“Nowadays, medicine is an open-resource team approach. I get all this information in the room with a patient in seconds, and then I use my experience and my knowledge to pull together a plan”
– Dr. Jonathan Weiss, a triple-board-certified physician explaining why he is against a test every ten years to maintain board certification;
NY Times, April 14, 2015, D3
A “board-certified physician” is one who has voluntarily applied for and passed a test of medical knowledge in one of 24 general specialities or over 30 subspecialties.. A non-profit American Board of Medical Specialties (ABMS) composed of physicians was established in 1933 to administer the tests to physicians who apply for the certification after completing their residency training. Each approved specialty board issues a certificate to successful candidates (It hangs on the wall in your physician’s office). Unlike the bar exam for lawyers, physicians are expected to pass the test the first time, though a second attempt is sometimes necessary in some specialties. Most hospitals and many health insurance companies require board certification as a sign of competence as part of their credentialing. States do NOT require board certification for licensure.
One of the founding specialty boards in 1933 was the American Board of Ophthalmology (ABO), which brings us to the 2016 Presidential candidates.
Rand Paul, MD, a recently announced Republican candidate for President, took and passed his ophthalmology boards in 1995. In 1997 he and 20 other practicing eye doctors protested the ABO’s changing of its certification from “lifetime” to “must be renewed every 10 years.” They argued that this Maintenance of Certification (MOC) test every ten years was “time-consuming for the practitioner, expensive ($1,500-$3,000), and irrelevant to patient care”. They formed a new board, the National Board of Ophthalmology (NBO), that would issue life-time certification for $500. Rand Paul was the lead organizer. He, his non-physician wife Kelley, and his non-physician father-in-law became members of its Board of Directors. NBO was never recognized by the ABMS, was dissolved by the State of Kentucky in 2000, was recreated in 2005 ( that just happened to be 10 years after Rand Paul was initially certified by ABO), and finally was dissolved again in 2011. It certified about 60 physicians in its lifetime.
Rand Paul is not the only critic of the ABMS and the Maintenance Of Certification (MOC) concept. Others have questioned the ABMS certification exams’ ability to evaluate actual clinical decision-making and clinical competence. Others have suggested that the exams’ heavy emphasis on memorized medical facts and pharmaceutical details is irrelevant, when nowadays such details are just a click or two away from the doctor in the exam room via electronic device. In 2013 a prestigious-sounding organization, the Association of American Physicians and Surgeons (AAPS) brought a “restraint of trade” suit against the ABMS for its MOC requirement.
I was impressed by that name, until I Googled it. The AAPS is an ultra-conservative organization established to fend off “the evils of socialized medicine”. Its positions include “HIV is not the cause of AIDS”, “abortions are associated with breast cancer”, and “childhood vaccinations cause autism”. Rand Paul and his father Ron, also a physician and a past presidential candidate himself, are both members of the AAPS.
“So what” you might think at this point.
Rand Paul’s beliefs and actions indicate to me that he has an excellent ability to create, maintain, and operate within his own reality, one which ignores accepted evidence. Perhaps one could say that very same thing about any politician with whom you disagree, but I don’t disagree with every thing that Rand Paul says. Physicians are trained to make decisions often using inadequate data. I am surprised that Rand Paul, as a trained physician, can successfully maintain a belief construct that is so at odds with established facts. Also, he tried, and failed, to develop an alternative governing body of his profession when he disagreed with its policies. It was NOT about trying for better patient care.
These are undesirable attributes in a President of the United States. It also makes Hilary’s real estate shenanigans in Arkansas, her use of more than one email address as Secretary of State, Jeb Bush’s claim to being Hispanic, and Elizabeth Warren’s claim to being Native American look pretty penny ante by comparison.