Relevance of Recertification for Primary Care Physicians

IN RESPONSE:

Dr. Gonzalez's response confirms my belief about the shortcomings of the recertification process. Physicians' practices, particularly those of primary care physicians, become customized over time, and it is wrong for any board examination to rate them according to academic standards that are disconnected from the practical problems these physicians face every day.

More important, the idea of failing a physician on a recertification examination is abhorrent and an affront to physicians' professionalism. Ideally, such examinations are meant to uncover areas of weakness and to recommend areas for remedial study. They are not meant to stigmatize physicians or impinge on a physician's ability to make a living. Yet this is exactly the threat they pose, because HMOs can use recertification results to rank physicians and hospitals can use them to refuse physicians' admission to their staffs. Physicians do not need any more threats to their peace of mind. The exigencies imposed by managed care and the threat of frivolous malpractice suits supply them with more than enough.

I applaud Dr. Gonzalez for speaking out. Several physicians have confided similar concerns to me but were worried about possible repercussions for publicly expressing them.

One of Dr. Gonzalez's ideas merits repeating and has particular relevance to primary care. He says that the best way to practice good medicine is to limit the number of patients seen in a day. Unfortunately, the low reimbursements paid for primary care services force these physicians to see too many patients in a typical day.

Physicians increasingly are too quick to order a battery of tests and imaging studies because they don't have the time to simply listen to a patient. Ironically, primary care physicians, who define themselves as delivering personalized and coordinated care, have become the ones least able to provide it.

No amount of certification, recertification, or any other academic accolade will ever replace the value of a physician who sits and listens to patients' complaints and gives them the time to tell their story.