MEDICAL COMPETENCY: Commission Wants Oversight Change

      Regulation of the U.S. health care workforce has "serious shortcomings," according to the Pew Health Professions Commission. In a report released on Friday, commission members said requiring doctors and other health care workers to demonstrate medical competency, not just once at the beginning of their careers, but periodically throughout their careers, would help rectify a system that doesn't offer consumers enough protections (Pew release, 10/23). The Washington Post reports that doctors are "virtually assured" of keeping their licenses "for life -- sometimes even after being found guilty of malpractice." Noting the problems with the current system, former Senate Majority Leader and commission chair George Mitchell said, "Once you are in the club, you are in forever. We became convinced there is today a public system which isn't protecting the public." The Pew commission, made up of "eminent health care administrators and researchers," also recommended that medical review boards improve their representation of consumers by having laypersons make up at least one-third of their memberships (Goldstein, 10/24). According to Mitchell, having the review boards dominated by members of a particular discipline "inevitably leads to 'scopes of practice' disputes which focus on turf battles rather than consumer protections." CongressDaily reports that the commission also called on Congress "to establish a national policy advisory body that would research, develop and publish national scopes of practice and continuing competency standards" (Norton, 10/23).

Managed Care Backlash?
      The Washington Post reports that the commission's call for increased regulation "is the latest response to growing fears about whether managed care has damaged the quality of the nation's health care system." But "major professional organizations" such as the American Medical Association and the American Nurses Association, "disparaged" some of the commission's recommendations as "unnecessary." AMA Trustee Chair Dr. Randolph Smoak said, "It would just be chaos." He noted that the AMA is currently pursuing a voluntary accreditation pilot program in New Jersey. James Winn of the Federation of State Medical Boards "said state licensing and discipline boards already are moving to include more members of the public and that 32 states require physicians to take courses in order to renew their licenses" (10/24). But Ed O'Neil, executive director of the Pew commission, said, "These recommendations should not be seen by health professionals as an infringement on their prerogatives. Rather the recommendations allow health professionals to insure that all practitioners deliver care in ways that help, not harm, the public. This is the best assurance that managed care organizations are not the only voice for real quality in health care" (Pew release, 10/23).

Power Of Suggestion
      The Washington Post notes that the commission, funded by the independent Pew Charitable Trusts, "has no powers beyond persuasion," but has proposed policies that "have been proven influential," such as restricting the number of doctors going into residency training and laying out medical school curricula (10/23). According to CongressDaily, O'Neil "acknowledged some doctors' groups could thwart reforms if the advisory commission is limited to non-binding recommendations." He said, however, "The overwhelming majority of doctors want to do the right thing" (10/23). To request a copy of the Pew recommendations, call the Center for Health Professions at 415/476-8181.