The New York Times posted an article yesterday that just caught my attention. It was about our perceptions of foreign-born and foreign-educated doctors. And though I started reading to see how or if it challenged my own ideas about foreign doctors (that’s another post), I was quickly distracted by the repeated references to board certification and its importance.
I ended up thinking more about Dr. Rand Paul than about foreign doctors. Paul, by entering the realm of politics, drew public attention to his “self-certification” as an ophthalmologist. The Times article, far better than I, made clear the importance of genuine board certification.
Paul may or may not succeed in his run for a U.S. Senate seat in Kentucky, so he’d best tend to his day job and renew his certification from the American Board of Ophthalmology — the real ophthalmology board. Because, yes, it’s that important.
Certification boards are like traffic signals. The only thing they provide is an excuse for not paying attention and they’re only valid for the date stamped on them. Hard to believe?
In the early 70’s I befriended a husband and wife and their preteen aged son who had just escaped from Czechoslovakia. He was an editor of a small Czech magazine and she was the head surgeon at a prominent Prague hospital. She struggled with certification for years because of her rudimentary English language skills and he was held back from continuing his editorial/publishing career for the same reason – although in his case, the language barrier made sense since it was fundamental to the job. When I met them, he was doing landscaping and custodial work while she was desperately trying to gain the language skills her certification required. A wealthy friend of mine who fancied himself a publisher but who lacked the knowledge and skill fundamentals gave the husband a chance to work with a team of people with writing, photography and compositional tools needed to bring off such a venture. All of us have long since retired, but the population was deprived of the wife’s surgical skills for years because of a piece of paper that did NOTHING to improve or validate her surgical expertise. Rand Paul is either a competent ophthalmologist or he isn’t, but his certification has nothing to do with it.
Legitimate certification will test Paul’s competence and will require his continuing education to maintain his competence.
As for your doctor friend with the language problem — it’s essential that a physician and patient be able to communicate clearly with one another. In an emergency, a physician must be able to communicate quickly and clearly with both patient and colleagues.
You said it well, Pied. As one who works with physicians and scientists for whom English is a second language, I know how important their language skills are to their success. No one is saying they have to write great works of literature and entertain the masses with grand soliloquies, but they do have to take continuing ed and they do have to communicate with their staffs. If you want to be certified in the U.S., you simply must be fluent in English.
If only. Certified doctors lose malpractice suits because they are incompetent.
If barring an imminently qualified surgeon from even a menial position in the medical field for years makes any rational sense… I just don’t see it.
I was recently a patient at the world renowned M. D. Anderson hospital in Houston, Texas. My doctor was born in Argentina and speaks with a heavy accent, but I could understand what she was saying. Her educational and occupational and research history were easily discovered on the internet. I decided for myself that she was qualified to do what was required for me.
Other of her patients from a variety of countries, spoke not a word of English and arrived with their own translators. I admit that on the operating table there may be times when quick and accurate comprehension is vital, but the anesthesiologist pretty much puts an end to conversations with the patient.
I’m not against professional organizations that endorse or discredit professionals on a voluntarily basis, but requiring someone to have a politically obtained key to the executive washroom is counterproductive in a supposedly free society because it stifles personal initiative and prudence.
Along with the fact that government (Medicare) doesn’t pay for my dental work or my glasses and they still cost about the same as they did 20 years ago… it’s all just my opinion.
You said it yourself; you could understand what your doctor was saying. Would you have been as trusting if you couldn’t understand her? How would you have explained your symptoms to her if she couldn’t understand you? How would she have explained your course of treatment to you if you couldn’t understand her? I assume she was board certified if she was practicing at Anderson. How would she have gotten board certified if she didn’t know English well enough to take her exams? How would we have judged her medical education and relative competence without that exam? Had someone else not already determined she was qualified to practice medicine in the U.S., you would never have had the option of deciding for yourself that she was qualified.
And there’s good reason for the screening of foreign doctors. A lot of foreign medical schools are not up to U.S. standards. The educations they offer are sub par; their graduates don’t know as much as U.S. doctors. I’m thinking particularly of Caribbean medical schools which, at least during my years with the medical association, had a bad reputation. A lot of their graduates were Americans who could not get into U.S. medical schools, We simply must have standards, rules, and testing to determine if people are qualified to practice medicine here.
Board certification is not a “politically obtained” key to the executive washroom and It’s certainly not about stifling personal initiative. It’s about standards of care, and ensuring that the people who deliver your health care and mine are actually qualified to do so.
I’m satisfied to agree to disagree. You trust that government regulations and watchdogs will protect your interests and I look around and see that many people trusted the FED and the government sponsored enterprises to protect their investments and to stabilize employment and the economy. Regulators keep the borders secure. Regulators guarantee the safety of off shore drilling. Regulators insure that the price of recreational drugs remain out of reach of many users forcing them to victimize those of us aren’t users. Most people prefer it this way because of the perception that somebody else is taking care of them… that’s what I mean when I say that mandatory regulations stifle personal initiative and prudence. I do love a good debatable topic.
Board certification is peer review, not government regulation. I’ll agree to disagree, but I’ll continue to worry that you don’t understand the difference between licensing and board certification.
I’m not against doctors being certified by peer review of some kind if it’s voluntary. Since it’s apparently possible to become a licensed doctor without being peer reviewed and certified by anybody at all, I leave the worth of a government license in your capable hands.
All that aside, when you look at the details surrounding this tempest in a teapot, I can’t imagine how anyone can say that Dr. Paul isn’t legally certified. In fact, if your ophthalmologist is older than you, he or she is probably less certified than Dr. Paul and the 200 or so of his colleagues certified by the board he founded. In my opinion this whole issue is a desperate attempt by his political opponents (both Republican and Democrat) who dread the thought of another legislator who will honor his oath of office.
A final note: There are some 19,000 ophthalmologists in the U.S. today, of which approximately 95%, or 18,000, are certified by the American Board of Ophthalmology.
Oh well, it’s been fun.
Wow. As someone who leans heavily towards the Libertarian point of view, I have to admit that I find much to agree with in what Joe R has said. But as a disabled (not through military service) veteran who has to deal with doctors I barely understand in a VA medical system so overwhelmed that there’s simply no time for me to ask clarifying questions, I need to at least know that a body of my doctor’s peers have said that he or she is qualified for the job.
Obviously, I’d prefer to have the opportunity to decide my doctor’s competence for myself, as would always be true in the ideal world of my Libertarian dreams. Unfortunately I don’t live in that world… *sigh*
Exactly. Who better to determine a physician’s qualifications in a particular specialty than a board of his peers?
The VA is better than no care at all, but it’s a good example of how the federal government runs a health care system. ‘Nuff said.