The man behind MOC defends the program against critics
ME: Despite the cost and time commitment required for that?
RB: The bulk of the time commitment is staying current in a rapidly-changing field. If we went out of business tomorrow, doctors would still need to spend a ton of uncompensated time reading journals, coming to meetings like this, studying. We don’t make people do that. We recognize that they have, and give them a way to acknowledge that they’ve done what they needed to do.
ME : That’s a good segue to my next question, which is that doctors say that between requirements for CME and the easy access to information on the internet, that more than keeps them abreast of developments in their field, so why certify at all?
RB: First of all, the wide availability of the internet, the patients have that too. Yet there’s a significant difference in what we expect from patients with regard to knowledge and ability and what we expect from physicians with regard to knowledge and ability. So doctors know stuff that patients don’t know. And when they’re seeing patients—and I was in practice for many years—if you had to look up everything on every patient you see you’d never get through the day.
So everyone’s doing the time-lookup balance, so the more you know the sager you’re going to be in managing that tension. So the first thing I’d say is the availability of the internet doesn’t mean that knowledge doesn’t matter.
Further reading: Top 10 challenges facing physicians this year
The second thing is everyone agrees CME varies enormously in quality and effectiveness. Everyone knows about courses you can go to on the cruise or at the ski resort and may or may not be getting any knowledge. And it’s important not just that your seat was in the seat, but that you actually know what you need to know to do what we do. And what we do is pretty important and it changes pretty rapidly and people are not good at assessing what they don’t know. People assume that what they know is the right thing, but as one of my colleagues said some years ago, 30 years of practice doing it the wrong way doesn’t make it right. And how you keep up and learn with changes is an important thing all of us care about.
And one more comment with respect to the internet. There are now credentials available on the internet too. My son’s getting married this month by somebody who went on the internet and clicked “become an ordained minister for free.” And he got that credential, and he’ll marry my son with legal authority in the state of New York. It’s OK with me that he’s marrying my son, it wouldn’t be OK if he was providing healthcare to my son. And I think most of us really are proud of having a credential that distinguishes us in a world where what’s behind that credential really makes it valuable.
ME: But of course, that’s not the same thing as getting licensed to practice medicine. There is a lot more that’s required of you to do that.
RB: That’s true, but once you are licensed, first of all, only 81% of doctors are board-certified, 19% are not. So one in five doctors in this country is a licensed doctor who’s not board-certified, and I assume most of them are working.