik Stratman, a dermatologist in Marshfield, Wis. Michael Haas/Marshfield Clinic

The new requirements, called maintenance of certification, are controversial among some physicians. But they reflect growing evidence that doctors, who are now recertified every 10 years, need to be more regularly assessed for competence in a fast-changing medical world.

While the 10-year retesting requirement still stands, the American Board of Medical Specialties has begun in recent years asking doctors to demonstrate more frequently that they are current in their medical knowledge. The group oversees 24 separate medical boards covering about 80% of licensed physicians. Maintenance-of-certification requirements vary among medical boards, but the programs are similar.

One of the largest medical boards, the American Board of Internal Medicine, beginning this year is requiring the doctors it certifies to choose from a variety of activities at intervals of two and five years to maintain their certification. The board certifies internists and 20 other specialties covering 25% of U.S. physicians.

Doctors can earn points toward maintenance of certification in several ways. They can take open-book tests to show they are keeping up with new developments in their field. They can undertake projects to improve care, such as evaluating how well their practice treats patients with chronic conditions. Every five years doctors must complete a patient-safety requirement and conduct a patient survey to help assess their communication skills.

Keep Doctors Up to Date

New requirements to maintain board certification call for doctors in most medical specialties to show they are current in their knowledge and taking steps to improve patient care. Doctors can choose from a variety of activities, usually at intervals of two to five years. Here is a sample of activities offered by the American Board of Internal Medicine, which oversees 21 specialties.

Medical knowledge

To fulfill this requirement, doctors can take open-book, multiple-choice tests on topics such as the latest guidelines for pain control in the elderly or new treatments for cancers.

Practice assessment

Physicians can undertake a quality improvement project in their own practice, such as developing a program to prevent patients from missing medical tests and exams.

Patient Safety

Options include medical-knowledge, open-book tests or practice assessments related, for example, to effective communication and preventing patient falls.

Patient experience

Doctors are required to get feedback from patients, often by surveying them on different topics, such as whether nurses and doctors were responsive to their needs and explained things clearly.

Maintenance-of-certification exam

As in the past, doctors must pass a closed-book exam every 10 years that tests knowledge relevant to their discipline in order to remain certified.

"Physicians have an obligation to keep up with the latest in their field of practice, listen to their patients, look at their practice and improve," says Richard J. Baron, the American Board of Internal Medicine's chief executive. Maintenance of certification "gives them a structured way to do that and at the same time assure patients and peers that their physicians have met a rigorous standard for knowledge."

Patients can check online whether doctors are board certified, including at the American Board of Internal Medicine website, which will begin publicly reporting in April whether its doctors are meeting the new requirements. Board certification can affect a physician's inclusion in health-plan networks and hospital privileges.

Doctors were once board-certified for life, but in the 1970s some boards began to issue time-limited certificates. Dr. Baron says physicians certified by his board before 1990 will remain certified for life but will be reported as "not meeting requirements" if they don't participate in maintenance activities.

Studies show clinical skills deteriorate over time and doctor's overconfidence can lead to diagnostic errors. A 2006 review in the Journal of the American Medical Association found that doctors aren't very good at evaluating their own skills. University of Michigan professor R. Van Harrison, an author of the study, says maintenance of certification "is part of a larger evolution of the health-care system." He says big hospital systems are helping doctors meet certification requirements as part of larger quality-improvement programs.

Erik Stratman, a dermatologist at Marshfield Clinic in Wisconsin, says a project he undertook to meet the American Board of Dermatology's requirements has helped improve his medical practice. Dr. Stratman treats many psoriasis patients, who are at increased risk for heart attacks, high cholesterol and diabetes. In reviewing data for the project, he found that patients weren't being regularly screened for those diseases and 40% didn't have a primary-care doctor who could follow up. He says his medical team has been working to manage those patients more closely or connect them to primary care.

"Taking a single test at a single point in time [to get certified] doesn't mean you are forever ready to practice in the current era of medicine," Dr. Stratman says.

Some physicians are resisting the new board requirements. They say they can keep up-to-date through the continuous-medical-education courses they must take to meet state-licensing requirements, which are separate from board certification. These doctors complain that failure to participate in maintenance of certification could hurt their business should they lose their board certification.

The Association of American Physicians and Surgeons, a doctors' group, has filed an antitrust suit in a federal court in New Jersey against the American Board of Medical Specialties, claiming its program is "a moneymaking self-enrichment scheme" for medical boards that reduces the supply of hospital-based physicians and decreases the time doctors have to spend with patients. Andrew Schlafly, general counsel for the physician's group, says the requirements don't have any "proven connection with improving quality of care."

Lois Margaret Nora, chief executive of the American Board of Medical Specialties, says the suit's claims are without merit and that maintenance of certification is a "voluntary program that promotes lifelong learning, self-assessment and improvement for physicians." The board has filed a motion to dismiss the suit.

Doctors stand to earn incentive payments from Medicare for participating in maintenance-of-certification activities. They can also earn credit for the state-required courses in continuous medical education.

Dr. Jay Geoghagan, a cardiologist in Little Rock, Ark., says new certification requirements prompted his practice to monitor patients with high blood pressure more closely. Heather Marshall

Jay Geoghagan, a cardiologist at Little Rock, Ark.-based Arkansas Cardiology, passed his 10-year recertification test in cardiovascular disease from the internal medicine board last year. As part of his requirements, he also evaluated his team's care for high blood pressure, surveying patients and auditing their charts to check if they had taken a recommended kidney-function test. The records indicated only 40% had the test, though Dr. Geoghagan says he thought he had performed them in 90% of cases. "It wasn't that they hadn't been done but we couldn't find documentation," he says. It reinforced his staff's efforts to monitor patients more closely and ensure tests were entered into electronic records.

The American Board of Internal Medicine maintenance-of-certification fees, which include practice-assessment tools and open-book tests, start at $194 a year for internal-medicine doctors and can rise if doctors maintain more than one certificate. Dr. Geoghagan says the cost can be much higher after factoring in materials to help prepare, other expenses and unreimbursed time.

"A lot of us are small-business men trying to continue our practice while trying to maintain balance and sanity in our life," Dr. Geoghagan says. Still, he says, "patients should have some assurance there is quality control and that their doctor is keeping up-to-date, because a lot of them don't, or haven't in the past."

Write to Laura Landro at laura.landro@wsj.com

http://online.wsj.com/news/articles/SB10001424052702304419104579327182263151704