Originally Posted by golfing eagles
(Post 1438974)
Oh, great---now I have to write a novel
I'll give you this: I should have added surgical skill to judgement, communication and compassion as items not tested in a board exam. Again, as I've already stated, board certification does not guarantee a good physician, but it sets a certain minimum standard of knowledge which is essential to becoming a good physician. Unfortunately, the bar keeps getting set lower and lower.
To sit for the board exam in Internal Medicine, first you have to be accepted into a medical school, then complete the requirements for graduation. You have to complete an accredited residency program, as well as pass parts 1,2, and 3 of the NBME (National Board of Medical Examiners), which is also the test requirement in 49/50 states for a license. You need a recommendation from your program director as to performance and character. Subspecialty boards also require the completion of an accredited fellowship program in that specialty. I believe surgical boards also require your procedure journal---a list of all surgeries that you performed or assisted at, and there are numerical requirements. One reason that foreign physicians tend to not be board certified is that they may have not completed an ACCREDITED residency. Does that answer you question?
As far as minimum standards go, I'm afraid they are declining. The year I applied to medical school, there were 126,000 individuals who graduated from AMERICAN universities competing for 17,000 seats. You would think that only the top candidates would be granted admission. WRONG, very wrong. I think the only institutions that are looking purely at merit are professional sports teams and Wall Street law firms. In 1980, I sat as a student representative on the admission committee at my medical school. There were over 11,000 applications for 224 seats, so again, you would think they would just pick the best of the best. WRONG. Even 37 years ago, one of the top priorities was to achieve "diversity" in the student body. As a result, frankly they admitted students who were lucky to graduate college. And so it starts. Then, to keep some of these less qualified students, they had the "6 year program"---they would repeat their first year, then get passed, repeat the second year, then get passed. By the time they hit the 3rd and 4th year, which is somewhat more subjective in grading and based on the opinion of supervising residents and attendings, no one had the guts to fail them. Now they had a MD degree! Sadly , it was no different at Harvard and Yale. The NBME is an easy exam, so now they could get a license. Beware! To make it worse, last year they changed the nature of the MCATs (Medical School Admission test). Believe it or not, they have de-emphasized knowledge of science and math, and instead are emphasizing "cultural awareness" What a joke. I want MY doctor to be aware of how the human body works, what goes wrong, and how to fix it. I couldn't care less about "cultural awareness", which is really nothing more than a way to justify certain student admissions.
By the way, have you ever sat on a medical school admission committee? Think hard. Also, if you don't believe that there is an art to medicine, think even harder.
Now, the Board exams are a much tougher test. Only about 65% of the candidates pass the test, so it ensures a much higher MINIMUM standard---no, not a great physician, but a high standard of minimal medical knowledge
Actually, DB is right and you are the one that should think hard. He was a hospital administrator and also worked with insurances, which means he had to vet physicians. I wouldn't have said your knowledge was "deficient", I think "incomplete" would have been a better term (or at least more polite)
Do you really think all physicians that complete a residency are created equal??? As chief of staff at our local hospital, I was one of the people who interviewed doctors who wanted staff privileges. BTW, have you ever had to interview physicians for a staff position? Don't bother, I already know the answer.
There was one OB-GYN that I interviewed that plopped an 80 page document on my desk at the interview. I asked what it was, and he replied "it's my business plan" OOPS, very wrong answer for me. I don't know how much time and effort he put into it, but it clearly showed me that his priority was not patient care, but dollars. He was accepted onto the staff despite my objections. One year later he was back at my desk as I fulfilled my legal obligation to revoke his surgical privileges. In the space of 8 months, he had transected 3 ureters during LAVH(Laparoscopic Assisted Vaginal Hysterectomy). The average for a GYN performing this procedure is 0.3 ureters transected in a 30 year career, and he had 10x as many in 8 months. So, I still agree, that board certification does not guarantee surgical skill.
So, no, a "test" did not make him better. But don't confuse a MINIMUM standard with achieving excellence either, but it isn't a bad starting point
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